The Dana-Farber lab of Kira Bona, MD, MPH, has uncovered an alarming reality: children from low-income households are more likely to experience cancer relapse and face lower survival rates compared to their more privileged peers, despite receiving treatment on highly standardized clinical trials at top academic centers.
The number of children for whom these data are relevant is not small, says Bona. One in three children diagnosed with cancer lives in a low-income household or in a family that is concerned about meeting basic needs — such as providing housing, food, and transportation — while the child is receiving cancer treatment.
Bona is taking a novel approach to reducing these disparities by looking at poverty as if it were a “druggable” condition, something that can be specifically treated to improve the outcomes of children with cancer. This approach, involving creative interventions designed to lessen financial strain, is bold. Bona aims to assure that every child with cancer benefits from treatment, regardless of zip code, socioeconomic status, gender, race, or ethnicity.
To achieve this goal, Bona has formed the IGNITE Consortium, the first national, pediatric hematology-oncology health equity research consortium. This consortium acts as a clinical trial network, only instead of focusing on testing novel cancer medicines for children, it focuses on evaluating health equity interventions.
“Childhood cancer is very rare, so from a practical standpoint, there is no one center in the U.S. that could run a pediatric clinical trial alone,” says Bona, a pediatric oncologist at the Dana-Farber/Boston Children’s Cancer and Blood Disorder Center. “IGNITE creates the research infrastructure we need to robustly develop evidence-based health equity interventions.”
What is a health equity intervention?
Kira Bona, MD, MPH
In pediatric oncology, a health equity intervention provides systematic supportive care to fill gaps that have been shown to influence a child’s health and survival during cancer treatment. Bona likens this support to other supportive care, such as pain management or interventions to reduce the likelihood of infection or reduce feelings of nausea. Supportive care interventions help patients and their families through the difficult ordeal of cancer treatment.
Examples of health equity interventions are:
- Pediatric RISE, designed by Bona, aims to address disparities due to income-poverty through twice-monthly direct transfers of cash to low-income families during the first 6-months of a child’s chemotherapy treatment.
- PediCARE, designed by Bona, provides food and transportation to children facing unmet basic needs during the first 6-months of a child’s chemotherapy treatment.
- CHEF (Cardiovascular Health Equity Through Food), designed by an IGNITE collaborator and DFCI early career investigator Rahela Aziz-Bose, MD, is focused on the 80% of children who survive cancer. The program aims to alleviate food insecurity by providing meal kits to families who are food insecure in the first 6-months after a child completes chemotherapy. CHEF aims to reduce the risk of cardiovascular disease, a complication of chemotherapy treatment that is the second leading cause of death for childhood cancer survivors. The condition disproportionately impacts childhood cancer survivors who are Black, Hispanic, or who live in low-income homes.
What is IGNITE?
The IGNITE Consortium includes pediatric oncology experts from 12 leading institutions across the United States, with Dana-Farber being the lead site. IGNITE makes it possible for a trial of a health equity intervention like RISE to be tested across the nation.
This network is necessary because childhood cancer is rare. A site like Dana-Farber, which specializes in childhood cancers, might see only 50 children a year with one of the more common forms of childhood cancer. To test an intervention for efficacy, many more children would need to receive the intervention. The collaborative reach of IGNITE makes it possible for Bona and her colleagues to work together to test and develop effective, evidence-based interventions.
The institutions involved are located across the U.S., so interventions like RISE can be tested in rural, suburban, and urban areas, where challenges that occur with poverty may differ.
“The involved centers are on the east coast and the west coast, in the south and middle of the country,” says Bona. “We really have a nice representation of the different experiences patients have accessing care.”
What will IGNITE do to help patients?
As a first step, the IGNITE team will be launching a clinical trial across the U.S. to evaluate Pediatric RISE to determine if it improves outcomes for low-income children being treated for high-risk neuroblastoma — the most common solid tumor that typically occurs in children under five.
In the future, IGNITE plans to evaluate CHEF in a nationwide clinical trial. The investigators are actively collaborating to develop additional health equity interventions.
A program called ECHO (Environmental Child Health Outcomes), which Bona originally launched at Dana-Farber, will be expanded to have nationwide reach through IGNITE. The study collects demographic information about childhood cancer patients so that researchers can learn more about how poverty and other factors influence outcomes.
“We know it takes a team effort to develop new drugs, so we have very robust early phase drug development consortia. Now, for the first time, we have a comparable infrastructure for health equity interventions; this is an incredible opportunity to improve outcomes for children with cancer,” says Bona. “No one can do this alone.”
Written by: Beth Dougherty