Disparities in pediatric and adolescent cancer survival: A need for sustained commitment

Approximately 16,000 children and adolescents aged birth to 19 years are diagnosed with cancer annually in the United States. Among this age group, approximately 2000 deaths occur each year due to cancer. The 5-year survival rate for patients with pediatric and adolescent cancers has improved greatly over the last several decades from 63% in 1975 to 1979 to approximately 84% for those diagnosed in 2011. Unfortunately, survival disparities across most cancer types still are apparent for racial and/or ethnic minority and lower socioeconomic status (SES) groups. In a 2014 study using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program data, the authors reported that survival rates for those diagnosed between 2003 and 2009 among non-Hispanic Black versus White children aged birth to 14 years and adolescents aged 15 to 19 years were 75.3% versus 84.2% and 76.8% versus 85.9%, respectively. Children and adolescents of all other racial and/or ethnic minority groups also were found to have lower survival compared with non-Hispanic White individuals, with survival rates of 80.3% and 76.8%, respectively, for Hispanics; 78.3% and 80.4%, respectively, for Asian/Pacific Islanders; and 78.5% and 77.3%, respectively, for American Indian/Alaska Natives. Racial and/or ethnic disparities in survival also have been reported for many specific cancer subtypes. In addition, a systematic review focusing on SES and pediatric cancer survival demonstrated that for the majority of studies across low-income, middle-income, and high-income countries, lower SES was associated with worse survival. In this issue of Cancer, Siegel et al have reported the recent results of a US descriptive epidemiological analysis that sheds further light on the issue of racial and/or ethnic and SES-associated cancer survival disparities using data from the US National Vital Statistics System (NVSS) and the National Program of Cancer Registries (NPCR). The results from the current article by Siegel et al have provided additional insight into cancer disparities using complementary mortality and survival rate statistics and data from a larger population of US children and adolescents than covered by most prior studies, which commonly used Surveillance, Epidemiology, and End Results data, which covers up to 28% of the US population. For the mortality rate analyses, the authors included children and adolescents who were identified in the NVSS database as having died of cancer at age <20 years from 2002 through 2016 and reported mortality rates that were age-adjusted to the 2000 US standard population. The NVSS, which is administered by the Centers for Disease Control and Prevention, collects data regarding deaths based on death certificates from each state and the District of Columbia. The investigators examined mortality rate trends using joinpoint regression, which allows for different linear trends to occur within different time intervals during the study period (eg, a period of increasing mortality followed by a period of decreasing mortality). Changes in linear trends are marked by “joinpoints” and the average annual percentage change (AAPC) is estimated over the entire time period as well as the annual percentage change between joinpoints. The investigators obtained individual information regarding demographics (race and/or ethnicity, age group at the time of diagnosis, and sex) and county-level information to measure SES (rural and/or urban status, educational level, poverty as measured by percentage of families with incomes less than the federal poverty level, and median household income) from the 2012 to 2016 American Community Survey. They also examined mortality rates by US Census region (Northeast, Midwest, South, and West) and cancer type cause of death coded according to the International Classification of Diseases, Tenth Revision (ICD-10) codes.