Treatment outcomes in black and white children with cancer: results from the SEER database and St Jude Children's Research Hospital, 1992 through 2007

Abstract

Purpose: Treatment outcome for black patients with cancer has been significantly worse than for their white counterparts. We determined whether recent improved treatment had narrowed the gap in outcome between black and white pediatric patients.

Patients and methods: In a parallel comparison, we analyzed survival by disease category between black and white patients with childhood cancer registered in one of the 17 cancer registries of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program or treated at St Jude Children's Research Hospital, which provides comprehensive treatment to all patients regardless of their ability to pay, from 1992 to 2000 and from 2001 to 2007.

Results: Analysis of the SEER data indicated that in both study periods, black patients had significantly poorer rates of survival than did white patients, with the exception of a few types of cancer. Despite significantly improved treatment outcomes for patients who were treated from 2001 to 2007, the racial difference in survival has actually widened for acute myeloid leukemia and neuroblastoma. By contrast, in the cohorts treated at St Jude Children's Research Hospital, there were no significant differences in survival between black and white patients in either study period, regardless of the cancer type. Importantly, the outcome of treatment for acute lymphoblastic leukemia, acute myeloid leukemia, and retinoblastoma has improved in parallel for both races during the most recent study period.

Conclusion: With equal access to comprehensive treatment, black and white children with cancer can achieve the same high cure rates.

Fig 1.

Kaplan-Meier estimates of survival for black compared with white children with acute lymphoblastic leukemia in the earlier (1992-2000) and recent (2001-2007) study periods. Patients were either (A) registered in the SEER program or (B) treated at the St Jude Children's Research Hospital (SJCRH). Survival was worse for black children during both the earlier (P < .01) and recent periods (P < .01) in the SEER program, but there were no significant race-related differences in survival during either period at SJCRH (P = .58 and P = .41, respectively). Numbers of patients still at risk are shown beneath the graph.

Fig 2.

Kaplan-Meier estimates of survival for black compared with white children with acute myeloid leukemia in the earlier (1992-2000) and recent (2001-2007) study periods. Patients were either (A) registered in the SEER program or (B) treated at the St Jude Children's Research Hospital (SJCRH). Survival did not differ between the two races during the earlier period (P = .81) but was worse for black children during the recent period (P < .01) in the SEER program. There were no significant race-related differences in survival during either period (P = .55 and P = .17, respectively) at SJCRH. Numbers of patients still at risk are shown beneath the graph.

Fig 3.

Kaplan-Meier estimates of survival for black compared with white children with neuroblastoma in the earlier (1992-2000) and recent (2001-2007) study periods. Patients were either (A) registered in the SEER program or (B) treated at the St Jude Children's Research Hospital (SJCRH). Survival did not differ between the two races during the earlier period (P = .53) but was worse for black children during the recent period (P < .01) in the SEER program. Significant race-related differences in survival were not apparent during either the earlier (P = .07) or recent period (P = .94) at SJCRH. Numbers of patients still at risk are shown beneath the graph.