Racial and Ethnic Disparities in Childhood and Adolescent Cancer Survival

A study published in JAMA Pediatrics found racial and ethnic disparities in childhood and adolescent cancer survival for non-Hispanic black, non-Hispanic American Indian/Alaskan Native, non-Hispanic Asian or Pacific Islander, and Hispanic patients.¹

Moreover, these disparities were found to be larger overall for more survivable cancer types, which are typically more amenable to medical intervention.

“The results from our study emphasize the need for continued research to identify modifiable factors that explain the disparities so that we can design interventions to eliminate them prior to diagnosis and throughout treatment,” senior author Kimberly J. Johnson, MPH, PhD, associate professor at Washington University in St. Louis, said in a press release.² “Although US cancer survival rates have increased over time, disparities by race/ethnicity remain, including for children and adolescents.”

Using a retrospective study cohort from the SEER database, researchers assessed 67,061 children and adolescents diagnosed at ages 0 to 19 years with a primary malignant cancer from January 1, 2000 to December 31, 2016. The patients were followed up from the dates of diagnosis to cancer death or the end of the follow-up period, whichever came first. 

Across the entire cohort, 36,064 participants (53.8%) were male and most of the individuals were non-Hispanic white (35,186 [52.5%]), followed by Hispanic of any race (19,220 [28.7%]), non-Hispanic black (7,100 [10.6%]), non-Hispanic Asian or Pacific Islander (4,981 [7.4%]), and non-Hispanic American Indian/Alaskan Native (574 [0.9%]). The median (SD) age at diagnosis was 9.66 (6.41) years)

Compared to non-Hispanic white children and adolescents, a higher adjusted hazard ratio (aHR) of death was observed for high- than low- 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 patients (high: aHR, 1.63; 95% CI, 1.50-1.78 vs low: aHR, 1.16; 95% CI, 1.08-1.25; P < .001 for interaction). For the other races and ethnicities, the results indicated similar patterns, however they were not found to be statistically significant. 

“Cancers that are more amenable to medical intervention may provide greater opportunities for disparities to manifest, as those with fewer resources may have greater challenges obtaining a timely diagnosis and optimal treatment course,” the authors wrote. 

Additionally, the authors noted that though childhood cancer is fundamentally different from adult cancer, given the added benefit of higher rates of health insurance, as well as surveillance of health from a guardian, racial and ethnic disparities by cancer type were similar to what has been reported for adult populations. And despite improving clinical knowledge about diseases and the management thereof, socioeconomic disparities continue to persist as a fundamental cause of disease, given that they allow individuals to avoid and better manage their illness.

“These disparities likely result from several factors, including differences in clinical trial enrollment, adherence to therapy, disease biological characteristics, and pharmacogenetics,” the authors wrote. “Beyond these factors, there is strong evidence that socioeconomic status mediates the association between race/ethnicity and childhood and adolescent cancer survival.” 

Given the findings as a whole, the researchers indicated that as childhood and adolescent cancer treatment continues to advance, the danger of leaving these disadvantaged groups behind increases, demonstrating the need for efforts to be made to promote health equity by race and ethnicity among all children and adolescents with cancer. 

References:

1. Delavar A, Barnes JM, Wang X, Johnson KJ. Associations Between Race/Ethnicity and US Childhood and Adolescent Cancer Survival by Treatment Amenability. JAMA Pediatrics. doi:10.1001/jamapediatrics.2019.6074.

2. Cancer survival disparities in minority children, adolescents greater for more treatable cancers [news release]. St. Louis, MO. Published February 27, 2020. source.wustl.edu/2020/02/cancer-survival-disparities-in-minority-children-adolescents-greater-for-more-treatable-cancers/. Accessed February 28, 2020.