Trying to Improve Cure Rates for Hispanics With Childhood Cancer
Dr. Paula Aristizabal always knew she wanted to be a pediatrician like her dad, but her path to get there was a surprising one. It carried her 3,600 miles from her native Colombia to bring her to her current home in Southern California, where she is a pediatric oncologist at the University of California, San Diego Rady Children’s Hospital San Diego.
During her pediatrics training, before her fellowship Dr. Aristizabal was not excited when she learned she had been assigned duties in the Pediatric Oncology department. She’d heard colleagues refer to it as a sad place to be as a doctor; however, it did not take long for her to turn that misconception on its head. She enjoyed engaging with the children and recognized the hope and tremendous potential for a cure. “I realized there was a high chance for a cancer cure. I loved it and continued my training, completing a fellowship in pediatric oncology-hematology. I realized I wanted to help children.”
The Feeling Is Mutual
It turns out Dr. Aristizabal’s patients need her as much as she needs them. Rady Children’s Hospital serves a population of 1 million children, of which almost 50 percent are Hispanic and 30 percent have Spanish-speaking parents. At her own clinic she treats a patient population that is approximately 95 percent Hispanic and 65 percent Spanish-speaking. Dr. Aristizabal’s family upbringing and medical training began to converge into a life path she couldn’t deny: “Being Hispanic and seeing that Hispanics in the U.S. did not have access to the same level of care as whites pushed me to start examining things more. I found survival rates for pediatric cancer were much different for minority children compared to non-Hispanic whites. I recently completed my masters in clinical research and focused on Hispanics’ access to care because I saw a lot of opportunity. With all the resources we have to improve care for this population, I am trying to make a difference for them.”
Hispanics Need A Difference Maker
As Dr. Aristizabal looked more closely at disparities in pediatric cancer care, the numbers began to jump out at her. Hispanics have a lower survival rate for pediatric cancer than non-Hispanic whites, 71 percent to 81 percent respectively. She also found that while the vast majority of pediatric cancer patients join clinical trials (70 percent) because those trials often lead to more successful outcomes, Hispanics are greatly under-represented in those trials.1 That worried Dr. Aristizabal because clinical trials can lead to better protocols and treatments; but when an entire population is left out, doctors don’t know if the same protocols will work on that group.
Once Dr. Aristizabal realized the dire need for change, it ignited a passion in her. She wanted to understand why there were such barriers to getting Hispanics involved in potentially life-saving clinical trials. “Patients are the source of our joy, treating them and making a difference in their lives,” Dr. Aristizabal says. “They are also the source of ideas for research. When I see a family struggling to understand the concept of a clinical trial, which often leads to non-participation, it makes me want to try to figure out what the barriers are. Trying to understand this population and their cultural norms will provide some great insight to performing proper interventions, increasing their participation in clinical trials and thus helping more patients.”
Dr. Aristizabal’s desire to research the cultural divide in pediatric cancer treatment between Hispanics and non-Hispanic whites led her to apply for research grants. Two organizations stepped in to meet her funding needs: Alex’s Lemonade Stand Foundation, a nonprofit organization that raises money and awareness of childhood cancers, and the Northwestern Mutual Foundation, which works to support families and raise funds to find a cure for pediatric cancer. The organizations partnered to provide Dr. Aristizabal with $100,000 in funding over two years to continue her work.
Today, Dr. Aristizabal is in the middle of her project. She’s trying to determine the causes of disparities in care for Hispanics. Specifically, she is searching for barriers Hispanic parents experience that prevent them from enrolling children in pediatric cancer clinical trials, which she sees as a vehicle to getting Hispanics to a higher cure rate. She says, “Being able to understand problems and address barriers allows us to help more patients locally, and if those efforts are successful, then we can help more patients across the U.S.” Dr. Aristizabal’s peers have also seen the value of this work, recognizing her with the prestigious 2016 Clinician Educator Award from The American Society of Pediatric Hematology and Oncology.
A sneak peek at Dr. Aristizabal’s research reveals some of the obstacles for Hispanic parents/patients. Barriers include things like difficulty in getting Spanish-speaking Hispanics past the language barrier. She says interpreters at hospitals are good but can sometimes lack the finesse needed for a medical conversation—even more so when talking to parents about their child’s cancer. Recent immigrants may not have a cultural reference point for advances in U.S. medicine. Some see participation in clinical trials as being asked to use their children as “guinea pigs” instead of the reality of improving their chance for a cure. Health literacy (barriers to understanding health care terms) is also a challenge; Dr. Aristizabal argues that only once barriers like these are understood and addressed can doctors create tailored interventions to mitigate them and increase survival rates for all patients.
Her efforts to level the playing field for treatments and cures for Hispanic pediatric cancer patients has lead Dr. Aristizabal down a path she may not have intended when she began her medical career, but she’s thankful she ended up in this place. In this place, she can be a game changer. “I have seen the needs. I have seen the disparities, and I feel the responsibility to try to improve outcomes for all populations. I’m very passionate about addressing disparities because I think we can make a difference and provide care equally to all populations.”
1Bhatia, S. Disparities in cancer outcomes: lessons learned from children with cancer. Pediatric Blood Cancer. 2011; 56(6): 994-1002. Bhatia S., Sather, H.N., Heerema, N.A., et al. Racial and ethnic differences in survival of children with acute lymphoblastic leukemia. Blood. 2002; 100(6): 1957-64.