More Than Treatment: Bridging Gaps in Pediatric Cancer Care

Pediatric cancer treatment is one of the greatest successes of modern medicine, with around 80% of diagnosed children living as long-term survivors. But many children—especially from underserved areas—don’t fully benefit from these advances due to barriers to accessing life-saving therapies and specialized care.

Lena Winestone, MD, MSHP, an Associate Professor of Pediatrics at the UC San Francisco Department of Pediatrics, leads a research program dedicated to reaching those children who might fall through the cracks and enhancing access to services at every stage of pediatric cancer care.

“The data on pediatric cancer health outcomes show the pervasive nature of survival disparities and suggest that the underlying mechanisms behind these differences relate to factors beyond the severity of the tumor,” said Winestone. By identifying the drivers of these disparities in pediatric cancer care, including income level, insurance type, neighborhood, and ethnicity, tailored solutions can then be developed to improve outcomes for the children facing difficulties finding timely and equitable care.

Unequal Access Leads to Unequal Outcomes

During her pediatric hematology-oncology fellowship at Children’s Hospital of Philadelphia, Winestone investigated a question that would set the stage for her research at UCSF: why do Black children with acute myeloid leukemia (AML) have a 45% survival rate compared to the 60% survival rate for White children?

Winestone found that black pediatric patients were more likely to have severe complications, such as multi-organ failure, when first diagnosed with AML. In the first 50 days after the diagnosis, Black children had more than twice the risk of death.

“However, White and Black children both received the same care once they were in one of the 40 children’s hospitals we studied. When accounting for their initial condition, both groups stayed in the hospital for the same length and received the same intensive therapies and supportive care,” said Winestone.

The findings suggest that something beyond the actual cancer was contributing to the different survival rates, as delays in receiving the initial diagnosis were disproportionally affecting Black children.

 

Finding Harmful Factors

Ultimately, Winestone’s goal is not only to understand disparities but to actively eliminate them, and her research uncovers ways that outside factors can lead to disparate survival rates and details strategies that reduce risk for vulnerable children and families.

For example, Winestone helped discover that when newborns are screened for severe combined immunodeficiency (SCID), racial disparities in subsequent bone marrow transplant outcomes to address SCID are eliminated. By testing all children at the same time (at birth), differences in the diagnosis timing are removed, effectively leveling the playing field. 

In a 2023 study, Winestone led a UCSF team in finding that 75% of respondents in low- and middle-income families dealt with housing, food, or energy insecurity in the 12 months following a pediatric cancer diagnosis. 18% of high-income families reported similar financial hardships. These hardships have been shown to lead to poorer health outcomes and increased use of emergency care.

A Long-Term Vision To Reduce Disparities

In the coming years, Winestone will implement and test initiatives based on her research findings, including a peer navigator program to guide parents through cancer clinical trial enrollment and a guaranteed income initiative for families during bone marrow transplants. In the Bay Area, one in three children with cancer lives in poverty, and these efforts help alleviate practical challenges so families can spend their energy helping their child heal.

Winestone has also positioned herself as a national leader in this crucial work: she helps lead IGNITE, a consortium of 12 leading hospitals dedicated to advancing pediatric cancer health equity, and serves as Vice Chair of the Diversity and Health Disparities Committee at the Children’s Oncology Group, an international group that runs clinical trials and unites over 12,000 childhood cancer experts.

“Decades ago, it was hard to justify dedicating time and money to disparities when cure rates were low,” said Winestone. “We’ve made incredible progress in improving treatments and achieving cures, but if kids and families don’t have equal access to these novel and innovative approaches, we can actually see disparities widen.”

You can support the UCSF Department of Pediatrics and Dr. Winestone’s work to help every child receive the care they need for the best possible chance of surviving a cancer diagnosis.