Race, ethnicity, and poverty are associated with worse outcomes in children treated for high-risk neuroblastoma

Children with high-risk neuroblastoma performed worse when they were from certain racial / ethnic groups or were on public rather than private insurance, despite being treated in clinical trials using standardized protocols, according to studies conducted researchers from Dana-Farber / Boston. Children’s Center for Cancer and Blood Diseases.

Research shows that young patients from historically marginalized populations or from lower incomes were below five-year survival, even if they were assigned to form initial treatment after diagnosis s high-risk neuroblastoma.

“These findings repeat what we have known for decades at the population level – children from historically marginalized groups are less likely to survive cancer,” said Puja J. Umaretia, MD, Clinical Officer of Pediatric Hematology / Oncology at Dana-Farber / Boston Pediatrics. “They add an essential next layer to our understanding of racial and ethnic differences childhood cancerand that’s what registration is on clinical trials insufficient to achieve racial and ethnic equality in survival. ”Umaretia presents the results of the study at the annual meeting of the American Society of Clinical Oncology (ASCO), held June 3-7, 2022, and the study is included in the ASCO Press Program.

“Clinical trials are a highly standardized service, but even if they receive help in clinical trials, children with high-risk neuroblastoma do not experience the same results based on their race, ethnicity and whether they live in poverty,” he said. Umaretia, the lead author of the book. research. “This is key because so far attention has been paid to historically marginalized groups participating in trials with the assumption that this will reduce differences in survival, but our data suggest that in pediatrics, participation in trials is the first a step, but one is clearly not enough ”.

The senior author is Kira Bona, MD, Master of Science, Fr. pediatric oncologist in Dana-Farber / Boston Children with a study to identify inconsistencies in outcomes related to childhood poverty and to develop measures to mitigate these differences.

Bona notes: “This bright race /ethnic disparities Survival is maintained despite participation in clinical trials, making it clear that pediatric cancer trials should include health equity measures. If a new gene mutation was found to increase the risk for patients in the study, pediatric oncology would without hesitation begin to intervene. The same urgency should apply to this data. It is essential that pediatric oncologists begin to test medical care and support interventions in our trials as we make new drugs. ”

The study looked at the results of 696 children who participated in three clinical trials of the pediatric oncology group (COG) for the treatment of high-risk neuroblastoma. Neuroblastoma is a type of cancer that forms in the nervous tissue. It often starts in one of the adrenal glands, but can also occur in the neck, chest, abdomen or spine. High-risk disease is determined by age, the extent of the disease, and the biological characteristics of cancer cells. The prognosis for long-term survival remains challenging. Treatment is usually an intensive combination of chemotherapy, surgery, stem cell transplantation, radiation and immunotherapy.

Of the 696 patients in the COG trial, 11% were Hispanic, 16% were black non-Hispanic, 4% were other non-Hispanic, and 69% were white non-Hispanic. One-third of children were at risk of poverty in households (covered by state insurance); 26% were prone to poverty at the neighborhood level (living in a zip code with a high poverty rate defined by 20% or more of the population living below the federal poverty line).

The five-year overall survival varied by race / ethnicity (47% for Hispanic children; 50% for other non-Hispanic children; 61% for white non-Hispanic children; and 63% for black non-Hispanic children.) After adjustment. in terms of disease-related factors, Hispanic children died 1.8 times more often, and other non-Hispanic patients died 1.5 times more often than white non-Hispanic children.

Patients who had only state insurance (household poverty rate) had a 53% five-year survival rate compared to 63% for others. Survival rates were also lower – 54% – in children living in poverty, compared to 62% in others.

“The huge advantage of how this dataset was created is that we have the opportunity to look at potential mechanisms that can explain these differences in survival,” Umaretti said. “For the first time, we will be able to ask whether certain groups have experienced delays in therapy or are more likely to stop participating in trials, perhaps because of competing family needs that are secondary to poverty. Most importantly, we will be able to start watching on what happens after relapse – a time when we know that treatment is becoming less standardized, which may increase the likelihood that racial, ethnic or socioeconomic privileges will help some families access access to life-prolonging therapy for their children. while others cannot. Understanding what happens after a relapse will be important for management intervention to improve the disparity in survival, and we are excited to take it further. ”