Demographic factors of prognosis in pediatric neuroblastoma.

Abstract

10041 Background: Neuroblastoma is a rare type of pediatric tumor derived from neural crest progenitor cells. It can arise anywhere along the sympathetic chain but is most commonly found in the retroperitoneum from the adrenal glands. At diagnosis, approximately 50% of patients have hematogenous spread of metastases and so timely, aggressive treatment may be life-saving. The National Cancer Database (NCDB) is an oncology database that collects data from over 1500 cancer centers in the United States. This study will utilize the NCDB to analyze how demographic factors may impact prognosis in patients with pediatric neuroblastoma. Methods: We conducted a retrospective analysis using the National Cancer Database (NCDB) and identified patients diagnosed with pediatric neuroblastoma under the age of 18 between 2004-2020 with ICD code 9500/3 (n = 2323). Multivariate Cox regression analysis was used to calculate hazard ratios (HR) analyzing race, Spanish/Hispanic origin, facility type, education, income, insurance status, age at diagnosis, distance traveled to the facility, and urban characteristics of the facility on prognosis. Results: The median age at diagnosis was one year-old. Patients aged greater than one year-old composed 48% of the sample and had a less favorable prognosis compared to patients younger than one-year old (HR 1.99, 95% CI 1.69-2.35, p < 0.001). The median distance to the facility was 21.4 miles. 50% of the sample patients lived greater than 21.4 miles of their chosen facility and had a poorer prognosis compared to patients who lived closer (HR 1.25, 95% CI 1.06-1.47, p = 0.008). Conversely, patients with private insurance composed 59% of the sample and had a more favorable prognosis (HR 0.54, 95% CI 0.30-0.99, p = 0.046) compared to patients with no insurance. Conclusions: To our knowledge, this study provides the most updated analysis on how demographic factors impact prognosis in patients with pediatric neuroblastoma. We highlight potential barriers to care including age, distance to facility, and insurance. We hope this study may serve as a foundation for further investigation into the systemic barriers that affect patients with pediatric neuroblastoma.