Many Minority Kids With Cancer Missed Needed Medication

Children with leukemia from certain minorities were less likely to get medications to prevent relapse

(RxWiki News) Children in remission from leukemia, the most common childhood cancer, need to take a certain medication to keep the cancer from coming back. But some of these children are not receiving all the medication they need.

A recent study showed that African-American and Asian children with leukemia were less likely than white children with leukemia to regularly take their medication to keep their cancer from recurring (coming back).

The researchers found that children with leukemia who did not take at least 90 percent of their medication were three times more likely to have their cancer come back than those who took their medication regularly.

"Make sure your child takes medications as prescribed."

This research was led by Smita Bhatia, MD, of the City of Hope National Medical Center in Duarte, California.

Dr. Bhatia and colleagues suspected that minorities might be less likely to adhere to the medication regimen. They conducted a previous study in which they found that Hispanic children were much more likely to miss doses of their medication than non-Hispanic white children.

This study included 298 children from 77 institutions in the United States. Of these children, 71 were Asian, 68 were African American and 159 were non-Hispanic Whites. All of the children were diagnosed with acute lymphoblastic leukemia (ALL), the most common childhood cancer. It is a cancer of the white blood cells. The average age at which a child entered this study was 6 years old.

Within a month of receiving cancer therapy, more than 95 percent of children with ALL enter remission (a period of time when their disease improves). In order not to have the cancer recur, these children must take a medication known as 6MP daily for two years.

In this study, 46 percent of African-American children took less than 90 percent of their prescribed medication. This was true of 28 percent of Asian children and 14 percent of non-Hispanic white children.

These children who did not take at least 90 percent of 6MP were 3.1 times more likely to have their cancer come back.

The most common reason parents gave for their children not taking the medication was that it was forgotten. 

The study authors had families fill out a questionnaire at the start of the study. In it, they asked about annual household income, the structure of the family, the parents' education and the parents' race.

The children had a monthly blood test to check their levels of 6MP. The families were also given the medication in a special container with a MEMS Track Cap, which means there was a computer chip in the cap that kept track of the date and time the pill box was opened.

The average follow-up time was 6.4 years, so the researchers were able to see which children relapsed after they completed the course of 6MP. Of the 298 children, 19 had the cancer come back, four children developed cancer at a second site in their body, and the rest of the children remained cancer-free.

The researchers learned that the African-American children mainly came from low-income, single-family households with parents who were not well-educated. Asian children were more likely to come from high-income, nuclear families with well-educated parents. Non-Hispanic white children mainly came from  homes with a more moderate income and average paternal education.

The researchers noted that the reasons for forgetting may be different between groups. For example, they suggested that single African-American mothers with many children may be distracted and find it difficult to remember to give the one child his or her medication.

In a press release, Dr. Bhatia noted how the main reason given for non-compliance was forgetting. "Our data demonstrate that one in four children in remission from ALL does not take the medicine needed to remain cancer free, and in an overwhelming majority, the primary reason why is that they forget to take their pills each day," said Dr. Bhatia.

"These results are the basis for further studies that will examine how physicians can successfully intervene, using technology, for example, to ensure that children do not experience an increased risk of relapse because they did not take their oral chemotherapy," she said.

This study appeared online June 2 in Blood, the journal of the American Society of Hematology.

Disclosures of potential conflicts of interest were related to those researchers from St. Jude Children’s Research Hospital. St. Jude’s allocates money it receives for findings to its researchers.

This study was partially funded from the National Institutes of Health.

Review Date: 
June 4, 2014