Addressing Socioeconomic Challenges in Acute Myeloid Leukemia Treatment | Mohamed Sorror, MD | #ASH24

My name is Mohamad Sorror, I work at the Fred Hutchinson Cancer Center. I’m professor of medicine. In this meeting we presented, data on a study that was we designed some time ago where we look at patients from the time of diagnosis of acute myeloid leukemia, when they start receiving the initial therapy. And we followed them for two years.

And while we're following them, we didn't intervene in the decision about treatment. We only collect information. And we collected a lot of information that other studies don't have the capacity to do that we were well funded. So we collected a lot of information about patient health, things like frailty, medical problems, people who might have some disability problems, other issues other than their cancer, collected a lot of information about the leukemia itself and then collected information about how the treatment decisions were made, what treatments were they given, and based on what information and collected all that information from almost 700 patients that were treated at 13 different leukemia centers in the nation.

And then we wanted to see how the social and economic factors played into the decisions made for these patients who received treatment or not. And the advantage of this study is we have all this medical information and information about leukemia. So we kind of in our tests or analysis, take this into account, because the main question we were trying to ask is if somebody cannot get a treatment, is it because medical problem like they have, something that make it an eligible for that treatment, or is it a social problem?

And when we did that study, we found that patients who came from neighborhoods where they were lower education level or some surrogates of poverty, for example, needing, what's called foods, food stamps or other types of, assistance, we found that these patients, first they had, they were dying more frequently early after diagnosis of AML. And the ones who survived, they were less likely to receive a curative treatment like the transplant, bone marrow transplant from a donor, which can be curative for many patients with leukemia.

We found that the patients who came from neighborhoods where there is lower education or some signs of poverty, were less likely to receive that treatment. The ones who reached the transplant and received it. It seems like they did kind of well compared to other patients who came from neighborhoods where there was higher education and higher income. And that made us conclude that it's not really a medical issue.

It's a social issue where there are barriers for patients who have lower education or signs of poverty in their neighborhoods for them to reach, advanced cancer centers that provide advanced treatment like transplant, that can cure their leukemia. And, as I said, that the unique thing about the study is we have all this information about the health of the patient themselves.

So we know if someone did not reach the transplant, it's not because this patient has so and so diabetes, high blood pressure, heart disease, lung disease that might make them not eligible for transplant. No. It's because of those barriers, education barriers and poverty barriers. And because of that, we, I am focused on my future research and trying to remove these barriers or at least make them a little bit easier.

And we we would like to investigate a lot of things to do that. So we already have a study that we do. It was what's called the bone marrow transplant Clinical Trial Network. That's a network that involved multiple transplant center across the nation where we creating information, infographics, my slides or videos two three minutes videos where previous patients from the same background talk to future patients from the same background and try to make them trust the system.

Talk to them about why it's important to be on a clinical trial for transplant. That's one of the ideas we're also trying to see. Well, if we give cash money for some of the patients, for example, would that help them to overcome the barriers to come through the center? Or if we, for example, hire someone navigator that will help them to cross the boundaries of why it's so difficult to do a costly procedure like this, would that help?

These are ideas for the future, and we'll need, well-funded research in order to prove if it's effective or not. But these are among some of the ideas that we are thinking to do in the future to remove that barrier. Because our goal here is we want to reach equality. If there is a promising treatment that can provide cure, we want to make sure it's available for everyone, regardless of their background, race, ethnicity, income, education.

It can be available for everyone to achieve the equality that we all seek.

We didn't look at that question specifically, but as I was saying, we collected that information. We collected all the molecular and details about the cancer itself, which is leukemia. And when we try to look at the impact of, their income and their education, all of that which we kind of took into account how aggressive the leukemia is to make sure that it's not really because of a leukemia is aggressive, that they are dying more frequently or not getting to treatment.

No, we took that into account. So we are balancing our comparisons for that, for that factor.

It's because it's multiple levels. One of them is what you call mistrust in the system. Some some patients might not have the enough education to trust our system. And that we are providing them with cure. Some patients might there could be misinformation. So these videos are meant to have a patient from the same background say, hey, I actually went through the process and it turned out to be a good process so we can remove the mistrust.

But that's not the only level because there is also other thing. There is institutional barriers, that is society barriers. There are other barriers that we also need to work on in the future if we want to resolve the problem. I am doing multiple research for patient with acute myeloid leukemia. So other than the socioeconomic factor we we I'm also focused on older patient anyone 60 years or above.

So now leukemia is very common in older patients. Median age is 68 meaning patient in their 70s would get, leukemia. And sometimes it's hard to decide should we give them a very strong treatment? Should we give them a transplant from someone else or there will be too much for them? So part of my research is developing models to tell us if the patient will benefit from treatment or not develop studies that say, okay, something called randomized, meaning a computer system would choose if you go this direction or that direction and build these studies in order, at the end of the day, to provide this information to physicians and patients when they are confronted with leukemia and they are in their 70s, should I get really aggressive treatment that could affect my quality of life? Or should I be more less intensive in the way I treat my leukemia and buy more quality of life? That balance? We're trying to build large studies that's done across the nation to try to answer this question, because guess what?

Until now, we don't have good quality studies to answer that question well for our patients. So that's the other aspects of the of my research that's affect everybody diagnosed leukemia, especially 60 years or above.