“We’re often held up as the success story in modern medicine,” said Kira Bona, a pediatric oncologist at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center. “But the flip side is that 20 percent of kids will die, and that is far too many.”
Bona is part of a team of researchers who assessed a decade’s worth of data showing how children with leukemia from different income areas fared after they went into remission. What they found was troubling. While the overall rates of relapse were roughly the same for all the patients, the children from high-poverty areas were much more likely to relapse early—less than 36 months into remission—and earlier relapses are linked with worse outcomes overall. “If you relapse early, it’s significantly harder to cure you,” Bona told me. “The difference is pretty dramatic.”
She and her colleagues found early relapses occurred among 92 percent of poor kids compared with 48 percent of wealthier children. Their work was published in the journal Pediatric Blood & Cancer in February. Now, doctors are working to figure out why this disparity exists, and what they can do about it.
One hypothesis looks at the extent to which underlying health problems—which are already more likely among poor people—play a role. “Perhaps poor children, at the time they’re diagnosed, have worse underlying health so they’re more vulnerable to the toxicities of chemotherapy,” she said. Another possibility is that low-income families have difficulty adhering to the schedule for administering oral chemotherapy at home, perhaps in some cases because they don’t have enough money to pay electricity bills—and therefore can’t keep their children’s medicines cold.
“When your financial situation is causing you to have your heat shut off—and your child has cancer, and they’re immune compromised—it’s a very dangerous situation,” said Carla Tardif, the CEO of the Family Reach Foundation, a grant-providing nonprofit that helps families cope with the financial burden of a cancer diagnosis. “Some of these medicines have to be taken with food. Healthy food for a sick child is critical. Many families cars have been repossessed. We have families taking a couple buses and trains just to get treatment.”
“It is a reality of cancer that people don’t talk about,” she added. “There are folks that enter cancer already in financial dire straits, but in a lot of cases we see it’s the cancer diagnosis that’s causing the financial devastation.”
Even for families with health insurance, out-of-pocket costs associated with cancer treatment can be anywhere between $10,000 to $35,000 or more, depending on the illness, according to several studies. Yet the median annual income for families in the United States is $52,000 annually. “That’s the math,” Tardif said. “That’s why you’re in financial trouble, not because you did anything wrong.”