Pediatric RISE: Development of a Poverty-Targeted Cash Support Intervention for Pediatric Cancer

Co-Authors: Colleen A. Kelly, Morgan A. Paul, Jennifer Kellett, Sunyu Kang Anna Revette, Rahela Aziz-Bose, Leanne Duhaney, Puja J. Umaretiya, Amy Lin, Erika Hanson, Kira Bona

• Journal: Pediatric Blood & Cancer
• Abstract:
  • Background: Poverty is independently associated with relapse and death in childhood cancer despite highly standardized treatment. Prior data shows that direct cash support interventions are feasible and improve child outcomes, however, no such interventions exist within pediatric oncology. To address this, we aimed to pilot and refine Pediatric RISE (Resource Intervention to Support Equity), a novel, direct cash support intervention in pediatric oncology.
  • Procedure: This was a single-arm pilot study among low-income children with cancer at a single center. Participants received twice monthly cash disbursements and optional benefits counseling for 3 months. Parent surveys and qualitative interviews evaluated acceptability, satisfaction, and 49 barriers to utilization to inform refinement.
  • Results: Families received all intended cash disbursements and used funds for essential resources with a reduction in household material hardship. Parents described RISE as useful and acceptable. There was no parent-reported loss or reduction of means-tested government benefits. Parents reported a need for larger disbursements and extended duration to mitigate treatment associated income losses.
  • Conclusion : RISE was acceptable and valuable, with appropriate mitigation of risk of means tested government benefit loss or reduction by intervention design. Parent feedback informed refinement, including an increase in cash disbursement dollar amount and duration. The refined RISE intervention is currently being evaluated in a multi-site, randomized signal-finding study.
• Why it matters: This study continues to build the evidence base to support innovations that directly address material hardship and resource insecurity as a means to improve health outcomes and disparities. This iteration of the study shows that theoretical, legal, and policy principles can be translated into actionable, evidence-based interventions, with potential to close deadly health gaps for children with cancer and others experiencing similar health hardships. Our hope is that more evidence will provide policymakers, clinicians, and advocates with a way forward on tackling the underlying conditions of health disparities and with compelling arguments to support reforms such as direct cash payment interventions in health care.

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