Disparities in survival improvement for U.S. childhood and adolescent cancer between 1995 and 2019: An analysis of population-based data |
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| Institution: | 1. Brown School, Washington University in St. Louis, St. Louis, MO, USA;2. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA;3. Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA;4. Rollins School of Public Health, Emory University, Atlanta, GA, USA;1. Faculty of Pharmacy, Universidade Federal de Minas Gerais, Brazil;2. Ezequiel Dias Foundation, Brazil;3. Hospital das Clínicas, Universidade Federal de Minas Gerais, Brazil;1. Department of Public Health, and Department of Endocrinology of the Children''s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children’s Health, Hangzhou 310058, China;2. Department of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China;3. Department of Public Health, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China;1. Department of Radiotherapy, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil;2. Department of Education and Research, Hospital de Câncer de Pernambuco, Recife, Pernambuco, Brazil;3. Department of Head and Neck Surgery, Hospital de Câncer de Pernambuco, Recife, Pernambuco, Brazil;4. Department of Oncology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil;5. Department of Pneumology, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil;6. Clinical Research Division, Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, Pernambuco, Brazil;1. Department of Registration, Cancer Registry of Norway, P.O. Box 5313 Majorstuen, N-0304 Oslo, Norway;2. Department of Oncology, Oslo University Hospital, P.O. Box 4950 Nydalen, 0424 Oslo, Norway;1. Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724, USA;2. Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724, USA;1. Division of Epidemiology, Department of Health Informatics and Public Health, Tohoku University School of Public Health, Graduate School of Medicine, Sendai, Japan;2. Division of Epidemiology, Miyagi Prefectural Cancer Research Center, Natori, Japan;3. Miyagi Cancer Society, Sendai, Japan |
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| Abstract: | BackgroundAlthough treatment advances have increased childhood and adolescent cancer survival, whether patient subgroups have benefited equally from these improvements is unclear.MethodsData on 42,865 malignant primary cancers diagnosed between 1995 and 2019 in individuals ≤ 19 years were obtained from 12 Surveillance, Epidemiology, and End Results registries. Hazard ratios (HRs) and 95 % confidence intervals (CIs) for cancer-specific mortality by age group (0–14 and 15–19 years), sex, and race/ethnicity were estimated using flexible parametric models with a restricted cubic spline function in each of the periods: 2000–2004, 2005–2009, 2010–2014 and 2015–2019, versus 1995–1999. Interactions between diagnosis period and age group (children 0–14 and adolescents 15–19 years at diagnosis), sex, and race/ethnicity were assessed using likelihood ratio tests. Five-year cancer-specific survival rates for each diagnosis period were further predicted.ResultsCompared with the 1995–1999 cohort, the risk of dying from all cancers combined decreased in subgroups defined by age, sex and race/ethnicity with HRs ranging from 0.50 to 0.68 for the 2015–2019 comparison. HRs were more variable by cancer subtype. There were no statistically significant interactions by age group (Pinteraction=0.05) or sex (Pinteraction=0.71). Despite non-significant differences in cancer-specific survival improvement across different races and ethnicities (Pinteraction=0.33) over the study period, minorities consistently experienced inferior survival compared with non-Hispanic Whites.ConclusionsThe substantial improvements in cancer-specific survival for childhood and adolescent cancer did not differ significantly by different age, sex, and race/ethnicity groups. However, persistent gaps in survival between minorities and non-Hispanic Whites are noteworthy. |
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| Keywords: | Healthcare disparities Pediatric Adolescent Neoplasm Survival |
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