Various Ailments Plague Some Pediatric Cancer Survivors More Than Others

Childhood cancer survivors of certain racial and ethnic groups were prone to more hospitalizations for various conditions years down the road, according to a cohort study from Washington State.

Racial disparities in outcomes began to emerge 5 years after diagnosis of childhood cancer, when overall hospitalization was more common among American Indian and Alaska Native survivors (HR 1.7, 95% CI 1.0-3.0) and Black survivors (HR 1.5, 95% CI 0.9-2.4) compared with non-Hispanic white survivors, the study showed in JAMA Network Open.

Certain groups were associated with different types of hospitalizations:

• Hispanic children: infection-, endocrine-, hematologic-, respiratory-, and digestive-related conditions
• American Indian/Alaska Native children: infection-, hematologic-, digestive-, and mental health-related conditions
• Black children: mental health-related conditions

“Racial and ethnic minority survivors of childhood cancer may have increased long-term disease burden and a range of conditions that require hospitalizations and compound medical costs, shorten life expectancy, and decrease quality of life,” study authors Marc Emerson, PhD, of University of North Carolina in Chapel Hill, and colleagues wrote.

Thus, pediatric cancer survivors of minoritized racial and ethnic groups appear more likely to have less favorable health outcomes in the long run, echoing similar findings in adults.

“We were surprised that there weren’t greater differences in mortality overall. But the differences in hospitalization experiences are important. Hospitalizations is a burden on the family, financially, logistically, and emotionally, so it is important to characterize who’s at greatest risk,” Emerson told MedPage Today.

Approximately 483,000 childhood cancer survivors live in the U.S., according to the study. Estimates suggest 15,900 children will be newly diagnosed with cancer in 2022, and 1,600 will die from it, resulting in cancer being the most common cause of disease-related death among children in the country.

“Future studies are needed to assess short- and long-term health outcomes and patterns of health care use and co-occurrence of other health-related conditions by race and ethnicity among childhood cancer survivors,” the investigators wrote.

“Examining access to care using geographic information tools to assess distance from care centers, or access to virtual care for those living far from care centers may also help identify reasons for the differences in outcomes that we observed,” Emerson added.

The cohort study analyzed survival and hospitalization rates in children born in Washington State who had been diagnosed with cancer from 1987 to 2012.

This included 4,222 children with a mean age of 8.4 years, with 52.1% being boys. Racial groups represented were American Indian and Alaska Native (2.7%), Asian (7.4%), Black (4.6%), Hispanic (9.2%), and non-Hispanic white (76.1%).

Leukemias, lymphomas, and central nervous system cancers comprised the most common cancers in this population.

Emerson and colleagues acknowledged that they had a small number of American Indian and Alaska Native in their dataset, somewhat limiting their ability to to do some comparisons. Furthermore, they were unable to analyze by cancer type and were unable to control for factors such as health insurance and education level. There was also a loss of follow-up due to participants leaving Washington.

“Pooling similar linked registry data from several states would help by increasing the precision of these estimates and expand generalizability to other U.S. regions,” they suggested.