Introduction: Financial toxicity as a side effect of cancer treatments has been well demonstrated in adults survivors, mainly in countries without universal healthcare coverage. Evidence supporting an association between socioeconomic deprivation and decreased survival for most prevalent adult cancer are mounting, including in various European healthcare coverage settings. As such, the relationship between cancer and socioeconomic status can generally be considered bidirectional. Although financial hardship on families during childhood cancer treatment has been demonstrated, long-term impact has been less studied. Purpose of the study: Study the long-term socioeconomic status evolution of childhood acute lymphoblastic leukemia (cALL) survivors and their family using residential aggregated data from Canadian government administrative databases. Methods: The PETALE cohort (n = 246) includes cALL survivors who were diagnosed and treated at Sainte-Justine University Health Center using DFCI treatment protocols. They participated to an extensive late adverse effects evaluation at 15.5 ± 5.2 years post-diagnosis, at an average age of 21.6 ± 6.3 years old. Patients with refractory disease, relapse or transplant were excluded from the study. Data from 1996, 2001, 2006, 2011 and 2016 Canadian government extensive population census linked to territorial codes (postal codes) were used to extrapolate socioeconomic variables. Centiles for average household income, % of single parent families, % of adults without minimal high school education completion, % of households with less than 20 000 CAD annual income and % of households under the minimum threshold of low income were compared at diagnosis and at PETALE study. Summary of findings: From diagnosis to PETALE Study, most families maintain (54.6%) or improve (33.5%) their socioeconomic status. However, for 1 out of 5 families (21.6%) suffer from a decrease in average household income. Age at diagnosis, participant gender and radiotherapy as part of the treatments do not alter outcomes. Excluding participants > 20 years old at PETALE (i.e. analyzing only families were participants can be assumed to live with their parents) did not change findings. Conclusions: Although ecological fallacy cannot be excluded, the ratio of precarious families does not seem to increase in a sustained way once non-complicated (no relapse, no graft) survivorship is achieved. The universal healthcare coverage and various financial supportive policies (example: financial assistance programs for handicapped children) and other public policies for kids and adolescents in Québec (Canada) could explain these findings.

Citation Format: Sophie Marcoux, Marie-France Raynault, Caroline Laverdière, Daniel Sinnett. Long-term socioeconomic status of childhood leukemia survivors and their family in a universal healthcare coverage system: A PETALE study [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D061.

©2020 American Association for Cancer Research.
2020
American Association for Cancer Research.