Pediatric Pearls: Does Race Affect Pediatric Cancer Survival?

Improvements in pediatric cancer care have led to significant improvements in outcomes over time. In fact, despite the slightly increased rate of cancer rates from 1975 to 2006, mortality rates have dropped more than 50%.¹ There is still much progress to be made, though. Evidence shows that these advancements benefit some groups more than others, in particular non-Hispanic white individuals and those with higher educational attainment. With this in mind, today we will examine how these disparities compare for pediatric and adolescent cancer type of varying survivability.

Survival probability is an indicator of how responsive a cancer is to medical intervention. In adults, it has been shown that greater disparities exist for cancers with higher amenability than those with lower amenability. This may be manifested through associated factors such as socioeconomic access, health care access, health literacy, and clinical trials.

The Research

Delavar and colleagues conducted a retrospective cohort study using US Surveillance, Epidemiology, and End Results (SEER) data from 67,061 children and adolescents diagnosed at birth through age 19 years with a first primary malignant cancer (January 1, 2000, to December 31, 2016).²

Participants were followed by dates of diagnosis to cancer death or end of follow up period. General response to treatment (amenability) was defined by the ratio of survival rate (RSR) of those with a particular cancer type relative to a comparable set of cancer-free individuals. The association between race/ethnicity and childhood and adolescent cancer survival by varying levels of amenability was calculated using adjusted hazard ratios (aHR) for high (>85% RSR), medium (70%-85% RSR), and low (<70% RSR) amenability categories.

The Results

Compared with non-Hispanic white children and adolescents, a higher aHR of death was observed among high amenability cancers for non-Hispanic black patients (high: aHR, 1.59; 95% CI, 1.41-1.80 vs low: aHR, 1.35; 95% CI, 1.24-1.47; p = .002 for interaction) and Hispanic/any race patients (high: aHR, 1.62; 95% CI, 1.50-1.78 vs low: aHR, 1.16; 95% CI, 1.08-1.25; p < .001 for interaction). All racial/ethnic minority groups in the study cohort showed worse cancer survival compared with the non-Hispanic white group.

The study showed that racial/ethnic minority children and adolescents had a higher risk of death than non-Hispanic white children and adolescents. In the case of cancers more amenable to medical intervention, there was a larger relative survival difference. These disparities are multifactorial in cause, but likely include differences in socioeconomic status, clinical trial enrollment, biological characteristics, pharmacogenetics, and availability of bone marrow donors.

Bottom Line — There continues to be innovation in the management of childhood cancer. Further efforts should be made to promote health equity, access to all and survivorship will improve even more.

Reference:

1. Smith MA, Seibel NL, Altekruse SF, et al.  Outcomes for children and adolescents with cancer: challenges for the twenty-first century. J Clin Oncol. 2010;28(15):2625-2634. https://doi.org/10.1200/jco.2009.27.0421.
2. Delavar A, Barnes JM, Wang X, Johnson KJ. Associations between race/ethnicity and US childhood and adolescent cancer survival by treatment amenability [published online February 24, 2020]. JAMA Pediatr. https://doi.org/10.1001/jamapediatrics.2019.6074.