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Scientific Achievements May Not Reach Everyone: Understanding Disparities in Acute Leukemia

  • Health Economics (N Khera, Section Editor)
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Abstract

Over the past decade, scientific advancements have resulted in improved survival from acute leukemia. Continued advancements are expected given the attention to precision medicine and the resulting growth in development and adoption of risk-stratified, personalized therapies. While precision medicine has great potential to improve acute leukemia outcomes, there remain significant barriers to ensuring equitable access to these technologies and receipt of these prescribed targeted, personalized therapies. Over the past 3 years, studies report persistent outcome disparities among patients from specific racial and ethnic backgrounds, insurance and socioeconomic status, and other socio-demographic factors after a diagnosis of acute leukemia. A few recent studies examine etiologies for acute leukemia disparities and highlight the importance of ensuring access and equitable delivery of scientific advancements. In the context of continued scientific progress, future strategies require thoughtfully considered improvements in the delivery of care that can overcome the current challenges our patients face.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. National Academies of Sciences, Engineering, and Medicine. Biomarker tests for molecularly targeted therapies: key to unlocking precision medicine. Washington, DC: The National Academies Press; 2016. doi:10.17226/21860. This report by the Institute of Medicine convening describes the benefits and challenges of precision medicine with recommendations of how to address future clinical practice, regulatory and reimbursement policy, and data challenges.

    Google Scholar 

  2. Precision Medicine Initiative Cohort Program. https://www.nih.gov/precision-medicine-initiative-cohort-program. Accessed February 22 2016.

  3. Druker BJ, Guilhot F, O’Brien SG, Gathmann I, Kantarjian H, Gattermann N, et al. Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med. 2006;355(23):2408–17. doi:10.1056/NEJMoa062867.

    Article  CAS  PubMed  Google Scholar 

  4. Hudis CA. Trastuzumab—mechanism of action and use in clinical practice. N Engl J Med. 2007;357(1):39–51. doi:10.1056/NEJMra043186.

    Article  CAS  PubMed  Google Scholar 

  5. Shepherd FA, Rodrigues Pereira J, Ciuleanu T, Tan EH, Hirsh V, Thongprasert S, et al. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med. 2005;353(2):123–32. doi:10.1056/NEJMoa050753.

    Article  CAS  PubMed  Google Scholar 

  6. Hematology/Oncology (Cancer) Approvals and Safety Notifications. http://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm279174.htm. Accessed February 22 2016.

  7. Patel MI, Ma Y, Mitchell B, Rhoads KF. How do differences in treatment impact racial and ethnic disparities in acute myeloid leukemia? Cancer Epidemiol Biomarkers Prev. 2015;24(2):344–9. doi:10.1158/1055-9965.EPI-14-0963. Using the California Cancer Registry linked to hospital discharge abstracts from the Office of Statewide Health Planning and Development, investigators demonstrated lower receipt of treatment among non-Hispanic black and Hispanic as compared to non-Hispanic white patients. Treatment receipt among these populations was associated with equitable survival outcomes.

    Article  CAS  PubMed  Google Scholar 

  8. Rhoads KF, Patel MI, Ma Y, Schmidt LA. How do integrated health care systems address racial and ethnic disparities in colon cancer? J Clin Oncol. 2015;33(8):854–60. doi:10.1200/JCO.2014.56.8642.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Rhoads KF, Ackerson LK, Ngo JV, Gray-Hazard FK, Subramanian SV, Dudley RA. Adequacy of lymph node examination in colorectal surgery: contribution of the hospital versus the surgeon. Med Care. 2013;51(12):1055–62. doi:10.1097/MLR.0b013e3182a53d72.

    Article  PubMed  Google Scholar 

  10. Morris AM, Billingsley KG, Baxter NN, Baldwin LM. Racial disparities in rectal cancer treatment: a population-based analysis. Arch Surg. 2004;139(2):151–5. doi:10.1001/archsurg.139.2.151. discussion 156.

    Article  PubMed  Google Scholar 

  11. Revels SL, Morris AM, Reddy RM, Akateh C, Wong SL. Racial disparities in esophageal cancer outcomes. Ann Surg Oncol. 2013;20(4):1136–41. doi:10.1245/s10434-012-2807-3.

    Article  PubMed  Google Scholar 

  12. Kilbourne AM, Switzer G, Hyman K, Crowley-Matoka M, Fine MJ. Advancing health disparities research within the health care system: a conceptual framework. Am J Public Health. 2006;96(12):2113–21. doi:10.2105/AJPH.2005.077628.

    Article  PubMed  PubMed Central  Google Scholar 

  13. American Society of Clinical, O. (2016). The State of Cancer Care in America, 2016: a report by the American Society of Clinical Oncology. J Oncol Pract, doi:10.1200/JOP.2015.010462.

  14. Patel MI, Ma Y, Mitchell BS, Rhoads KF. Understanding disparities in leukemia: a national study. Cancer Causes Control. 2012;23(11):1831–7. doi:10.1007/s10552-012-0062-3.

    Article  CAS  PubMed  Google Scholar 

  15. Patel MI, Ma Y, Mitchell BS, Rhoads KF. Age and genetics: how do prognostic factors at diagnosis explain disparities in acute myeloid leukemia? Am J Clin Oncol. 2015;38(2):159–64. doi:10.1097/COC.0b013e31828d7536. Using the Surveillance, Epidemiology, and End Results Database, investigators identified that non-Hispanic black and Hispanic patients are diagnosed at younger ages and with more favorable cytogenetic subtypes.

    Article  PubMed  Google Scholar 

  16. Overview of leukemia. http://www.merckmanuals.com/professional/hematology-and-oncology/leukemias/overview-of-leukemia. Accessed Feb 22 2016.

  17. Morton LM, Turner JJ, Cerhan JR, Linet MS, Treseler PA, Clarke CA, et al. Proposed classification of lymphoid neoplasms for epidemiologic research from the Pathology Working Group of the International Lymphoma Epidemiology Consortium (InterLymph). Blood. 2007;110(2):695–708. doi:10.1182/blood-2006-11-051672.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Welch JS, Ley TJ, Link DC, Miller CA, Larson DE, Koboldt DC, et al. The origin and evolution of mutations in acute myeloid leukemia. Cell. 2012;150(2):264–78. doi:10.1016/j.cell.2012.06.023.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Grupp SA, Kalos M, Barrett D, Aplenc R, Porter DL, Rheingold SR, et al. Chimeric antigen receptor-modified T cells for acute lymphoid leukemia. N Engl J Med. 2013;368(16):1509–18. doi:10.1056/NEJMoa1215134.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Maude SL, Frey N, Shaw PA, Aplenc R, Barrett DM, Bunin NJ, et al. Chimeric antigen receptor T cells for sustained remissions in leukemia. N Engl J Med. 2014;371(16):1507–17. doi:10.1056/NEJMoa1407222.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Burnett AK, Russell NH, Hunter AE, Milligan D, Knapper S, Wheatley K, et al. Clofarabine doubles the response rate in older patients with acute myeloid leukemia but does not improve survival. Blood. 2013;122(8):1384–94. doi:10.1182/blood-2013-04-496596.

    Article  CAS  PubMed  Google Scholar 

  22. Cooper SL, Brown PA. Treatment of pediatric acute lymphoblastic leukemia. Pediatr Clin North Am. 2015;62(1):61–73. doi:10.1016/j.pcl.2014.09.006.

    Article  PubMed  Google Scholar 

  23. Kalashetty M, Dalal B, Roland K, Mourad Y, Barnett M, Broady R, et al. Improved survival in adults with mixed-phenotype acute leukemia following stem cell transplantation (SCT): a single centre experience. Blood. 2013;21:122.

  24. Kreutzman A, Ilander M, Porkka K, Vakkila J, Mustjoki S. Dasatinib promotes Th1-type responses in granzyme B expressing T-cells. Oncoimmunology. 2014;3, e28925. doi:10.4161/onci.28925.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pulte D, Redaniel MT, Jansen L, Brenner H, Jeffreys M. Recent trends in survival of adult patients with acute leukemia: overall improvements, but persistent and partly increasing disparity in survival of patients from minority groups. Haematologica. 2013;98(2):222–9. doi:10.3324/haematol.2012.063602. Investigators used the Surveillance Epidemiology and End Results database to describe survival trends for patients with acute leukemia. Investigators reported the improved survival for non-Hispanic white patients after a diagnosis of acute leukemia with a smaller increase in survival among patient populations from other racial and ethnic backgrounds.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Abrahao R, Lichtensztajn DY, Ribeiro RC, Marina NM, Keogh RH, Marcos-Gragera R, et al. Racial/ethnic and socioeconomic disparities in survival among children with acute lymphoblastic leukemia in California, 1988–2011: a population-based observational study. Pediatr Blood Cancer. 2015;62(10):1819–25. doi:10.1002/pbc.25544. Investigators used the California Cancer Registry to evaluate outcomes among patients ages 0–19 years to evaluate the influence of neighborhood socioeconomic status on survival outcomes. Investigators showed an association of increased risk of death among children living in low socioeconomic status neighborhoods as compared to children living in higher socioeconomic status neighborhoods.

    Article  PubMed  Google Scholar 

  27. Cancer facts & figures (2015). http://www.cancer.org/research/cancerfactsstatistics/cancer-facts-figures-for-african-americans. Accessed Feb 22 2016.

  28. Abrahao R, Ribeiro RC, Medeiros BC, Keogh RH, Keegan TH. Disparities in early death and survival in children, adolescents, and young adults with acute promyelocytic leukemia in California. Cancer. 2015;121(22):3990–7. doi:10.1002/cncr.29631. Investigators used the California Cancer Registry to describe 7-day and 30-day mortality among patients diagnosed with acute leukemia ages 0 to 39 and show that patients with lack of insurance had a higher early death and lower survival.

    Article  CAS  PubMed  Google Scholar 

  29. Borate UM, Mineishi S, Costa LJ. Nonbiological factors affecting survival in younger patients with acute myeloid leukemia. Cancer. 2015;121(21):3877–84. doi:10.1002/cncr.29436.

    Article  PubMed  Google Scholar 

  30. Yung RL, Chen K, Abel GA, Gesten FC, Roohan PJ, Boscoe FP, et al. Cancer disparities in the context of Medicaid insurance: a comparison of survival for acute myeloid leukemia and Hodgkin’s lymphoma by Medicaid enrollment. Oncologist. 2011;16(8):1082–91. doi:10.1634/theoncologist.2011-0126.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Brunner AM, Blonquist TM, Sadrzadeh H, Perry AM, Attar EC, Amrein PC, et al. Population-based disparities in survival among patients with core-binding factor acute myeloid leukemia: a SEER database analysis. Leuk Res. 2014;38(7):773–80. doi:10.1016/j.leukres.2014.04.001.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Appelbaum FR, Gundacker H, Head DR, Slovak ML, Willman CL, Godwin JE, et al. Age and acute myeloid leukemia. Blood. 2006;107(9):3481–5. doi:10.1182/blood-2005-09-3724.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Lowenberg B, Downing JR, Burnett A. Acute myeloid leukemia. N Engl J Med. 1999;341(14):1051–62. doi:10.1056/NEJM199909303411407.

    Article  CAS  PubMed  Google Scholar 

  34. Grimwade D, Hills RK, Moorman AV, Walker H, Chatters S, Goldstone AH, et al. Refinement of cytogenetic classification in acute myeloid leukemia: determination of prognostic significance of rare recurring chromosomal abnormalities among 5876 younger adult patients treated in the United Kingdom Medical Research Council trials. Blood. 2010;116(3):354–65. doi:10.1182/blood-2009-11-254441.

    Article  CAS  PubMed  Google Scholar 

  35. Byrd JC, Dodge RK, Carroll A, Baer MR, Edwards C, Stamberg J, et al. Patients with t(8;21)(q22;q22) and acute myeloid leukemia have superior failure-free and overall survival when repetitive cycles of high-dose cytarabine are administered. J Clin Oncol. 1999;17(12):3767–75.

    CAS  PubMed  Google Scholar 

  36. Tallman MS, Andersen JW, Schiffer CA, Appelbaum FR, Feusner JH, Ogden A, et al. All-trans-retinoic acid in acute promyelocytic leukemia. N Engl J Med. 1997;337(15):1021–8. doi:10.1056/NEJM199710093371501.

    Article  CAS  PubMed  Google Scholar 

  37. Pidala J, Craig BM, Lee SJ, Majhail N, Quinn G, Anasetti C. Practice variation in physician referral for allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2013;48(1):63–7. doi:10.1038/bmt.2012.95.

    Article  CAS  PubMed  Google Scholar 

  38. Pui CH, Pei D, Pappo AS, Howard SC, Cheng C, Sandlund JT, et al. Treatment outcomes in black and white children with cancer: results from the SEER database and St Jude Children’s Research Hospital, 1992 through 2007. J Clin Oncol. 2012;30(16):2005–12. doi:10.1200/JCO.2011.40.8617.

  39. Patel MI, Rhoads KF. Integrated health systems and evidence-based care: standardizing treatment to eliminate cancer disparities. Future Oncol. 2015;11(12):1715–8. doi:10.2217/fon.15.90.

    Article  CAS  PubMed  Google Scholar 

  40. Bhatia S, Landier W, Shangguan M, Hageman L, Schaible AN, Carter AR, et al. Nonadherence to oral mercaptopurine and risk of relapse in Hispanic and non-Hispanic white children with acute lymphoblastic leukemia: a report from the children’s oncology group. J Clin Oncol. 2012;30(17):2094–101. doi:10.1200/JCO.2011.38.9924.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Mardis ER. Anticipating the 1,000 dollar genome. Genome Biol. 2006;7(7):112. doi:10.1186/gb-2006-7-7-112.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Hornberger J, Cosler LE, Lyman GH. Economic analysis of targeting chemotherapy using a 21-gene RT-PCR assay in lymph-node-negative, estrogen-receptor-positive, early-stage breast cancer. Am J Manag Care. 2005;11(5):313–24.

    PubMed  Google Scholar 

  43. McVeigh TP, Hughes LM, Miller N, Sheehan M, Keane M, Sweeney KJ, et al. The impact of Oncotype DX testing on breast cancer management and chemotherapy prescribing patterns in a tertiary referral centre. Eur J Cancer. 2014;50(16):2763–70. doi:10.1016/j.ejca.2014.08.002.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Jasem, J., Amini, A., Rabinovitch, R., Borges, V. F., Elias, A., Fisher, C. M., et al. (2016). 21-Gene recurrence score assay as a predictor of adjuvant chemotherapy administration for early-stage breast cancer: an analysis of use, therapeutic implications, and disparity profile. J Clin Oncol, doi:10.1200/JCO.2015.65.0887.

  45. Chen J, Vargas-Bustamante A, Mortensen K, Ortega AN. Racial and ethnic disparities in health care access and utilization under the Affordable Care Act. Med Care. 2016;54(2):140–6. doi:10.1097/MLR.0000000000000467.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Burwell SM. Setting value-based payment goals—HHS efforts to improve U.S. health care. N Engl J Med. 2015;372(10):897–9. doi:10.1056/NEJMp1500445.

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Correspondence to Manali I. Patel.

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Patel, M.I. Scientific Achievements May Not Reach Everyone: Understanding Disparities in Acute Leukemia. Curr Hematol Malig Rep 11, 265–270 (2016). https://doi.org/10.1007/s11899-016-0329-y

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