Research from St. Jude Children’s Research Hospital scientists have have found that socioeconomic deprivation, the presence of treatable chronic health conditions and frailty are independently associated with increased late mortality in childhood cancer survivors. The work utilized the well-characterized group of survivors, the St. Jude lifetime cohort study (St. Jude LIFE). The research shows that treating chronic health conditions alone may be inadequate to improve survivors’ lifespans without policies to improve local environments. The ﬁndings were published in JAMA Network Open.
“The new discovery was the relationship between social determinants of health at the regional level and increased mortality,” said corresponding author Matthew Ehrhardt, MD, MS, St. Jude Department of Oncology. “Living in Census blocks with high deprivation was associated with increased mortality rates for childhood cancer survivors.”
Scientists found the association between increased mortality and resource deprivation using the area deprivation index (ADI). ADI measures housing quality, education level, employment status and poverty to a Census block level (~600-1,000 people). They found that survivors living in the most resource-deprived places, as measured by ADI, had a ﬁve-to-eight times increased risk of mortality compared to those in the places with the least deprivation.
Modiﬁable chronic health conditions are those that have effective treatments. They are graded in increasing severity from 1 to 4. Even though treatments for these modiﬁable chronic health conditions exist they can be difﬁcult to access, and survivors still experienced a two-to-four-fold increase in mortality compared to community controls.
“We found that having both a greater number of modiﬁable chronic health conditions and conditions of higher severity was associated with a higher risk of mortality in survivors,” Dr Ehrhardt said.
Increases in mortality associated with poor local socioeconomic conditions was statistically independent from the risk associated with chronic health conditions. That means that living in an impoverished area and having untreated chronic health conditions, especially severe ones, may combine to form an unfortunate ‘double whammy’ to a survivor’s risk of increased mortality.
The association with modiﬁable chronic health conditions emphasizes the importance of efforts to ensure access to interventions that may improve these health conditions and subsequently reduce mortality risk. Separately, the association with local measures of poverty suggests that the local environment impacts mortality beyond lack of access to speciﬁc treatments.
“The biggest take-home is that when we develop interventions, we need to account for not only the intervention itself, but the supporting factors that help with the delivery and effectiveness of the intervention,” Dr Ehrhardt said. “And in this case, we show some evidence that those environmental factors included in the ADI are important contributors to risk that need to be considered.”
The study also has a direct implication for clinical care – especially how clinicians interact with patients.
“It is important for clinicians to ask patients about their speciﬁc situation,” Dr Ehrhardt said. “It's easy to prescribe medications or to tell people to exercise. It takes more time and more thoughtfulness to sit and understand environments in which they are residing. As clinicians, we may have limited ability to modify some of those factors. But we can work closely with the rest of the healthcare team, such as social workers, for example, to help survivors to identify and access local resources.”Back To Top
St. Jude Finds Higher Mortality in Childhood Cancer Survivors Without Access to Resources. Appl Rad Oncol.