Associations Between Race/Ethnicity and US Childhood and Adolescent Cancer Survival by Treatment Amenability

Abstract

IMPORTANCEAlthough US cancer survival rates have increased over time, disparities by race/ethnicity remain, including for children and adolescents.OBJECTIVE To examine whether racial/ethnic disparities in childhood and adolescent cancer survival vary by cancer type according to relative survival rates (RSRs), a marker for amenability to medical intervention. DESIGN, SETTING, AND PARTICIPANTSIn a retrospective cohort study using US Surveillance, Epidemiology, and End Results data, 67 061 children and adolescents diagnosed at ages 0 to 19 years with a first primary malignant cancer from January 1, 2000, to December 31, 2016, were evaluated. Data analysis was performed from June 19 to November 3, 2019. Participants were followed up from the dates of diagnosis to cancer death or the end of the follow-up period, whichever came first.EXPOSURES Race/ethnicity defined as non-Hispanic white, non-Hispanic black, non-Hispanic American Indian/Alaskan Native, non-Hispanic Asian or Pacific Islander, or Hispanic (any race). MAIN OUTCOMES AND MEASURESCancer amenability was defined using 5-year RSRs for 103 cancer types. Cox proportional hazards regression was used to compute adjusted hazard ratios (aHRs) and 95% CIs for the association between race/ethnicity and cancer survival for high (>85% RSR), medium (70%-85% RSR), and low (<70% RSR) amenability categories. RESULTS Among 67 061 cancer cases, 36 064 were male (53.8%); most individuals were non-Hispanic white (35 186 [52.5%]) followed by Hispanic of any race (19 220 [28.7%]), non-Hispanic black (7100 [10.6%]), non-Hispanic Asian or Pacific Islander (4981 [7.4%]), and non-Hispanic American Indian/Alaskan Native (574 [0.9%]). Mean (SD) age at diagnosis was 9.66 (6.41) years. Compared with non-Hispanic white children and adolescents, a higher aHR of death was observed for high-than low-amenability cancers for non-Hispanic black patients

Area deprivation is associated with poorer overall survival in children with acute lymphoblastic leukemia

“…It was performed in a population‐based sample from one of the largest and most racially, ethnically, and geographically diverse states in the country. Recent data suggest that racial and ethnic disparities in childhood cancer outcomes may be widening as survival improves 3 . This implies that as survival for children with ALL improves and treatments become more complex, the impact of SES may become more pronounced; for this reason, it is important to note that our study includes children diagnosed through 2011.…”

“…Acute lymphoblastic leukemia (ALL) is the leading cause of cancer death in children and adolescents 1,2 . Survival has improved dramatically over the past several decades but racial and ethnic disparities persist, with outcomes remaining poorer among Hispanics and non‐Hispanic Blacks than non‐Hispanic Whites 2‐7 . Prognostic features including cell lineage, age at diagnosis, and cytogenomics differ by race/ethnicity, and socioeconomic and environmental characteristics also contribute to disparities through their impacts on health care access and adherence to therapy 7‐10 .…”

“…Prognostic features including cell lineage, age at diagnosis, and cytogenomics differ by race/ethnicity, and socioeconomic and environmental characteristics also contribute to disparities through their impacts on health care access and adherence to therapy 7‐10 . Importantly, recent evidence suggests that disparities are wider for childhood cancers with high treatment amenability, including ALL 3 . As survival improves and therapy becomes more complex and individualized, the potential impact of socioeconomic status (SES) on survival may increase.…”

“…As survival improves and therapy becomes more complex and individualized, the potential impact of socioeconomic status (SES) on survival may increase. Accordingly, because of the intersection of SES and race/ethnicity in the United States, disparities in survival may be increasing for children in certain race/ethnic groups 3,4 …”

Disparities in pediatric and adolescent cancer survival: A need for sustained commitment

“…For cancers that are easier to treat and cure, disparities may become apparent due to differences between groups with regard to access to the health care system and the best available treatments. 5 Cancer survival disparities associated with race and/or ethnicity and SES for pediatric and adolescent cancer have been attributed to many factors, including differences between groups with regard to insurance, timing of diagnosis, clinical trial participation, adherence to therapy, and disease biology. 15 However, evidence that disparities can be reduced after removing financial barriers to care has been reported in one study comparing survival outcomes between Black and White children treated at St. Jude Children's Research Hospital (St. Jude), which treats all patients regardless of their race and/or ethnicity or ability to pay, with those in the SEER data.…”