After Childhood Cancer, Racial Minorities Face Worse Outcomes

Megan Brooks

June 30, 2022

Childhood cancer survivors from racial minority groups face disproportionately increased risks for hospitalization for various physical and mental health conditions, new research shows.

"Racial and ethnic minority survivors of childhood cancer may have increased long-term disease burden and a range of conditions that require hospitalizations and compound medical costs, shorten life expectancy, and decrease quality of life," the study team writes.

"Work needs to be done to ensure that all children with cancer receive optimal care to reduce and prevent adverse outcomes," first author Marc Emerson, PhD, MPH, from 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 Open

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

To better understand possible disparities, the researchers evaluated data on 4222 children diagnosed with cancer before age 20 from the period 1987-2012. Leukemia was the most common malignancy. Roughly 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 all racial and ethnic groups. However, compared with 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 among Black children (HR, 1.5) at least 5 years after diagnosis.

The data also suggest that Hispanic children may experience greater hospitalization in the first 5 years after diagnosis, whereas American Indian and Alaska Native and Black children are more likely to experience greater hospitalization after that point.

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

Hispanic children had an increased risk for hospitalization as a result of infection (HR, 1.4), endocrine (HR, 1.3), hematologic (HR, 1.3), respiratory (HR, 1.3), and digestive (HR, 1.2) conditions.

American Indian and Alaskan Native childhood cancer survivors were at an elevated risk for infection (HR, 2.3), hematologic (HR, 3.0), and digestive (HR, 2.6) conditions.

When looking at cause-specific hospitalizations and deaths, some groups did demonstrate elevated risks for mortality. For instance, among survivors at 5 years or longer, both American Indian and Alaska Native (HR, 3.6) and Black (HR, 2.5) children had increased mental health-related hospitalizations and death.

This study helps expand our knowledge of outcomes among childhood cancer survivors by race and ethnicity, and in particular for American Indian and Alaska Native children, a group rarely examined, Emerson noted.

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

The findings "underscore the long-term needs of racial and ethnic minority survivors and need for attention from healthcare practitioners to monitor survivors' status and inform appropriate interventions," they say.

Support for the study was provided by the Alex's Lemonade Stand Foundation for Childhood Cancer; the Surveillance, Epidemiology, and End Results Program (SEER) of the National Cancer Institute; 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. Full text

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