‘Catastrophic’ earnings loss widespread for households with pediatric ALL
December 06, 2025
5 min learn
Key takeaways:
- A couple of third of households with youngsters with ALL lose no less than 25% of their annual family earnings inside 2 years of beginning therapy.
- An identical proportion expertise housing, meals or utility insecurity, too.
ORLANDO — Throughout his first 12 months of fellowship, Daniel J. Zheng, MD, MHS, MSHP, sat in clinic ready for a younger baby with leukemia scheduled for chemotherapy.
As they waited, a nurse navigator messaged Zheng that the affected person’s household wouldn’t be capable to make it.
Information derived from Zheng D, et al. Summary 710. Introduced at: ASH Annual Assembly and Exposition; Dec. 6-9, 2025; Orlando.
The household had hardships past the affected person’s most cancers. One mother or father had their very own medical issues, they usually already needed to juggle quite a few appointments. Their automobile additionally had been damaged into, and the household had no different means of attending to the clinic. They’d to determine childcare for different siblings, too.
Daniel J. Zheng
“I bear in mind sitting within the clinic workroom, and the nurse practitioner appeared up from her desk and mentioned to me, ‘Dan, the saddest factor is that for a few of our households, the toughest factor that they’re dealing with proper now shouldn’t be their baby’s most cancers prognosis,’” Zheng, now an attending doctor within the division of oncology at Kids’s Hospital of Philadelphia, informed Healio. “That’s a quote I take into consideration typically.”
At ASH Annual Assembly and Exposition, Zheng detailed the “heartbreaking” actuality some households face.
About 30% of households with youngsters with acute lymphoblastic leukemia expertise family materials hardship, reminiscent of housing, meals or utility insecurity, or “catastrophic” earnings loss inside 2 years of therapy.
“This can be a main drawback in pediatric oncology, particularly pediatric ALL,” Zheng mentioned.
‘Quite a bit’ of prices
Kids with ALL who obtain 2 or extra years of multiagent chemotherapy have a survival fee of greater than 90%, in keeping with research background.
Nonetheless, this therapy can require greater than 200 outpatient visits and 40 inpatient days, Zheng mentioned.
“That generates quite a bit direct and oblique prices on households,” he added.
The Dana-Farber Most cancers Institute ALL Consortium Trial 16-001 investigated threat elements for therapy choices for ALL and a brand new chemotherapy drug referred to as pegaspargase (Oncaspar, Servier Prescription drugs).
As a part of the trial, sufferers might choose right into a correlative family materials hardship research.
General, 422 sufferers (15% Hispanic; 7% Black; 23% single-parent households; 40% earnings beneath 200% federal poverty stage) selected to take part.
Mother and father and guardians of sufferers accomplished surveys at prognosis, 6, 12 and 24 months about their hardships and monetary toxicities.
At baseline, 27% reported a family materials hardship.
Incidence of latest family materials hardships and catastrophic earnings loss (25% or extra of annual family earnings) from 6 to 24 months served as major endpoints.
Magnitude ‘putting’
At 6 months, 19.3% of individuals reported new family materials hardships. At 1 12 months, the cumulative quantity grew to 27.7%, and it elevated to 30% at 2 years.
Moreover, 20.3% of individuals had catastrophic earnings loss at 6 months. Cumulative incidence rose to twenty-eight.6% at 1 12 months and 31.5% at 2 years.
“I assumed that this was going to be important. I assumed that this is a crucial difficulty. My scientific suspicion was that a lot of households skilled it, however I feel we had been all stunned by the magnitude that we noticed,” Zheng mentioned.
A subgroup evaluation of sufferers who didn’t report hardships at baseline additional highlighted the monetary toxicity related to therapy.
Amongst that cohort, 24.3% of individuals reported experiencing family materials hardships sooner or later throughout therapy by 2 years and 27.9% had catastrophic earnings loss.
“Hanging,” Zheng mentioned. “That’s an necessary paradigm shift [for screening]. It’s not one thing {that a} baby begins most cancers remedy, you have got a one-time social work display screen, and also you determine that this household is okay. That doesn’t predict that they’re going to be effective over 2 years of remedy. It’s necessary to revisit that evaluation. Mitigating disparities actually entails standardizing that and doing it longitudinally for all households.”
Researchers additionally discovered sure populations had an elevated threat for brand new family materials hardships, together with Hispanic households (HR 4.0, 95% CI: 2.6-6.2), non-Hispanic Black households (HR = 5.5; 95% CI: 3.4-9.0), single-parent households (HR = 3.1; 95% CI: 2.2-4.5), those that most popular a non-dominant language (HR = 3.3; 95% CI, 2.3-4.9), these with Medicaid insurance coverage (HR = 2.8, 95% CI: 1.9-4.2), and those who had a baseline earnings lower than 200% the federal poverty stage (HR = 2.9; 95% CI, 2.1-4.2).
“Nearly each sociodemographic issue that we hypothesized is likely to be associated to an elevated threat of growing new materials hardship was related to new materials hardship,” Zheng mentioned. “This phenomena of economic toxicity is especially impacting those that are already dealing with different societal and structural disadvantages. It may be a compounding of challenges as you’re making an attempt to maintain a baby with most cancers.”
Must do ‘higher’
Researchers didn’t examine what led to hardships or earnings loss. Zheng had “suspicions” although, together with discount in work hours, quitting jobs outright, stress of caring for a affected person with most cancers and different prices associated to care, together with childcare and transportation.
“All of it provides up,” he mentioned.
Zheng famous a number of areas of future analysis, together with comparable research into different pediatric malignancies, extra longitudinal information, and investigations into monetary toxicity’s impression on outcomes, reminiscent of survival, high quality of life and persistent well being burden. Additionally, does having one hardship result in others sooner or later?
Regardless of these questions, establishments must be working to deal with these points now, Zheng mentioned.
CHOP not too long ago built-in a ready meal and meals pantry service into its oncology clinic. Rideshare and parking packages can assist, too.
Zheng additionally highlighted research being carried out by research coauthors Puja Umaretiya, MD, assistant professor within the division of pediatrics at UT Southwestern Medical Middle, and Kira Bona, MD, MPH, attending doctor at Dana-Farber Most cancers Institute and affiliate professor of pediatrics at Harvard Medical Faculty.
“Dr. Umaretiya is advantages counseling as a possible intervention,” Zheng mentioned. “Can we join weak and high-risk households to governmental advantages extra successfully? Dr. Bona is main a number of research direct money switch as an intervention. Can that mitigate monetary toxicity?”
Federal and state governments might enact insurance policies to assist, as nicely, reminiscent of increasing entry to advantages from the Household and Medical Go away Act.
“I feel we’ve began to do a greater job of [focusing on financial toxicity],” Zheng mentioned. “It will possibly’t simply all the time be this concentrate on optimizing the treatment fee. We even have to consider the impression that our most cancers remedies have on households globally. This analysis stresses we have to do a greater job of supporting households of youngsters present process most cancers remedy.”
For extra data:
Daniel J. Zheng, MD, MHS, MSHP, might be reached at zhengd1@chop.edu.
Sources/Disclosures
Supply:
Zheng D, et al. Summary 710. Introduced at: ASH Annual Assembly and Exposition; Dec. 6-9, 2025; Orlando.
Reference:
Disclosures:
Zheng studies no related monetary disclosures. Please see the research for all different authors’ related monetary disclosures.
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