Racial/Ethnic Patterns of Morbidity and Mortality Among Childhood Cancer Survivors
An analysis in the Childhood Cancer Survivor Study cohort reported by Liu et al in the Journal of Clinical Oncology indicated that differences in risk for poor outcomes among black, Hispanic, and white survivors of childhood cancer were generally mediated by differences in socioeconomic status and cardiovascular risk factors.
Study Details
The study included data from 694 black, 750 Hispanic, and 12,397 white 5-year survivors of childhood cancer. At baseline, black and Hispanic patients had a lower socioeconomic status and a higher prevalence of obesity, and black patients had a higher prevalence of hypertension.
Differences in Outcome
Black patients had higher all-cause mortality than white patients (relative rate [RR] = 1.4, P = .008). The difference was no longer significant after adjustment for socioeconomic status (RR = 1.0, P = .9).
Nonmelanoma skin cancer was not observed among black patients receiving radiotherapy; Hispanic patients were at lower risk than white patients (RR = 0.3, 95% confidence interval [CI] = 0.1–0.7). Black and Hispanic patients had an increased risk for diabetes, with the increased risk persisting after adjustment for socioeconomic status and obesity (RRs = 2.8, 95% CI = 1.1–6.7, among black patients, and 3.1, 95% CI = 1.5–6.4, among Hispanic patients). Black patients were more likely than white patients to report cardiac conditions (RR = 1.8, P = .01), but the difference was reduced after adjustment for socioeconomic status and cardiovascular risk factors (RR = 1.5, P = .08).
Therapeutic exposures did not affect racial/ethnic differences in all-cause or cancer-specific mortality, chronic health conditions, or subsequent neoplasms.
The investigators concluded: “By and large, [non-Hispanic black] and Hispanic childhood cancer survivors experience a comparable burden of morbidity and mortality to their [non-Hispanic white] counterparts. The few differences in risk were explained by the racial/ethnic differences in socioeconomic status and/or cardiovascular risk factors.”
The study was supported by the National Cancer Institute and American Lebanese–Syrian Associated Charities.
Smita Bhatia, MD, MPH, of the University of Alabama at Birmingham, is the corresponding author of the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
