title: Trajectory of Material Hardship and Income Poverty in Families of Children Undergoing Chemotherapy: A Prospective Cohort Study.
abstract: BACKGROUND
  Poverty is correlated with negative health outcomes in pediatric primary care, and is emerging as a negative prognostic indicator in pediatric oncology. However, measures of poverty amenable to targeted intervention, such as household material hardship (HMH)--including food, energy, and housing insecurity--have not been described in pediatric oncology. We describe the trajectory of family reported HMH and income poverty at a pediatric oncology referral center in New England with high psychosocial supports.
  
  
  METHODS
  Single site, prospective cohort study including 99 English-speaking families of children receiving chemotherapy for primary cancer. Families completed face-to-face surveys at two time-points: (1) Within 30 days of child's diagnosis (T1) (N = 99, response rate 88%); (2) 6-months following diagnosis (T2) (N = 93, response rate 94%). HMH was assessed in three domains: food, energy, and housing insecurity.
  
  
  RESULTS
  Twenty percent of families reported low-income (≤200% Federal Poverty Level) and at least one HMH prior to their child's diagnosis. At T2, 25% of families lost >40% annual household income secondary to treatment-related work disruptions, and 29% of families reported HMH despite utilization of psychosocial supports.
  
  
  CONCLUSIONS
  Low-income and HMH are prevalent in a significant proportion of newly diagnosed pediatric oncology families at a large referral center. Despite psychosocial supports, the proportion of families experiencing unmet basic needs increases during chemotherapy to nearly one in three families. HMH provides a quantifiable and remediable measure of poverty in pediatric oncology. Interventions to ameliorate this concrete component of poverty could benefit a significant proportion of pediatric oncology families.
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.|Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Center for Outcomes and Population Research, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Kira
authors.initials: K
authors.lastname: Bona
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.|Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Wendy B
authors.initials: WB
authors.lastname: London
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.|Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: Dongjing
authors.initials: D
authors.lastname: Guo
authors.affiliation: Boston University School of Medicine, Boston, Massachusetts.|Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Frank
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.|Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Center for Outcomes and Population Research, Dana-Farber Cancer Institute, Boston, Massachusetts.|Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Joanne
authors.initials: J
authors.lastname: Wolfe
mesh_terms: D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D009369:Neoplasms / Q000191:economics* / Q000628:therapy; D009511:New England; D011203:Poverty; D011446:Prospective Studies; D012944:Social Support; D011795:Surveys and Questionnaires
keywords: chemotherapy; outcomes research; pediatric oncology; psychosocial; quality of life; support care