Social factors may impact survival among young patients with leukemia

A new study reveals that insurance status, marital status, and county-level income may affect the chances of survival for young patients with acute myelogenous leukemia (AML). The findings, published in CANCER (2015; doi:10.1002/cncr.29436), indicate that efforts are needed to address the social factors that impact critical aspects of health for these patients.

An estimated 20,830 Americans will develop AML and 10,460 will die of the disease in 2015. Tremendous progress has been made in identifying disease characteristics that cause a patient to have a higher or lower chance of cure following intense treatment, which often involves bone marrow transplantation.

Investigators at the University of Alabama at Birmingham (UAB) have analyzed a database with 5,541 patients younger than 65 years to demonstrate that, in addition to age and disease characteristics, other nonbiological patient characteristics also matter. The study is the largest to date to look at the impact of socioeconomic factors in outcomes of younger patients with AML.

Patients who were single or divorced, patients who were uninsured or were Medicaid beneficiaries, and patients who lived in areas with lower income had substantially higher risks of dying prematurely.

“We believe these three factors indicate lack of material and social support preventing young patients from successfully walking the long and difficult road towards a cure,” said Uma Borate, MD, lead author of the study, and assistant professor in the UAB Division of Hematology and Oncology.

The findings show that factors not necessarily related to care can have significant impact on AML patients' outcomes.

“As physicians, we often emphasize more of the biology of the cancer, especially with the recent focus on personalized medicine. But we need to pay the same attention to resources available to our patients, as this greatly impacts their chances to survive leukemia,” said senior author Luciano Jose Costa, MD, PhD, associate professor in the UAB Division of Hematology and Oncology.

This will be especially important as the United States transitions to a health care system that ties physician and hospital payments to patient outcomes.

“Taking from the results of this study, factors that have nothing to do with quality of care need to be accounted for when comparing predicted with actual outcomes; otherwise, we will create a disincentive for hospitals and doctors to care for less privileged patients,” said Borate.

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