Effect of social disparities on 10 year survival in pediatric patients with Wilms' tumor

Abstract

Background To stratify 10‐year survival outcomes by degree of social disparities in pediatric Wilms' tumor patients. We applied the Social Deprivation Index (SDI) to survival outcomes from the national SEER database to elucidate the effects of lower socioeconomics on cancer survival. Methods A retrospective cohort study was performed using the national Surveillance, Epidemiology, and End Results (SEER) oncology registry from 1975 to 2016 based on county‐level data. Pediatric patients (<18 years old) with a diagnosis of WT (C64.9) and confirmed based on histology codes (8960/8963) were included. SDI scores were calculated for each patient and initially divided into quintiles. Patients were delineated into high‐risk (>60th percentile/more deprived) or low‐risk (<60th percentile/less deprived) groups. Statistics were assessed using Fisher's exact test, Student's t ‐test, and Kaplan–Meier assessed survival differences with log‐rank test for trend. Results A total of 3406 patients were included with 1366 patients reported in the high‐risk group and 2040 patients in the low‐risk group. Quintile data demonstrated a stratification in survival based on socioeconomic status. Patients in more socially deprived counties were significantly ( p = 0.035) more likely to have worse overall survival compared with those living in less deprived areas at 10‐year (87.3% vs 89.3%) follow‐up. Conclusions 10‐year overall and cancer‐specific survival data for patients with Wilms' tumor stratify by socioeconomic lines. This represents an area that needs to be addressed in this pediatric oncologic population. Patients from more socially deprived areas have significantly worse 10‐year overall survival rates and noticeably different 10‐year cancer‐specific survival rates.

Children's Oncology Group's 2023 blueprint for research: Renal tumors

“…Current data indicate that children with WT who suffer from more social deprivation, experience worse survival. 17 Comprehensive cancer care requires more than just chemotherapy, surgery, and radiation. To achieve optimal survival for children with renal tumors, support of the whole child and their family is necessary.…”

“…An additional emerging area of focus is better understanding the impact of social determinants of health on outcomes for children with renal tumors. Current data indicate that children with WT who suffer from more social deprivation, experience worse survival 17 . Comprehensive cancer care requires more than just chemotherapy, surgery, and radiation.…”

Investigating the Impact of Tumor Biology and Social Determinants on Time to Diagnosis and Stage at Presentation of Wilms Tumor

“…In Wilms tumor, unfavorable histology or loss of heterozygosity are considered negative prognostic factors. 7 Metastatic cancer portends worse prognosis, demonstrating the importance of diagnosis at an early stage. Patients with retinoblastoma who have extraocular disease are noted to have decreased overall survival and worse outcomes in terms of preservation of vision.…”

“…In recent years, loss of heterozygosity has also been used to indicate more aggressive cancer and is considered a poor prognostic factor. 7 We aimed to identify the impact of socioeconomic barriers and tumor biology in Wilms patients at Children's Hospital Colorado on stage at diagnosis and diagnostic timing. Demographic information including race, ethnicity, primary language, insurance type, age of patient, and city of residence were obtained from patient charts.…”

“…Cancer biology has also been noted to affect overall survival. In Wilms tumor, unfavorable histology or loss of heterozygosity are considered negative prognostic factors 7 …”