Children's Oncology Group Hospital Membership and Survival of Pediatric Lymphoblastic Leukemia

Children's Oncology Group Hospital Membership and Survival of Pediatric Acute Lymphoblastic Leukemia by Paul David Betts MS, Texas State University, 2002 BS, Stephen F. Austin State University, 1986 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University June 2017 Abstract Acute lymphoblastic leukemia (ALL) predominates in children ages 0-14 years and has an excellent prognosis for cure with 5-year survival exceeding 90% in the United States. However, not all children experience such positive outcomes. The purpose of this quantitative, retrospective cohort study was to evaluate differences in survival of ALL among children who reside in the 32-county Texas-Mexico border region. While factors such as poverty and health insurance have been strongly associated with poorer cancer outcomes, additional factors such as geographic isolation and treatment disparities are not as well-documented in children. This study examined the association between use of Texas Children’s Oncology Group (COG) pediatric research facilities and survival among children in Texas diagnosed with ALL. This study used cancer incidence data 1995-2009 from the Texas Cancer Registry. Differences in survival and use of COG facilities were investigated between children who reside within the 32-county TexasMexico border region and the combined remaining 222 Texas counties. Chi-square was used to analyze area of residence, gender, race/ethnicity, and poverty status between COG and non-COG reported cases. Logistic regression was used to examine ALLAcute lymphoblastic leukemia (ALL) predominates in children ages 0-14 years and has an excellent prognosis for cure with 5-year survival exceeding 90% in the United States. However, not all children experience such positive outcomes. The purpose of this quantitative, retrospective cohort study was to evaluate differences in survival of ALL among children who reside in the 32-county Texas-Mexico border region. While factors such as poverty and health insurance have been strongly associated with poorer cancer outcomes, additional factors such as geographic isolation and treatment disparities are not as well-documented in children. This study examined the association between use of Texas Children’s Oncology Group (COG) pediatric research facilities and survival among children in Texas diagnosed with ALL. This study used cancer incidence data 1995-2009 from the Texas Cancer Registry. Differences in survival and use of COG facilities were investigated between children who reside within the 32-county TexasMexico border region and the combined remaining 222 Texas counties. Chi-square was used to analyze area of residence, gender, race/ethnicity, and poverty status between COG and non-COG reported cases. Logistic regression was used to examine ALL survival differences between COG and non-COG facilities controlling for multiple variables. COG affiliation alone was not a significant predictor of survival. An interaction between race/ethnicity, region, poverty status, and COG facility affiliation was observed as a significant predictor of poorer survival. The results of this study have the potential to promote positive social change by implementing interventions addressing access to equivalent pediatric cancer care in the 32-county Texas-Mexico border area. Children's Oncology Group Hospital Membership and Survival of Pediatric Acute Lymphoblastic Leukemia by Paul David Betts MS, Texas State University, 2002 BS, Stephen F. Austin State University, 1986 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University June 2017 Dedication This work is dedicated to my late father and mother, Mr. and Mrs. Charles Donald Betts, who taught me the most important things no book or classroom could. Acknowledgments I would like to express my sincere thanks to my entire family over this long and challenging process. I could have never reached this point without you. I would also like to think my Dissertation Chair, Dr. Talmage Holmes for his help and patience though this entire project. Dr. Richard Palmer was also a source of outstanding guidance and support. Additionally, warm and heartfelt thanks to Drs. Michael O'Brien and the late Sidney Stewart. It was an honor, pleasure, and an incredible learning experience working with such skilled and caring physicians.