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Health disparities among tennessee pediatric renal tumor patients
Kevin Neuzil1, Annie Apple1, Amelia Sybenga2
1School of Medicine, Vanderbilt University Medical Center, 1611 21(st) Avenue South, Nashville, TN; Surgical Outcomes Center for Kids, Vanderbilt University Medical Center, 2200 Children's Way, Nashville, TN.
Insights
Black children in Tennessee with any pediatric renal cancer present with more advanced disease and have worse survival. Treatment at a comprehensive cancer center may reduce these disparities.
Area of Science:
- Pediatric oncology
- Cancer health disparities
- Renal cancer epidemiology
Background:
- Wilms tumor disproportionately affects black children globally.
- Existing data on health disparities for other pediatric renal cancers are limited.
- This study addresses health disparities in Tennessee children with all types of renal cancer.
Purpose of the Study:
- To characterize health disparities among Tennessee children diagnosed with any type of renal cancer.
- To compare the incidence, presentation, and survival rates of different renal cancer subtypes across racial groups.
- To evaluate the impact of treatment setting on survival outcomes for pediatric renal cancer patients.
Main Methods:
- Retrospective cohort study utilizing the Tennessee Cancer Registry (TCR) and an institutional cancer registry (ICR).
- Inclusion of patients aged 18 years or younger with diagnoses of Wilms tumor, Sarcoma/Other, or Renal Cell Carcinoma.
- Statistical analyses included Wilcoxon/Pearson tests, Kaplan-Meier survival analysis, and logistic regression.
Main Results:
- Wilms tumor was the most common renal cancer, followed by Sarcoma and Renal Cell Carcinoma, with significant age differences across types.
- In the TCR, black patients (26%) presented with more distant disease (37% vs. 16%) and had worse overall survival (73% vs. 89%) compared to white patients.
- Sarcoma and presence of metastases were independent predictors of mortality in both registries; however, the ICR showed similar survival between racial groups.
Conclusions:
- Black children in Tennessee with renal cancers, including Renal Cell Carcinoma and Sarcoma, face disparities in advanced disease presentation and survival.
- Treatment within a comprehensive pediatric cancer center appears to mitigate these observed survival disparities.
- Further research is needed to understand and address the systemic factors contributing to these health inequities.
Background/Purpose:
Wilms tumor (WT) poses a cancer health disparity to black children globally, which has not been evaluated thoroughly for other pediatric renal cancers. We aimed to characterize health disparities among Tennessee children treated for any renal cancer.
Methods:
The Tennessee Cancer Registry (TCR) was queried for patients ≤18 years having any renal cancer (n = 160). To clarify treatment and outcomes, we performed a retrospective cohort study of pediatric renal cancer patients in our institutional cancer registry (ICR; n = 121). Diagnoses in both registries included WT, Sarcoma/Other, and Renal Cell Carcinoma. Wilcoxon/Pearson, Kaplan-Meier, and logistic regression were completed.
Results:
In both registries, WT comprised the most common renal cancer and youngest median age. Sarcoma was intermediate in frequency and age, and RCC was least common, having the oldest age (p < 0.001). In the TCR, black patients comprised 26% of all patients, presented more commonly with distant disease than white patients (37% v. 16%; p = 0.021), and showed worse overall survival (73% v. 89%; p = 0.018), while the ICR showed similar survival between race groups (92% v. 93%, p = 0.868). Sarcoma and metastases were independent predictors of death in both registries (p ≤ 0.002).
Conclusions:
Black children in Tennessee presented with more advanced disease and experienced worse survival when combining all renal cancer types, particularly RCC and Sarcoma. When treated at a comprehensive pediatric cancer center, these survival disparities appear diminished.
Type Of Study:
Prognostic study.
Level Of Evidence:
Level II (retrospective cohort).
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