Racial minorities face worse outcomes after childhood cancer

Pediatric cancer survivors from racial minority groups are at a disproportionately increased risk of hospitalization for a variety of physical and mental health conditions, new research shows.

“Racial and ethnic minority survivors of childhood cancer may have an increased long-term burden of disease and a range of conditions that require hospitalization and higher medical costs, shorten life expectancy and impair quality of life,” the research team writes.

“Work needs to be done to ensure all children with cancer receive optimal care to reduce and prevent adverse outcomes,” first author Marc Emerson, PhD, MPH, of the Gillings School of Global Public Health, University of North Carolina , Chapel Hill, told Medscape Medical News

The study was published online June 28 in JAMA network opened

Although childhood cancer survivors are hospitalized more often than those without a cancer history, there is limited data on the role race and ethnicity may play in long-term outcomes in survivors.

To better understand possible differences, the researchers reviewed data on 4,222 children diagnosed with cancer before age 20, from the period 1987-2012. Leukemia was the most common malignancy. About half (52%) of the children were male; 76% were non-Hispanic White, 9% Hispanic, 7% Asian, 5% Black, and 3% American Indian and Alaska Native.

Emerson and colleagues found that mortality was similar across racial and ethnic groups. Compared to non-Hispanic white childhood cancer survivors, hospitalization was 70% more common for American Indian and Alaska Native children (hazard ratio [HR]1.7) and 50% more common in black children (HR, 1.5) at least 5 years after diagnosis.

The data also suggests Hispanic children require more hospitalizations in the first 5 years after diagnosis, while American Indians and Alaskan Native and Black children are more likely to be hospitalized more often thereafter.

The pattern of cause-specific hospitalizations also varied by race.

Hispanic children had an increased risk of hospitalization due to infection (HR, 1.4), endocrine (HR, 1.3), haematological (HR, 1.3), respiratory (HR, 1.3) and digestive (HR, 1.2) disorders.

Childhood cancer survivors in American Indian and Alaskan Native Americans were at increased risk of infection (HR, 2.3), hematologic (HR, 3.0) and digestive disease (HR, 2.6).

When looking at cause-specific hospitalizations and deaths, some groups showed increased risks of death. For example, among survivors aged 5 or more, American Indian as well as Alaska Native (HR, 3.6) and Black (HR, 2.5) children had increased rates of mental health-related hospitalizations and deaths.

This study helps expand our understanding of the outcomes in childhood cancer survivors by race and ethnicity, and in particular for American Indian and Alaska Native children, a group that is rarely studied, Emerson noted.

With an estimated 483,000 childhood cancer survivors in the United States, and more children likely to survive in the coming years due to advances in therapies, these new data become particularly relevant.

The findings “underscore the long-term needs of racial and ethnic minority survivors and the need for attention from health care providers to monitor survivors’ status and inform appropriate interventions,” they say.

The study was supported by the Alex’s Lemonade Stand Foundation for Childhood Cancer; the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER); Fred Hutchinson Cancer Research Center; and the Centers for Disease Control and Prevention. The authors reported no relevant financial relationships.

JAMA Netw Open. Published online June 28, 2022. Entire text

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