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Pediatric Hodgkin’s lymphoma outcomes appear worse among black patients
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Black pediatric patients with Hodgkin’s lymphoma have inferior survival rates compared with white and Hispanic patients, according to results of a population-based analysis.
Further, patients in Florida appear to have worse outcomes compared with a national sample.
Although survival rates for pediatric Hodgkin’s lymphoma are favorable, with current 5-year survival at approximately 95%, racial and ethnic disparities persist in this population.
Joseph Panoff
“It appears that pediatric Hodgkin’s lymphoma patients in Florida have worse outcomes with regard to OS when compared with the rest of the country,” study researcher Joseph Panoff, MD, a radiation oncologist at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, told HemOnc Today. “The fact that African American patients had worse OS than whites or Hispanics is concordant with previous studies from other cancer histologies.”
To examine potential disparities across ethnicities, Panoff and colleagues evaluated the survival outcomes of pediatric and adolescent patients with Hodgkin’s lymphoma diagnosed and treated in Florida between 1981 and 2010 using the Florida Cancer Data System. They then validated these findings using 1983 to 2010 data from the SEER database.
The analysis included data from 1,778 patients from the Florida cohort and 6,027 patients from the national cohort. The median age at diagnosis was 17 years (range, 0.1-21) for both cohorts.
The majority of both cohorts were non-Hispanic white (Florida, 67.7%; SEER, 70%), followed by Hispanic (Florida, 18%; SEER, 19%) and non-Hispanic black (Florida, 13%; SEER, 11%).
Five-year OS was 84.2% in the Florida cohort and 93.5% in the national cohort.
In the Florida cohort, black patients appeared to have worse OS than non-Hispanic white and Hispanic patients at all time points. Thirty-three percent (95% CI, 20-46) of black patients achieved 25-year OS compared with 49.1% (95% CI, 42-56) of white and 44.7% (95% CI, 27-61) of Hispanic (P = .0005) patients.
In a multivariate regression model, black race increased risk for mortality compared with being white (HR = 1.81; 95% CI, 1.32-2.5) and Hispanic (HR = 1.64; 95% CI, 1.07-2.51).
Adjusted analyses also showed male sex increased risk for mortality (HR = 1.76; 95% CI, 1.38-2.25).
In the SEER cohort, the rate of 25-year OS again appeared worse among black patients (74.2%) compared with white (82%) and Hispanic (82%; P = .0005) patients. A smaller proportion of black patients (85.7%) also achieved 25-year disease-specific survival compared with white (90.8%) and Hispanic (88.1%; P = .0002) patients.
A multivariate Cox regression analysis showed black race was independently associated with worse OS (HR = 1.64; 95% CI, 1.31-2.01) and disease-specific survival (HR = 1.24; 95% CI, 1.16-1.33).
Patient sex did not appear to influence 25-year OS and disease-specific survival outcomes in the SEER cohort. However, researchers also found a smaller proportion of Hispanic males achieved 25-year disease-specific survival than white males (84.8% vs. 90.6%; P = .0478).
The researchers noted several study limitations, including that the results were not adjusted for socioeconomic status, which has been negatively associated with pediatric cancer survival.
Also, researchers acknowledged misclassification of race or ethnicity is possible, especially among patients in the Hispanic group, and classifying patients to only one race or ethnicity for research purposes may not address the complexity of racial interactions on American health outcomes.
“This [racial/ethnic] disparity along with the worsened disease-specific survival for male Hispanic patients is likely due to sociocultural factors such as mistrust of the health care system and decreased access to care,” Panoff said. “However racial/ethnic tumor biology differences should not be excluded as a possible etiology.
“It will be interesting to evaluate whether the Affordable Health Care Act improves this racial and ethnic disparity over the next decade,” he added. – by Anthony SanFilippo
For more information:
Joseph Panoff , MD, can be reached at Department of Radiation Oncology, University of Miami, Suite 1500, 1475 NW 12 Ave., Miami, FL 33136; email: jpanoff@med.miami.edu.
Disclosure: The researchers reported no relevant financial disclosures.
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