Dr Lena Winestone on Understanding the Cause of Disparities in Pediatric AML in Order to Intervene

December 24, 2019

Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco, explains how her research into disparities in pediatric acute myeloid leukemia (AML) may help identify the cause of those disparities and how best to intervene in order to improve outcomes for these patients.

Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco, explains how her research into disparities in pediatric acute myeloid leukemia (AML) may help identify the cause of those disparities and how best to intervene in order to improve outcomes for these patients.

Transcript

How do we overcome the fact that neighborhood income or poverty level impacts treatment children with cancer receive?

Yeah, I think it's a great question, and obviously, the main goal of this work is to eventually allow for these disparities to be at least attenuated and ideally eliminated. I think that we're not at the point where we can really intervene on these findings yet, because we are really teasing apart the mechanisms or causes of the disparities that exist.

So, part of what I described as we're looking at, is it related to relapse? Is it related to the treatment-related toxicity? Is it related to the comorbidities that patients come in with? In addition, we're looking really closely at the timing. So, I mentioned that we looked at early mortality, but we're also looking at the timing of death about whether they occur sort of during that on therapy, while they're receiving chemotherapy, or in the after period, once they are off chemotherapy. And that'll help us to figure out where to target and interventions.

If it's something related to access to care, then for example, a health navigator may be part of the way to mitigate these effects. So, someone who can really assess the needs of a family and say, “Oh, they're really having insurance issues, let's help them with that piece,” or “They're really having transportation issues, let's help them with that piece.” And so, you could tailor the intervention to each individual and the specific needs that are sort of barriers to care for them.

Another alternative that one of my colleagues is investigating is actually addressing the concrete needs of families. So, for example, you don't have enough food to eat. And so that makes it really hard to take your medication. In the setting of pediatric AML that's less of an issue because all of the chemotherapy is administered in the hospital. But we do still think that things like nutritional status, potentially having an impact on outcome, both relapse and treatment-related mortality.

And so, thinking about both concrete interventions and more supportive interventions that can be tailored to families is definitely the goal of this research, ultimately.