Survival trends for children and young adults with cancer have improved over the years in the United States, with 5-year overall survival rates reaching 90% in 2017, according to comprehensive findings for U.S. childhood cancer survival statistics published in the Journal of the National Cancer Institute. However, survival disparities persist by race and ethnicity across several cancer types.
“Our study shows that childhood cancer is one of modern medicine’s greatest success stories,” said lead author Lindsay Schwartz, MD, MS, a pediatric oncologist at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “Molecularly targeted agents and immunotherapies have increasingly been integrated into treatment and may have improved survival among young patients not cured with conventional chemotherapy while reducing late mortality from toxic treatments. Survival gains also likely have been driven by advances in precision diagnostics, risk stratification, and inclusive cooperative group trials. Our findings, however, also point to where children and families still need us to do better.”
Study Methods
Researchers looked at survival trends for children and adolescents with cancer in the United States between 1975 and 2022 to update outcome statistics and highlight disparities in trends to help guide future research.
They used the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 8 and 17 databases to find data for patients who were diagnosed at ages 0 to 19 years. Overall survival was stratified by race, ethnicity, diagnosis, and population density.
Key Findings
Between the two databases, they found 152,275 children and young adults diagnosed with cancer in the time period. Five-year overall survival rates across all cancers were 60% (95% confidence interval [CI] = 56%–64%) in 1975 and 90% (95% CI = 88%–91%) in 2017.
Improvements in survival trends were greatest for acute lymphoblastic leukemia (43% in 1975 to 95% in 2017), with more modest improvements across solid tumors.
“For acute myeloid leukemia, sarcomas, and high-risk neuroblastoma, children still need new and better treatments, and research on them should be a priority,” said Dr. Schwartz. The overall survival rate for patients with acute myeloid leukemia is still about 72%, while it holds at about 74% for sarcomas.
Differences in survival trends were seen by race and ethnicity (P < .001). Non-Hispanic Black patients experienced the lowest 5-year overall survival rates for multiple cancers, even after rates were adjusted for age and decade of diagnosis.
Across all cancer types combines, 5-year survival rates were 88% for non-Hispanic White patients, 84.5% for Hispanic patients, 85.6% for patients of other races and ethnicities, and 80.8% for non-Hispanic Black patients.
Mortality beyond 20 years was maintained for some cancers such as Hodgkin lymphoma. Young people who were previously treated for Hodgkin lymphoma tended to die at higher rates 20 to 30 years after their cancer was cured, often due to long-term treatment effects. Hodgkin lymphoma had an 87% survival rate for patients treated in the 1970s and early 1980s at 5 years after their diagnosis, but 30 years after their diagnosis, the rate was 63%.
“Families and doctors should know that lifelong follow-up care after cancer matters, including screening for second cancers and heart problems,” stressed Dr. Schwartz. “Collectively, our findings underscore the need for continued progress not only in developing effective and less toxic therapies but also in ensuring these advances are accessible to every child and adolescent with cancer.”
The study authors stressed that understanding the drivers of such disparities is essential for achieving equitable outcomes for all young patients with cancer. “We still need to learn why survival gaps persist,” Dr. Schwartz said. “The reasons for these gaps are probably a mix of factors—access to care, insurance, where families live, how the cancer itself behaves biologically and treatment side effects. Learning which of these matters most is key to making sure every child benefits from medical advances.”
DISCLOSURES: This work was supported by the National Cancer Institute at the National Institutes of Health (NIH), the National Center for Advancing Translational Sciences at the NIH, the U.S. Department of Defense, Alex’s Lemonade Stand Foundation, and the National Clinical Trials Network Operations Center Grant for the Children’s Oncology Group. For full disclosures of the study authors, visit academic.oup.com.
