Racial and ethnic minority children and adolescents with cancer have a higher risk of death than non-Hispanic white children and adolescents, with evidence for larger disparities in survival for more treatable cancers, finds a new study from the Brown School at Washington University in St. Louis.
“The results suggest that there are modifiable racial and ethnic disparities in childhood cancer survival,” said Kim Johnson, associate professor and senior author of “Associations Between Race/Ethnicity and US Childhood and Adolescent Cancer Survival by Treatment Amenability,” published Feb. 25 in JAMA Pediatrics.
“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,” she said. “Although U.S. cancer survival rates have increased over time, disparities by race/ethnicity remain, including for children and adolescents.”
In the cohort study of 67,061 American children from birth to age 19 with a first primary malignant cancer between 2000 and 2016, those with racial/ethnic minority status had worse cancer survival compared with non-Hispanic white children and adolescents.
Among non-Hispanic black and Hispanic (all races) children and adolescents, the disparity was generally greater for cancer types with higher survival rates.
“Among children and adolescents, racial/ethnic disparities in cancer survival are well documented, particularly for those of African American and Hispanic descent,” Johnson said. “However, to our knowledge, no previous study has examined how these disparities compare for cancer types of varying survivability.”
Cancers that are more amenable to medical intervention may provide greater opportunities for disparities to manifest, as people with fewer resources may have greater challenges obtaining a timely diagnosis and optimal treatment course, the authors said.
Despite the availability of state-of-the-art therapy and clinical trials to most children and adolescents with cancer in the United States, as well as the fact that there are more policies that lead to better health care access for children than adults, racial/ethnic survival disparities remain for young cancer patients, the authors wrote.
These disparities likely result from several factors, they say, including differences in clinical trial enrollment, later diagnosis, adherence to therapy and disease biological characteristics.
Beyond these factors, there is strong evidence that factors related to socioeconomic status may mediate some of the association between race/ethnicity and childhood and adolescent cancer survival.