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Published on: October 14, 2016
Poverty, race, ethnicity, and survival in pediatric nonmetastatic osteosarcoma: a Children's Oncology Group report
Lenka Ilcisin1,2, Ruxu Han3, Mark Krailo4,5
1Department of Pediatric Oncology, Division of Population Sciences, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA.
Insights
This study found no survival differences in osteosarcoma for children based on race, ethnicity, or poverty. However, non-Hispanic Black children had worse outcomes after relapse, highlighting a critical area for further research.
Area of Science:
- Pediatric Oncology
- Cancer Disparities Research
- Epidemiology
Background:
- Children from marginalized racial/ethnic groups and lower socioeconomic statuses often face worse cancer outcomes.
- Osteosarcoma survival disparities in these populations are not well-understood.
- This study examines survival differences in nonmetastatic osteosarcoma based on race, ethnicity, and poverty.
Purpose of the Study:
- To investigate the association between race, ethnicity, and poverty with event-free survival (EFS) and overall survival (OS) in children with nonmetastatic osteosarcoma.
- To identify potential disparities in osteosarcoma treatment outcomes among different demographic groups.
Main Methods:
- Retrospective cohort study of 758 US patients (aged 5-21) with nonmetastatic osteosarcoma from Children's Oncology Group trial AOST0331.
- Race and ethnicity were categorized as Hispanic, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White.
- Poverty was proxied at household and neighborhood levels; survival analyses used Kaplan-Meier and log-rank tests.
Main Results:
- No statistically significant association was found between poverty or race/ethnicity and event-free survival or overall survival.
- However, postrelapse survival significantly differed across racial and ethnic groups.
- Non-Hispanic Black children exhibited the highest risk of death after relapse (4-year postrelapse survival 13.0%).
Conclusions:
- Frontline osteosarcoma therapy delivered via cooperative group trials appears to yield equitable event-free and overall survival regardless of poverty or race/ethnicity.
- Significant disparities exist in postrelapse survival, with non-Hispanic Black children facing the greatest risk.
- Further research into the mechanisms driving these postrelapse survival disparities is crucial.
Background:
Children living in poverty and those of marginalized race or ethnicity experience inferior disease outcomes across many cancers. Whether survival disparities exist in osteosarcoma is poorly defined. We investigated the association between race, ethnicity, and proxied poverty exposures and event-free and overall survival for children with nonmetastatic osteosarcoma receiving care on a cooperative group trial.
Methods:
We conducted a retrospective cohort study of US patients with nonmetastatic, osteosarcoma aged 5-21 years enrolled on the Children's Oncology Group trial AOST0331. Race and ethnicity were categorized to reflect historically marginalized populations, as Hispanic, non-Hispanic Black, non-Hispanic Other, and non-Hispanic White. Poverty was proxied at the household and neighborhood levels. Overall survival and event-free survival functions of time from trial enrollment were estimated using the Kaplan-Meier method. Hypotheses of associations between risks for event-free survival, death, and postrelapse death with race and ethnicity were assessed using log-rank tests.
Results:
Among 758 patients, 25.6% were household-poverty and 28.5% neighborhood-poverty exposed. Of the patients, 21% of children identified as Hispanic, 15.4% non-Hispanic Black, 5.3% non-Hispanic Other, and 54.0% non-Hispanic White. Neither household or neighborhood poverty nor race and ethnicity were statistically significantly associated with risks for event-free survival or death. Postrelapse risk for death differed statistically significantly across race and ethnicity with non-Hispanic Black patients at greatest risk (4-year postrelapse survival 35.7% Hispanic vs 13.0% non-Hispanic Black vs 43.8% non-Hispanic Other vs 38.9% non-Hispanic White; P = .0046).
Conclusions:
Neither proxied poverty exposures or race and ethnicity were associated with event-free survival or overall survival, suggesting equitable outcomes following frontline osteosarcoma trial-delivered therapy. Non-Hispanic Black children experienced statistically significant inferior postrelapse survival. Investigation of mechanisms underlying postrelapse disparities are paramount.
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