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Racial and ethnic disparities in treatment and survival of pediatric sarcoma
Andrew J Jacobs1, Erika B Lindholm2, Carolyn Fein Levy3
1Hofstra Northwell School of Medicine, Hofstra University, Hempstead, New York.
Insights
Racial and ethnic disparities in pediatric sarcoma care persist in the U.S. Black and Hispanic children are diagnosed at later stages and have worse survival outcomes than white children, with these gaps widening over time.
Area of Science:
- Pediatric oncology
- Cancer epidemiology
- Health disparities research
Background:
- Childhood sarcomas are rare cancers requiring complex, multidisciplinary treatment.
- Understanding potential racial and ethnic disparities in pediatric sarcoma care is crucial.
Purpose of the Study:
- To investigate the existence of racial and ethnic disparities in the diagnosis, treatment, and survival of pediatric sarcoma patients in the United States.
Main Methods:
- Utilized the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database.
- Analyzed data from 1973-2012 for pediatric patients (0-21 years) diagnosed with primary sarcomas.
- Employed Kaplan-Meier survival analysis and log-rank testing to compare outcomes by race and ethnicity.
Main Results:
- Non-Hispanic Black and Hispanic patients were more likely to present with advanced-stage disease compared to white patients.
- White patients received radiation therapy more frequently than Black and Hispanic patients (P=0.01).
- Overall survival rates were lower for Black and Hispanic patients compared to white patients, with disparities widening over four decades.
Conclusions:
- Significant racial and ethnic disparities exist in pediatric sarcoma care, affecting disease stage, treatment, and survival.
- Black and Hispanic children with sarcoma face worse prognoses and present with more advanced disease.
- The survival gap between racial/ethnic groups has increased over the past 40 years, highlighting an urgent need for targeted interventions.
Background:
Childhood sarcomas are rare and require complex interdisciplinary care including surgery, chemotherapy, and radiation. The goal of this study was to determine if racial or ethnic disparities exist for pediatric sarcoma patients in the United States.
Methods:
The United States' National Cancer Institute's Surveillance, Epidemiology, and End Results database was used to identify patients aged 0-21 diagnosed with primary sarcomas from 1973 to 2012. Patients were considered by race and ethnicity. Survival curves were computed using the Kaplan-Meier method and the log-rank test.
Results:
A total of 11,502 patients were included in this study. When stratified by race, non-Hispanic black and Hispanic patients were significantly more likely to present with advanced stage disease than white patients. White patients were more likely to receive radiation therapy than black and Hispanic patients (P = 0.01). There was no significant difference between patients who underwent surgery (P = 0.21). Overall survival was better for white patients than black or Hispanic ones. Despite the overall 5-year survival improvement during the study period (56.2%-70.3%), survival disparities between race and ethnicity have grown.
Conclusions:
Racial and ethnic disparities do exist with respect to stage, treatment, and survival of these rare tumors. Black and Hispanic patients are presenting at more advanced stage and have overall worse survival. This survival disparity has widened over the past 4 decades.
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