Blood cancers

Indigenous disadvantage apparent for kids with leukaemia

The Indigenous health gap is apparent for children who have acute leukaemia, and the disadvantage in outcomes seen among Aboriginal children is being attributed to remote location of residence.

A review of 455 cases of childhood leukaemia in WA, South Australia and the Northern Territory between 2009 and 2018 found that Indigenous children were more likely to present at a later stage, less likely to be enrolled in clinical trials and more likely to be lost to follow up than non-Indigenous children with leukaemia.

The analysis covered all children with acute lymphoblastic leukaemia (ALL, 80%) and acute myeloid leukaemia (AML, 20%) treated at the state’s specialist paediatric oncology centres

It found there was a trend for lower five year overall survival rates for Indigenous children with ALL compared to non-Indigenous children (82.4% vs 92.2%), but no difference in survival rates for children with AML.

The review of data for children showed that the 29 Indigenous children were mostly from remote/very remote localities, and children from these areas had inferior overall survival (p = .004) compared to those from metropolitan and regional areas. The most common cause of death for these children was due to relapse/progressive disease (57%), followed by infection (29%).

Over five-year overall survival for all children was 91.7% for those with acute lymphoblastic leukaemia (ALL) and 69.8% for acute myeloid leukaemia (AML).

Indigenous children were significantly older at diagnosis compared to non-Indigenous children (mean 8.8 vs. 6.4 years), less likely to be enrolled on clinical trials (34.5% vs. 53.1%) and more likely to be lost to follow-up (26.1% vs. 9.2%).

The study investigators, led by Dr Tom Revesz of the Department of Haematology and Oncology, Women’s and Children’s Hospital, Adelaide, said the findings were similar to those of other studies that showed poor rates of cancer survival for children who lived in more remote area. Geographical isolation was presumed to contribute to poor outcomes due to reduced access to health care, advanced disease presentation at diagnosis, poor adherence to therapy and increased challenges associated with diagnosis, treatment and long-term follow up, they said.

The Indigenous children with leukaemia also tended to be from lower socioeconomic areas, which may be another factor in poor outcomes, they added.

A novel finding  was that Indigenous children were overrepresented among those with AML (60.0% vs. 14.4%,).

The authors said the inequities revealed by the study reinforced the need for national policy to address the challenges of children with leukaemia in remote areas, if Australia is to achieve the goal of ‘Zero Lives Lost to Blood Cancer’.

“Effective strategies are required to ensure children from regional/rural locations and Indigenous children with leukaemia receive appropriate service delivery and resource allocation to improve their survival and follow-up,” they wrote.

The findings are reported in Pediatric Blood and Cancer.

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