Research Abstract

I am a pediatric oncologist and investigator focused on improving disease outcomes for pediatric cancer patients by systematically intervening on social determinants of health. One in five children in the United States lives in poverty. Emerging evidence demonstrates that despite highly protocolized care, poverty-related outcome disparities exist in childhood cancer in the United States. The mechanisms underlying this relationship have not been defined, nor have modifiable domains of poverty been investigated. My research agenda frames this disparity as an opportunity to improve residual morbidity and mortality in pediatric cancer by systematically considering poverty as a risk factor for poor outcome and integrating it into the existing robust clinical trial model of discovery and care in pediatric cancer. I have formal training in health services and outcomes research, and clinical expertise in pediatric oncology with a specific focus on hematological malignancies. As an early career investigator I have developed content expertise in the areas of financial hardship and measures of poverty in pediatrics. My work to date has demonstrated an association between community-level poverty and higher risk of early relapse in children with acute lymphoblastic leukemia (ALL). I have additionally identified a high rate of a remediable measure of poverty (household material hardship (HMH)) in the pediatric oncology clinical setting. I am currently conducting an embedded investigation of HMH to investigate the impact of poverty on relapse, overall survival and chemotherapy adherence in the context of a multicenter therapeutic clinical trial for pediatric ALL (DFCI 16-001). These data will lay the groundwork for future research testing poverty-targeted interventions in the pediatric clinical trial setting. My career goal is to reduce residual morbidity and mortality in pediatric cancer through the design of interventions targeting poverty as a determinant of child health outcomes.