{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T13:31:09Z","timestamp":1780579869355,"version":"3.54.1"},"reference-count":42,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Costs to parents and associated financial distress may contribute to observed health disparities in pediatric oncology. We describe financial distress in a cohort of parents with children newly diagnosed with acute lymphoblastic leukemia (ALL) and identify factors contributing to high financial distress.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Procedures<\/jats:title>\n                    <jats:p>Settings were 28 Children's Oncology Group practices in the National Cancer Institute Community Oncology Research Program. We included English\u2010 or Spanish\u2010speaking parents of children with newly diagnosed ALL. Analyses focused on baseline surveys completed by parents during their child's ALL induction therapy. Survey items asked about socio\u2010demographics, household material hardships, financial burden, financial distress, and financial coping behaviors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort included 104 parents. Most were female (87; 83.7%), White (68; 65.4%), non\u2010Hispanic (50; 48.1%), and paid for their child's care with Medicaid or CHIP (60; 57.7%). Financial burden totaled greater than 15% of monthly gross household income for half (54, 51.5%), and 45 (43%) indicated high financial distress (score 1\u20134). Prevalent coping behaviors with health implications included cutting back on groceries (62, 59.6%) or other necessities (61, 58.7%). Parents who had poverty\u2010level income (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0009), paid with Medicaid or CHIP (OR 3.0 [CI: 1.26, 7.13],\n                      <jats:italic>p<\/jats:italic>\n                      = 0.01), were unemployed (OR 2.5 [CI: 1.1, 5.7],\n                      <jats:italic>p<\/jats:italic>\n                      = 0.04), or lived where more than 50% of residents had socioeconomic disadvantages (OR 3.0 [CI: 1.13, 8.05],\n                      <jats:italic>p<\/jats:italic>\n                      =\u00a0.03) were more likely to indicate high financial distress than others.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>During their child's ALL induction therapy, sizeable proportions of parents exhibited high financial burdens, high levels of financial distress, and multiple financial coping behaviors with health implications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pbc.31710","type":"journal-article","created":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T00:34:27Z","timestamp":1745368467000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Baseline Characteristics of Parents Enrolled in Children's Oncology Group Study ACCL20N1CD: Financial Toxicity During Treatment for Pediatric Acute Lymphoblastic Leukemia in the United States"],"prefix":"10.1002","volume":"72","author":[{"given":"Sheila Judge","family":"Santacroce","sequence":"first","affiliation":[{"name":"The University of North Carolina at Chapel Hill School of Nursing  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4058-1586","authenticated-orcid":false,"given":"Melissa P.","family":"Beauchemin","sequence":"additional","affiliation":[{"name":"Columbia University Mailman School of Nursing  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Ponce","sequence":"additional","affiliation":[{"name":"Children's Oncology Group (COG)  Monrovia California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingyun","family":"Ji","sequence":"additional","affiliation":[{"name":"Children's Oncology Group (COG)  Monrovia California USA"},{"name":"University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhash","family":"Ramakrishnan","sequence":"additional","affiliation":[{"name":"Children's Oncology Group (COG)  Monrovia California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5602-7059","authenticated-orcid":false,"given":"Kira","family":"Bona","sequence":"additional","affiliation":[{"name":"Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yudy","family":"Mu\u00f1eton\u2010Casta\u00f1o","sequence":"additional","affiliation":[{"name":"Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna M.","family":"Robles","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Vargas","sequence":"additional","affiliation":[{"name":"Children's Oncology Group (COG)  Monrovia California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crystal","family":"De Los Santos","sequence":"additional","affiliation":[{"name":"Driscoll Children's Hospital  Corpus Christi Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth","family":"Fisher","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9695-1702","authenticated-orcid":false,"given":"Sarah","family":"Alexander","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lillian","family":"Sung","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan K.","family":"Parsons","sequence":"additional","affiliation":[{"name":"Tufts University School of Medicine  Boston Massachusetts USA"},{"name":"Tufts Medical Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Hidden Hardship in the United States. 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