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Race, socioeconomic status, young age risk factors for early cancer death in children
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Children of a disadvantaged socioeconomic status, a minority race, aged younger than 1 year or who received specific diagnoses appeared more likely to die of cancer within a month of diagnosis than other children, study data showed.
“Childhood cancer outcomes have improved significantly over the past decades in the United States. However, there remains a group of children with cancer who do not survive long enough to start treatment, or they die early in the treatment process,” Adam L. Green, MD, assistant professor at the University of Colorado Anschutz Medical Campus, and colleagues wrote. “Although this group is relatively small, it represents a significant number of childhood cancer deaths, many of which may be preventable. The characteristics of these individuals and the reasons for their poor outcomes are not well understood.”
The researchers retrieved SEER 13 registry data on 36,337 patients diagnosed with cancer between 1992 and 2011, all aged zero to 19 years. Green and colleagues considered early death to be within 1 month of diagnosis. Researchers used census data from the year 2000 for data on socioeconomic status for each patient’s home county and estimated odds ratios for any association between early death and demographic, as well as clinical and socioeconomic factors.
Overall, 555 patients (1.5%) died within 1 month of diagnosis. Those who had acute myeloid leukemia, infant acute lymphoblastic leukemia, hepatoblastoma and malignant brain tumors showed the highest risk for early death.
Across all disease groups, multivariate analysis showed age younger than 1 year strongly predicted early death. Multiple disease groups showed black race and Hispanic ethnicity as predictors of early death.
Early death of hematologic malignancies occurred more often in children who lived in poverty(OR = 1.7; 95% CI, 1.32-2.19) and those who lived in counties where social disadvantages such as unemployment (OR = 1.35; 95% CI, 1.06-1.72) and language isolation (OR = 1.28; 95% CI, 1.01-1.63) were common.
The percentage of early deaths decreased over time. However, when researchers stratified analysis by tumor type, only hematologic malignancies showed a significant decrease (–3.5%; 95% CI, –0.57 to –1.3). Changes in early death rates in the solid tumor and CNS tumor groups did not achieve clinical significance.
“As advances through clinical and translational research continue to increase the percentage of children and adolescents with cancer who can be cured, we must readily address the underreported problem of early death and assure that all individuals have the opportunity to receive the best available treatments,” Green and colleagues wrote.
The researchers recommended a two-pronged approach: prospective registration studies and targeted initiatives that focused on specific risk groups “to make care more equitable for all children and adolescents with cancer.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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