Hispanic children with high-risk neuroblastoma have worse survival outcomes
Click Here to Manage Email Alerts
Hispanic children with high-risk neuroblastoma had worse survival outcomes than other children with the disease despite receiving treatment on clinical trials with standardized protocols, according to study results.
Researchers observed the disparities even after controlling for disease-related factors.
The findings, scheduled for presentation at ASCO Annual Meeting, also showed poorer 5-year OS rates among those with public vs. private insurance.
“We acknowledge that simply describing disparities is not enough,” Puja J. Umaretiya, MD, clinical fellow in pediatric hematology/oncology at Dana-Farber Cancer Institute and Boston Children's Hospital, said during a press briefing Thursday ahead of the annual meeting, which opens June 3. “We must identify mechanisms that cause inequitable outcomes.”
Background and methods
Previous studies have shown Black children with neuroblastoma are more likely than their white counterparts to experience late relapse, and that children who lack public insurance have a higher likelihood of relapse and death on immunotherapy clinical trials, Umaretiya said.
“The causes of these racial and socioeconomic disparities remain unknown, and clinical trials are the ideal setting in which to study this because the care children receive on trials is highly standardized,” she added.
The retrospective cohort study included 696 children (69% white, 16% Black, 11% Hispanic, 4% other non-Hispanic) with high-risk neuroblastoma enrolled on Children’s Oncology Group clinical trials between 2007 and 2016. One-third had household poverty exposure, defined as those who had public insurance only; 26% lived in high-poverty areas based on ZIP codes and 15% resided in rural areas.
The researchers had two aims: to identify associations of race, ethnicity and socioeconomic status with survival outcomes and to evaluate the relationships of those patient factors with possible mechanisms for shorter survival, including early trial discontinuation, induction chemotherapy delays and disease relapse.
Key findings
Results showed lower 5-year OS rates among children who had household poverty exposure vs. other children (52.9% vs. 62.8%; P = .04) and those who lived in high-poverty ZIP codes vs. other children (53.8% vs. 61.7%; P = .05). Hispanic children had the lowest 5-year OS rate (47.1%), followed by other non-Hispanic children (50.4%), white children (61.3%) and Black children (62.5%). Researchers reported HRs for death of 1.78 for Hispanic children and 1.45 for other non-Hispanic children vs. white children after adjustment for disease factors associated with worse prognosis.
In their investigation of possible mechanisms for shorter OS, Umaretiya and colleagues found no significant differences among racial and ethnic groups in delays in therapy, early termination of trial participation or frequency of relapse.
“About half of patients relapsed regardless of race or ethnicity,” Umaretiya said.
Next steps
The researchers plan to examine the intersection of race, ethnicity and poverty, acknowledging the intersection of these factors in the U.S. because of structural racism, Umaretiya said.
“Our next steps will focus on the post-relapse period and specifically look at enrollment on early-phase trials as a proxy for access to life-extending therapy, as well as the causes of death, looking at whether these children die of disease of toxicity,” she said.
Perspective
Back to TopBrenton Francisco, MD
Despite extraordinary improvements in treatment over the last several decades, socioeconomic disparities have resulted in inferior overall survival outcomes in many childhood cancers. This study shows that this imbalance exists despite patients receiving standardized treatment on the same clinical trials with no difference in tumor stage and biology among racial and socioeconomic groups.
Further research, including prospective studies, will look to identify differences in therapy delivery, such as improved access to clinical trials for relapsed therapy, informed consent and delays in treatment, which may be ameliorated with targeted social assistance. The information from future studies in the high-risk neuroblastoma group would not only provide direction on how to eliminate gaps in outcomes in this patient population, but also inform multidisciplinary treatment strategies in other pediatric malignancies where disparities in outcomes related to socioeconomic status exist.
Perspective
Back to Top
Everett E. Vokes, MD
This is really important work. We do encourage patients to be enrolled on clinical trials, and that actually happened here. This is a cohort of patients where treatment was regimented through these clinical trials and it should have led to similar outcomes, but it didn’t. That, of course, leaves questions open.
We see discrepancies here in overall survival ... and they seem to correlate with socioeconomic factors and race. But the specific causes of increased death in those groups are not elucidated yet, and I think that will be important work moving forward. So, it is important to enroll in clinical trials, and then these trials allow us to go a step further to get into these kinds of analyses to further evaluate socioeconomic factors.
University of Chicago Medicine
Collapse
Umaretiya PJ, et al. Abstract 10005. Scheduled for presentation at: ASCO Annual Meeting; June 3-7, 2022; Chicago.
Click Here to Manage Email Alerts