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Healthcare utilization disparities among children with high-risk neuroblastoma treated on Children's Oncology Group

Jamie Shoag1, Yimei Li2, Kelly D Getz2,3

  • 1Division of Pediatric Hematology and Oncology, Department of Pediatrics, Cleveland Clinic, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.

Pediatric Blood & Cancer
|July 13, 2024
PubMed

Insights

Hispanic children with high-risk neuroblastoma (HRNBL) experienced more intensive care unit (ICU) admissions, suggesting treatment toxicity may drive survival disparities. Further research is needed to address these inequities.

Area of Science:

  • Pediatric Oncology
  • Health Disparities Research
  • Clinical Toxicology

Background:

  • Persistent survival and relapse disparities exist for high-risk neuroblastoma (HRNBL) in marginalized populations.
  • Differential treatment toxicity is a potential driver of these disparities in other cancers.
  • Understanding racial and ethnic differences in HRNBL treatment toxicity is crucial.

Purpose of the Study:

  • To investigate racial and ethnic disparities in treatment-associated toxicity among children with HRNBL.
  • To examine intensive care unit (ICU)-level care utilization as a proxy for toxicity.
  • To identify potential mechanisms underlying outcome disparities in HRNBL.

Main Methods:

  • Retrospective analysis of a merged cohort from Children's Oncology Group (COG) trials ANBL0032 and ANBL0931 (2005-2014).
  • Categorization of race-ethnicity: Hispanic, non-Hispanic Black (NHB), non-Hispanic Other (NHO), and non-Hispanic White (NHW).
  • Log binomial regression used to assess associations between race-ethnicity and ICU-level care, reporting risk ratios (RR) and 95% confidence intervals (CI).

Main Results:

  • The study included 370 children with HRNBL.
  • Hispanic children showed a significantly higher risk of ICU-level care (aRR 2.5, 95% CI: 1.6-3.7) compared to non-Hispanic White (NHW) children.
  • Hispanic children had the highest incidence of cardiovascular-driven ICU-level care.

Conclusions:

  • Hispanic children with HRNBL receiving clinical trial therapy were more likely to require ICU-level care.
  • These findings highlight the need to investigate treatment-related toxicity as a factor in outcome disparities.
  • Further research into modifiable mechanisms is warranted to address HRNBL survival inequities.
Abstract

Keywords:
ICUdisparitiesethnicitypediatric oncologyraceutilization

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