Advances and disparities in survival of childhood and adolescent cancers.

The incidence of childhood, adolescent, and young adult (AYA) cancers have been increasing since 1975.[1][1] In 2014, an estimated 10 450 and 5330 new cancers will be diagnosed among children aged birth–14 and adolescents aged 15 to 19 years old, respectively.[2][2] For young adults aged 20 to 34

The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute reports cancer incidence, prevalence, and survival from selected geographic areas of the United States (1). However, estimates of the incidence of secondary cancers among SEER childhood cancer survivors could be invalidated by outmigration because cancer diagnoses for persons residing outside SEER catchment areas are not reportable (2,3). Outmigration bias has not previously been assessed (4). We, therefore, report results from the first study, to our knowledge, of underascertainment in SEER incidence rates for second primary cancers (SPCs) in survivors of childhood or adolescent cancer, a population in which change of residence could be frequent. Data on SPCs in 5-year childhood cancer survivors were obtained from SEER 9 Registries Database Nov 2010 Sub (1973–2008) (1) and the Childhood Cancer Survivor Study (CCSS), an ongoing cohort of survivors identified in 26 North American medical centers between 1970 and 1986 with 85% complete follow-up (5). We included individuals who were diagnosed with an International Childhood Cancer Classification (ICCC) malignancy before age 20 years and who were alive 5 years after the diagnosis of the first cancer (6). SPC in CCSS was the first SEER-reportable primary malignancy subsequent to a childhood cancer. SEER included SPC diagnoses occurring before 2009; CCSS before 2010. Because of differences in the characteristics of the SEER- and CCSS-eligible populations (Table 1), we matched each childhood cancer survivor in SEER to an individual in CCSS based on sex, birth year, age at diagnosis, and first primary cancer diagnosis using the 12 major ICCC categories. SEER survivors without an exact match were excluded. Where multiple matches were possible, one pairing was randomly selected. Table 1. Summary characteristics of 5-year childhood cancer survivor cohorts before and after matching Underascertainment bias was assessed in the matched data set by computing the SPC incidence ratio (IR) as the ratio of the total number of SEER SPC cases to total person-years divided by the ratio of total number of CCSS SPC cases to total person-years. Person-years were calculated as the time from first primary diagnosis to the development of SPC, death, or end of follow-up (December 31, 2008), assuming no loss to follow-up. We also computed the incidence ratio for all-cause mortality, an endpoint that should not be affected by outmigration because mortality data are obtained from the National Death Index. Bootstrap resampling was used to obtain 95% confidence intervals (CIs) for the incidence ratios. SEER reported 7967 5-year childhood cancer survivors whose first cancer was diagnosed before 1987, and CCSS reported 13 771 such individuals. Based on sex, birth year, age at diagnosis, and type of diagnosis, 5604 exact matches were found in the CCSS cohort. There were 422 SPCs among the matched SEER survivors. We found statistically significantly higher incidence of SPCs in SEER survivors than among their CCSS matches (IR = 1.15, 95% CI = 1.06 to 1.27). The incidence ratio was unchanged when Canadians (n = 1017 individuals) were excluded from the analysis (IR = 1.13, 95% CI = 1.04 to 1.24). When we additionally matched on first course radiation treatment and geographic region (San Francisco, Atlanta, Seattle), SPC incidence remained statistically significantly higher in SEER than in CCSS (IR = 1.24, 95% CI = 1.02 to 2.81). We could not determine if this elevated risk was due to differences in childhood cancer treatment between SEER and CCSS survivors, as SEER collects only limited information about the first course of treatment. In contrast to SPC rates, the rates of all-cause mortality were not statistically significantly different between these groups (IR = 0.71, 95% CI = 0.54 to 1.03). In a matched comparison of long-term childhood cancer survivors in SEER and the CCSS cohort, a large sample of survivors treated at North American academic medical centers, we found no evidence of an outmigration bias in the incidence of SPCs in SEER.

Background: Curative therapy places childhood cancer survivors at increased risk of second primary malignancies (SPMs). However, there have been few population-based attempts to characterize differences in outcomes between SPMs in childhood cancer survivors and comparable de novo first primary malignancies (FPMs). Methods: We extracted clinical and demographic information from childhood cancer survivors who developed SPMs and from individuals with comparable de novo FPMs using the Surveillance, Epidemiology, and End Results (SEER) 1973-2015 database. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated with Cox proportional hazards models comparing overall survival (OS) between individuals with and without a history of childhood cancer. OS was evaluated overall and within specific cancers diagnosed in ≥50 childhood cancer survivors. Models accounted for potential confounders, including sex, race, age, decade of diagnosis, histology, and disease stage. Results: Compared to individuals with FPMs (n=1,332,203), childhood cancer survivor with a similar SPM as the FPMs (n=1,409) experienced poorer OS (HR=1.86, 95%CI: 1.72-2.02) after accounting for age, sex, race, and decade of diagnosis. Estimated five-year overall survival for SPMs diagnosed in survivors of childhood cancer was 61.7% (95% CI: 58.9-64.4), compared to 77.4% (95% CI: 75.0-79.5) among de novo FPMs propensity score-matched on confounding factors. A history of childhood cancer remained a poor prognostic factor for all specific cancer evaluated, including: breast (HR=2.07, 95%CI: 1.63-2.62), thyroid (HR=3.59, 95%CI: 2.08-6.19), acute myeloid leukemia (HR=2.38, 95%CI:1.87-3.05), brain (HR=2.09, 95%CI:1.72-2.55), melanoma (HR=2.57, 95%CI: 1.55-4.27), bone (HR=1.88, 95%CI:1.37-2.57), and soft tissue sarcoma (HR=2.44, 95%CI: 1.78-3.33). Survival disparities were most pronounced in survivors diagnosed with a childhood cancer before age 10 (HR=2.83, 95%CI: 2.46-3.25), diagnosed with a SPM within 10 years of the childhood cancer (HR=2.61, 95%CI: 2.29-2.99), and exposed to radiotherapy during childhood (HR=2.13, 95%CI: 1.92-2.37). Conclusion: Compared to individuals without a prior cancer diagnosis, survivors of childhood cancer with a SPM experience inferior outcomes. These survival disparities persist across cancer types, therapeutic exposures, and clinical factors. Citation Format: Austin L. Brown, Vidal M. Arroyo, Jennifer Agrusa, Michael E. Scheurer, Maria M. Gramatges, Philip J. Lupo. Survival disparities for second primary malignancies diagnosed among childhood cancer survivors: A population-based assessment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3287.

Background: Curative therapy places childhood cancer survivors at increased risk of second primary malignancies (SPMs). However, there have been few population-based attempts to characterize differences in outcomes between SPMs in childhood cancer survivors and comparable de novo first primary malignancies (FPMs). Methods: We extracted clinical and demographic information from childhood cancer survivors who developed SPMs and from individuals with comparable de novo FPMs using the Surveillance, Epidemiology, and End Results (SEER) 1973-2015 database. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated with Cox proportional hazards models comparing overall survival (OS) between individuals with and without a history of childhood cancer. OS was evaluated overall and within specific cancers diagnosed in ≥50 childhood cancer survivors. Models accounted for potential confounders, including sex, race, age, decade of diagnosis, histology, and disease stage. Results: Compared to individuals with FPMs (n=1,332,203), childhood cancer survivor with a similar SPM as the FPMs (n=1,409) experienced poorer OS (HR=1.86, 95%CI: 1.72-2.02) after accounting for age, sex, race, and decade of diagnosis. Estimated five-year overall survival for SPMs diagnosed in survivors of childhood cancer was 61.7% (95% CI: 58.9-64.4), compared to 77.4% (95% CI: 75.0-79.5) among de novo FPMs propensity score-matched on confounding factors. A history of childhood cancer remained a poor prognostic factor for all specific cancer evaluated, including: breast (HR=2.07, 95%CI: 1.63-2.62), thyroid (HR=3.59, 95%CI: 2.08-6.19), acute myeloid leukemia (HR=2.38, 95%CI:1.87-3.05), brain (HR=2.09, 95%CI:1.72-2.55), melanoma (HR=2.57, 95%CI: 1.55-4.27), bone (HR=1.88, 95%CI:1.37-2.57), and soft tissue sarcoma (HR=2.44, 95%CI: 1.78-3.33). Survival disparities were most pronounced in survivors diagnosed with a childhood cancer before age 10 (HR=2.83, 95%CI: 2.46-3.25), diagnosed with a SPM within 10 years of the childhood cancer (HR=2.61, 95%CI: 2.29-2.99), and exposed to radiotherapy during childhood (HR=2.13, 95%CI: 1.92-2.37). Conclusion: Compared to individuals without a prior cancer diagnosis, survivors of childhood cancer with a SPM experience inferior outcomes. These survival disparities persist across cancer types, therapeutic exposures, and clinical factors. Citation Format: Austin L. Brown, Vidal M. Arroyo, Jennifer Agrusa, Michael E. Scheurer, Maria M. Gramatges, Philip J. Lupo. Survival disparities for second primary malignancies diagnosed among childhood cancer survivors: A population-based assessment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3287.

Purpose: Racial disparities in survival persist in patients with early-stage non-small cell lung cancer (NSCLC). Possible contributors to these disparities are stage at diagnosis, comorbidities, and socioeconomic factors. The goal of this study is to compare differences in survival between black and white patients from veteran and non-veteran populations, while accounting for treatment. Methods: Black and white men aged ≥65 years diagnosed with stage I NSCLC from 2001-2009 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and Veterans Affairs (VA) cancer registry. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for differences between black and white patients in postoperative mortality among surgery patients, 5-year overall survival (OS), and lung cancer specific survival (LCSS). Results: There were 8,744 and 7,895 patients in the SEER and VA cohorts, respectively. Overall, black patients were less likely to be treated than white patients (74% vs 85% in SEER, p<0.0001; 69% vs 77% in VA, p<0.0001), and among treated patients, to receive surgery only (47% vs 62% in SEER, p<0.0001; 55% vs 62%, p=0.0007 in VA). OS was worse for black compared to white patients after adjustment for demographic and clinical factors (HR: 1.17, 95% CI: 1.06-1.30 in SEER; HR: 1.08, 95% CI: 1.00-1.16 in VA). However, there was no difference in OS when also adjusting for treatment (HR: 0.99, 95% CI: 0.89-1.09 in SEER; HR: 0.97, 95% CI: 0.91-1.05 in VA). For LCSS, the HRs for black vs. white patients were 1.21 (95% CI 1.07-1.37) in SEER and 1.06 (95% CI 0.96-1.17) in VA, when adjusting for demographic and clinical factors. LCSS HRs were not statistically significant in either cohort when also adjusting for treatment (HR: 0.99, 95% CI: 0.87-1.12 in SEER; HR: 0.93, 95% CI: 0.85-1.02 in VA). Similar results were obtained when analyses were restricted to patients receiving treatment, accounting for treatment modality. Among patients receiving surgery only, adjusted OS was similar across races (HR: 1.11, 95% CI: 0.91-1.36 in SEER; HR: 1.08, 95% CI: 0.95-1.23 in VA). There was no significant difference in postoperative 30-day survival in black vs. white patients (HR: 1.57, 95% CI: 0.99-2.49 in SEER; HR: 1.10, 95% CI: 0.71-1.70 in VA), nor in postoperative 90 day survival (HR: 1.28, 95% CI: 0.87-1.89 in SEER; HR: 0.90, 95% CI: 0.63-1.29 in VA). Conclusion: Among older stage I NSCLC patients, no significant racial differences in overall or lung cancer survival were detected in VA or SEER cohorts when accounting for treatment, despite observing racial differences in receipt of treatment in both populations. This suggests that survival disparities are significantly reduced when black and white patients receive similar treatment, even in populations covered by different health care systems. Effort to facilitate stage appropriate treatment in minority patients should be initiated. Citation Format: Naomi D. Alpert, Christina D. Williams, Thomas Redding, A. Jasmine Bullard, Raja Flores, Emanuela Taioli. Racial differences in survival among veterans and nonveteran populations with stage I non-small cell lung cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B007.

Rural-Urban and Racial Trends in Survival of Patients with Multiple Myeloma: 1975-2019 Surveillance, Epidemiology, and End Results (SEER) Analysis

Enrollment Characteristics and Outcomes of Hispanic and Black AYA ALL Patients Enrolled on a U.S. Intergroup Clinical Trial: A Comparison of the CALGB 10403 (Alliance) Cohort with U.S. Population-Level Data

Pineoblastoma: prognostic factors and survival outcomes in young children.

e18529 Background: Acute lymphoblastic leukemia (ALL) in the pediatric population has a 5-year overall survival that exceeds 90%, however, the survival rate drops significantly in the adolescent and young adult (AYA) population. 80% of ALL-related deaths occur in AYA patients, despite AYA patients representing less than one-fourth of total ALL cases. In addition, there is an increasing incidence of ALL among minority AYAs in the United States. Although worse survival in Hispanic and non-Hispanic Black ALL patients have been reported, there is paucity of data on the AYA population specifically. In this study, we sought to investigate the impact of racial/ethnic and sociodemographic disparities on recent overall survival of adolescent and young adult patients with ALL, using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: The SEER database was utilized to extract data on patients with a histological diagnosis of ALL between 2000-2021. Patients between the ages of 15-39 were included in our AYA cohort, as defined by the National Cancer Institute. Our primary outcome of interest was overall survival (OS), defined as the time from ALL diagnosis to death from any cause. Kaplan-Meier methods were used to estimate 5-year survival rates. Cox proportional hazards regression was used for multi-variable modelling of the survival database. The difference between the observed number of events between each group was compared using a log-rank statistical test and hazard ratios reflecting 5-year OS between groups. Results: Our data captured 6,655 AYA patients with ALL from 2000 to 2021. Races were categorized into non-Hispanic Black (n=439, 6.6%), non-Hispanic White (n=2517, 37.8%), Hispanic (n=3076, 46.2%), non-Hispanic Asian or Pacific Islander (NHAPI) (n=551, 8.3%), and non-Hispanic American Indian/Alaska Native (NHAIAN) (n=72, 1.1%). The estimated 5-year OS was 64% for non-Hispanic White patients, 65% for NHAPI, 51% for NHAIAN, 56% for Hispanic, and 50.5% for non-Hispanic Black patients. Compared to non-Hispanic White patients, a statistically significant worse overall survival was seen in non-Hispanic Black patients [HR 1.6 (95% CI 1.38-1.9, p<0.001)] and Hispanic patients [HR 1.4 (95% CI 1.31-1.5, p<0.001)]. There were no statistically significant differences in OS when stratified by income, gender, or urban vs rural location. Conclusions: From 2000 to 2021, race among AYA ALL predicted worse overall survival in Black and Hispanic AYA patients. It is important to better understand the disparities that impact the AYA population, whom may be particularly vulnerable to social factors impacting their care.

What Should the Age Range Be for AYA Oncology?

Survival trends provide a measure of improvement in detection and treatment over time. In the current study, updated childhood and adolescent cancer survival statistics are presented, overall and among demographic subgroups, including Hispanics, for whom to the authors' knowledge national rates have not been previously reported. These results extend those provided by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program in their detail and interpretation. Survival trends of primary cancers in children and adolescents (ages birth to 19 years) were evaluated using SEER 9 data. Five-year and 10-year relative survival rates across 5-year (1975-1979, 1985-1989, and 1995-1999) and 10-year (1975-1984 and 1985-1994) cohorts were compared via Z-tests. Annual percent change (APC) in survival was computed via weighted least-squares regression. Rates in Hispanic children and adolescents were compared with those in non-Hispanic whites and blacks (SEER 13, 1995-1999). Five-year survival rates increased significantly overall (1975-1979: 63% vs 1995-1999: 79%; P< .0001) and for nearly all histologic types examined; increases were greatest for ependymoma (+37%; P< .0001) and non-Hodgkin lymphoma (+34%; P< .0001). Hispanic children and adolescents had somewhat poorer 5-year rates than non-Hispanic whites overall (74% vs 81%; P< .0001) and for Ewing sarcoma, leukemia, central nervous system tumors, and melanoma. Ten-year rates also increased significantly overall (1975-1984: 61% vs 1985-1994: 72%; P< .0001) and for a majority of cancer types. The largest improvements were noted for acute lymphoblastic leukemia (+19%; P< .0001) and non-Hodgkin lymphoma (+19%; P< .0001). Observed trends reinforce the need for resources devoted to advancing treatment modalities, reducing disparities among racial/ethnic groups and adolescents, and providing long-term care of survivors.

e19056 Background: Cutaneous T-cell lymphoma (CTCL), including mycosis fungoides (MF) and Sézary syndrome (SS), exhibits survival disparities by race and sex. Although delayed diagnosis has been implicated in poorer outcomes among Black patients, earlier onset and worse survival suggests additional biological and systemic contributors. This study aimed to analyze epidemiological trends in overall survival (OS) and disease-specific survival (DSS) among MF and SS patients. Methods: The Surveillance, Epidemiology, and End Results (SEER) 8 registries database (1975–2021) was analyzed to identify MF and SS cases. Outcomes, including OS and DSS, were stratified by race and sex, and survival trends were evaluated. Kaplan-Meier methods were used to calculate age-adjusted OS and DSS, stratified by race (Non-Hispanic White [NHW], Non-Hispanic Black [NHB], Hispanic) and sex. SEER 22 database (2000-2021) was used for further validation. Statistical significance was defined as p&lt;0.05. Results: 5330 MF and 193 SS patients were analyzed. Median age at diagnosis for MF and SS were 69 and 60 years. MF and SS were more common in males (MF: 59.5% male vs. 40.5% female; SS: 60.6% male vs. 39.4% female) and White (MF: 76.3% White vs. 23.7% other races; SS: 80.8% White vs. 19.2% other races). For MF, Black patients peaked in the 41–60 age range, while White patients peaked in the 61–70 age range. In SS, Black patients were more evenly distributed across midlife and older groups (31–80), while White patients peaked in the 71–80 range. For MF, the 5-year OS was 74.1% (95% CI: 72.5%–75.5%) and the DSS was 87.2% (95% CI: 85.9%–88.4%). NHW patients had better 5-year OS and DSS compared to NHB patients (OS: 74.6% [95% CI: 72.8%–76.3%] vs. 61.8% [95% CI: 55.2%–67.7%]; DSS: 86.9% [95% CI: 85.3%-88.3%] vs. 78.9% [95% CI: 71.5%-84.5%], respectively). Females had higher OS but similar DSS to males. For SS, the 5-year OS was 42.1% (95% CI: 33.6%–50.2%) and DSS was 53.4% (95% CI: 43.9%–62.1%). NHB males had the poorest outcomes compared to NHW male patients, with a 5-year OS of 25.9% vs. 39.6% and a 5-year DSS of 29.6% vs 51.4%. With SEER 22, we further confirmed significantly lower OS and DSS in Black male patients, especially those over 60. For MF, DSS improved after the late 1990s, reflecting advances like interferon and Bexarotene, with the most notable gains in 5-year DSS observed after 2010. For SS, OS and DSS have significantly increased since 2010, likely due to introduction of targeted therapies like mogamulizumab. Conclusions: This study highlights racial and sex-based survival disparities in MF and SS, with NHB males facing worse outcomes. We hypothesize that variations in the genetic landscape across races contribute to outcome differences. Our future research will incorporate institutional data and cancer somatic mutation data to explore the causes and develop targeted interventions to reduce disparities in underserved populations.

Socioeconomic Disadvantage Is Associated with Decreased Long-Term Survival in Adolescent and Young Adult Patients with Acute Lymphoblastic Leukemia

Hematology-Oncology| October 01 2001 Late Mortality in Childhood Cancer: Time to Count Our Chips AAP Grand Rounds (2001) 6 (4): 40–41. https://doi.org/10.1542/gr.6-4-40 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Late Mortality in Childhood Cancer: Time to Count Our Chips. AAP Grand Rounds October 2001; 6 (4): 40–41. https://doi.org/10.1542/gr.6-4-40 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: childhood cancer, cancer, survivors Sources: (1) Mertens AC,Yasui Y, Neglia JP, et al. Late mortality experience in five-year survivors of childhood and adolescent cancer: the Childhood Cancer Survivor Study. Clin Oncol. 2001;19:3163–3172. (2) Möller TR, Garwicz S, Barlow L, et al. Decreasing late mortality among five-year survivors of cancer in childhood and adolescence: a population-based study in the Nordic countries. J Clin Oncol. 2001;19:3173–3181. Survivors of childhood and adolescent cancer remain at risk for a shortened life span because of the possible long-term sequelae of cancer therapy and recurrence of the primary malignancy. These 2 excellent reports, a multi-institutional study from The Childhood Cancer Survivor Study (CCSS) in the US, and a population-based study in 5 Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden), are the largest studies to date evaluating long-term survivors of childhood cancer. The purpose of both retrospective studies was to assess the risk of death among childhood and adolescent cancer survivors. The CCSS was a retrospectivecohort study initiated in 1994 and designed to study late effects among long-term survivors of childhood cancer. The study population consisted of a cohort of 20,227 patients who were less than 21 years of age when diagnosed with cancer between 1970 and 1986 and who survived at least 5 years beyond the date of diagnosis. Standardized mortality ratios (SMRs) were calculated based on 208,947 person-years of follow-up in this population. The cumulative mortality was 6.4% at 10 years from diagnosis, 9.3% at 15 years, 11.4% at 20 years, and 14.0% at 25 years: a 10.8-fold increase in mortality rate when compared to the general population. Female gender, diagnosis before 5 years of age, and the diagnosis of leukemia or brain tumor were associated with a statistically significant higher mortality. Causes of death, in order of frequency, included recurrence of original disease accounting for 67% of deaths, treatment-related second malignancies (SMR 19.4), organ toxicity (such as cardiac [SMR 8.2], pulmonary [SMR 9.2], etc.) and others (SMR 3.3). As noted above, there was a 19-fold increased risk of death secondary to treatment-related second malignancy in this population relative to the risk of malignancy in the general population. No excess mortality was observed for non-cancer-related causes (motor vehicle accidents, suicide, or AIDS). Patients with a diagnosis of kidney tumor and neuroblastoma had the best overall survival, while those with CNS tumors had the poorest. The population-based Nordic study included data from the nationwide cancer registries of 5 countries. The study cohort included 13,711 patients who were diagnosed with cancer before the age of 20years between 1960 and 1989 and who survived at least 5 years from diagnosis. The estimated overall mortality for the 5-year survivors was .10 at 15 years after diagnosis (expected mortality rate .01) and .14at 25 years after diagnosis (expected mortality rate .02). Unlike the CCSS study, higher mortality rates were observed among males and patients diagnosed after the first 5 years of life. The overall SMRs for validated causes of death based on 156,046... You do not currently have access to this content.

Enteropathy-associated T-cell lymphoma in the US: higher incidence and poorer survival among Asians.