Dr. Winestone on Disparities with Diagnosis in Pediatric Leukemia

Lena Winestone, MD, assistant professor, Department of Pediatrics, University of San Francisco Helen Diller Family Comprehensive Cancer Center, discusses disparities with diagnosis in pediatric leukemia.

Defining a delay in diagnosis of leukemia can be complex due to the ambiguity of some of the disease’s symptoms, Winestone explains, adding that a symptom such as fatigue could be attributed to leukemia or a range of other factors. Even after a blood test confirms the diagnosis, it is difficult to link a patient’s previous symptoms to the disease, Winestone continues.

However, there has not been evidence that a delay in diagnosis leads to problems in care for leukemia, Winestone adds. Rather than focusing on a potential delay in diagnosis, clinicians concentrate on defining how sick patients are at diagnosis and what effect the leukemia has had on the body’s other organs, Winestone explains. Identifying a patient’s acuity score can involve looking at their breathing, kidney function, liver function, and mental status, Winestone says.

Connecting a patient’s acuity score to a delay in diagnosis is still a complicated process, but Winestone notes that patients who are sicker and need to go to cancer intensive care unit at the time of diagnosis have worse outcomes. Higher rates of worse acuity scores at diagnosis have been documented in Black patients, and researchers are concerned that this is one of the factors attributing to worse outcomes among that population, Winestone concludes.