Racial, socioeconomic factors associated with pediatric nasopharyngeal cancer diagnosis

Factors such as lower socioeconomic status, black race and rural residence appeared associated with an increased risk for a pediatric diagnosis of nasopharyngeal cancer, according to the results of a retrospective cohort study.

However, although pediatric patients appeared more likely to be diagnosed at an advanced disease stage, they had a lower mortality rate than adult patients, results showed.

Nasopharyngeal cancer is a rare condition in the Western world, affecting less than one in 1 million U.S. children, according to study background. Little is known about racial, demographic and biological characteristics of the disease in children.

Thus, Morgan K. Richards, MD, MPH, a pediatric surgeon at Seattle Children’s Hospital, and colleagues sought to observe the differences in disease among pediatric and adult patients, and to determine whether race influenced survival among children with nasopharyngeal cancer.

The researchers reviewed all diagnosed cases of nasopharyngeal cancer in the National Cancer Data Base between January 1998 and December 2011. They stratified patients based on pediatric (aged 21 years or younger) or adult (aged older than 21 years) age.

Adjustment factors included race, sex, income, education, insurance status, place of residence (urban vs. rural) and disease stage.

Richards and colleagues identified 17,317 U.S. patients diagnosed with nasopharyngeal cancer (pediatric, n = 699; adult, n = 16,618).

Black race predominated among pediatric patients (43.6%; n = 299), whereas adult patients most frequently tended to be non-Hispanic white (60%; n = 9,839; P < .001).

Further, pediatric patients appeared less likely to be Asian than adult patients (5.7% vs. 19.7%; P < .001).

Compared with adult patients, pediatric patients more commonly resided in rural areas (P = .01), in areas with lower median household income (P < .001) and in areas with lower educational achievement (P < .001).

Pediatric patients appeared more likely to have regional nodal evaluation (35.3% vs. 24%) and to present at stage IV than adult patients (58.4% vs. 47.8%; P < .001 for both).

However, despite these characteristics, adults patients experienced a higher mortality rate (HR = 0.37; 95% CI, 0.25-0.56).

Further, despite racial disparities in diagnosis, the researchers did not observe a difference in mortality by racial group among pediatric patients (HR = 1.1; 95% CI, 0.82-1.4).

The researchers acknowledged limitations of their study, including their inability to differentiate between disease-specific and all-cause mortality due to coding. Further, the researchers were unable to determine whether patients received treatment at adult or pediatric centers.

“Although uncommon, pediatric nasopharyngeal cancer appears to affect a different patient demographic relative to adult nasopharyngeal cancer,” Richards and colleagues wrote. “Nasopharyngeal carcinoma in children is associated with rural location, low socioeconomic status and more advanced disease at presentation. Despite these differences, pediatric nasopharyngeal cancer is associated with a lower mortality rate than adult disease.” – by Cameron Kelsall

Disclosure: The researchers report no relevant financial disclosures.