Survival Differences Persist Between Black and White Children with Cancer

Despite substantial improvements in childhood cancer survival over the past several decades, racial disparities in survival rates persist—and, in fact, have worsened for some cancer types—according to a study published online April 30 in the Journal of Clinical Oncology.

The study, by researchers from St. Jude Children’s Research Hospital, showed that over two different study periods, black children diagnosed with cancer in the United States were less likely to survive 5 years after diagnosis than white children. But when the researchers analyzed survival rates for children treated at St. Jude specifically, there was no survival difference between black and white patients. St. Jude accepts and treats all patients regardless of ability to pay and absorbs all costs not covered by third-party insurers.

To conduct the study, the research team analyzed data from NCI’s Surveillance, Epidemiology, and End Results (SEER) database and from St. Jude’s own patient registry. The researchers looked at data for two periods: 1992 to 2000 and 2001 to 2007. The analysis included only black and white patients.

Although survival rates improved substantially for several cancers from the earlier to the later study period, the SEER data analysis “showed significantly inferior outcomes for black patients in the vast majority of disease categories,” the researchers reported. The survival disparity narrowed over time for acute lymphoblastic leukemia and Hodgkin lymphoma but expanded for acute myeloid leukemia and neuroblastoma. At St. Jude, survival rates also improved between the two time periods for most types of cancer but were similar in blacks and whites.

Although information on participants' socioeconomic status was not available, when the researchers looked at insurance coverage as a proxy for socioeconomic status, black patients were far more likely to have public insurance and far less likely to have private insurance.

The study’s lead investigator, Dr. Ching-Hon Pui, chair of St. Jude Department of Oncology, said he was “disappointed” to see that survival disparities between black and white patients in the United States had not narrowed but was encouraged by the results at St. Jude showing that this disparity can be overcome.

Lack of access to team-oriented care with strong medical and psychosocial support is clearly a driving factor behind the continued disparities, Dr. Pui added. He cited, for example, lower rates of adherence to treatments among underprivileged patients. “It takes a lot of time and effort to explain to parents or guardians how to take the medicine and to make sure that patients actually get their medicine,” he said. “[At St. Jude] we have a team of nurse practitioners, nurses, social workers, and doctors of pharmacy to help with those sorts of things.”

For more information about cancer disparities research, visit NCI’s Center to Reduce Cancer Health Disparities

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