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Hospital Volume and Induction Mortality in Children, Adolescents, and Young Adults with Acute Leukemia

Children’s Hospital of Philadelphia
Jennifer Wilkes, MD
Grant Type: 
Young Investigator Grants
Year Awarded: 
Type of Childhood Cancer: 
Project Description: 

2016: Jennifer Wilkes is now employed at Seattle Children's Hospital and Regional Medical Center

Project Goal

This project will evaluate how hospital volume affects mortality in the first phase of treatment for children, adolescents and young adults with leukemia. It will apply the powerful paradigm of volume-outcome relationships to a new clinical area in which this information is limited: pediatric cancer. It is predicted that this project will identify clusters of high or low mortality institutions. Further work will be necessary to determine why institutions may differ including identification of best practices and potential recommendations for standardization of pediatric cancer care.

2016 Project Update

Acute Lymphoblastic Leukemia (ALL) is the most common diagnosis of cancer in the pediatric population. Because of this children diagnosed with ALL can be treated a variety of different types of institutions across the United States. In our study of a nationally representative sample of patients with ALL treated at a variety of institutions across the United States, mortality was rare; pediatric hospital volume did not influence mortality rates across institutions. Hospitals with low volume of pediatric oncology diagnoses who admitted patients with this most common of pediatric oncologic diagnosis did not have an inferior mortality rate in the first phase of therapy. In addition, hospitals with lower pediatric volume did not show an increased need for intensive care level resources.

We continue to evaluate the impact of volume and another hospital metric, hospital complexity, on early treatment outcomes including mortality and intensive care needs in the pediatric AML and adolescent and young adult ALL and AML population. Our early data indicates that the volume of pediatric patients at an institution influences the type of induction chemotherapy received in adolescents and young adults with ALL and AML. We will further describe these differences in upcoming publications.

"The Young Investigator Award from Alex's Lemonade Stand Foundation is crucial to being able to continue my research looking at how hospital experience shapes the care of our children and young adults with leukemia. With this stepping stone, we hope to be able to identify best practices of care to improve treatment for all of our patients." ~Jennifer Wilkes, MD