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. 2016 May 10;34(14):1634-43.
doi: 10.1200/JCO.2015.66.3567. Epub 2016 Mar 21.

Racial/Ethnic Differences in Adverse Outcomes Among Childhood Cancer Survivors: The Childhood Cancer Survivor Study

Qi Liu  1 , Wendy M Leisenring  1 , Kirsten K Ness  1 , Leslie L Robison  1 , Gregory T Armstrong  1 , Yutaka Yasui  1 , Smita Bhatia  2
Affiliations

Racial/Ethnic Differences in Adverse Outcomes Among Childhood Cancer Survivors: The Childhood Cancer Survivor Study

Qi Liu et al. J Clin Oncol. .

Abstract

Purpose: Childhood cancer survivors carry a high burden of treatment-related morbidity; however, race/ethnicity-specific risks of adverse outcomes are not well understood.

Methods: Data from the Childhood Cancer Survivor Study, a cohort of survivors of at least 5 years, were used to compare Hispanic (n = 750, 5.4%) and non-Hispanic black (NHB: n = 694, 5.0%) survivors to non-Hispanic white patients (NHW: n = 12,397, 89.6%) for late mortality, subsequent neoplasms, and chronic health conditions.

Results: NHBs and Hispanics reported lower socioeconomic status (SES) and higher prevalence of obesity, and NHBs reported higher prevalence of hypertension. NHBs had higher rate of all-cause mortality (relative rate [RR], 1.4; 95% CI, 1.1 to 1.9; P = .008), which was abrogated (RR, 1.0; 95% CI, 0.8 to 1.4; P = .9) after adjusting for SES. Nonmelanoma skin cancer was not observed among irradiated NHBs, and the risk was lower among Hispanic survivors (RR, 0.3; 95% CI, 0.1 to 0.7) compared with NHWs. Both NHBs and Hispanics demonstrated elevated risks for diabetes; these risks persisted after adjusting for SES and obesity (NHBs: RR, 2.8; 95% CI, 1.1 to 6.7; Hispanics: RR, 3.1; 95% CI, 1.5 to 6.4). NHBs were more likely to report cardiac conditions (RR, 1.8; 95% CI, 1.1 to 2.7), but the risk was attenuated after adjusting for cardiovascular risk factors. Therapeutic exposures did not affect racial/ethnic differences in mortality (all cause or cause specific), chronic health conditions, or subsequent neoplasms.

Conclusion: By and large, NHB and Hispanic childhood cancer survivors experience a comparable burden of morbidity and mortality to their NHW counterparts. The few differences in risk were explained by the racial/ethnic differences in socioeconomic status and/or cardiovascular risk factors.

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Conflict of interest statement

Authors’ disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
CONSORT diagram showing the study participants included in the study.
Fig 2.
Fig 2.
(A) Survival probability of 5-year survivors of childhood cancer. (B) Cumulative incidence of cause-specific mortality by race/ethnicity in childhood cancer survivors. (C) Cumulative incidence of subsequent neoplasm (SN) categories (subsequent malignant neoplasm [SMN], nonmalignant meningioma, nonmelanoma skin cancer [NMSC], and other SN) by race/ethnicity among childhood cancer survivors.
Fig 2.
Fig 2.
(A) Survival probability of 5-year survivors of childhood cancer. (B) Cumulative incidence of cause-specific mortality by race/ethnicity in childhood cancer survivors. (C) Cumulative incidence of subsequent neoplasm (SN) categories (subsequent malignant neoplasm [SMN], nonmalignant meningioma, nonmelanoma skin cancer [NMSC], and other SN) by race/ethnicity among childhood cancer survivors.
Fig 2.
Fig 2.
(A) Survival probability of 5-year survivors of childhood cancer. (B) Cumulative incidence of cause-specific mortality by race/ethnicity in childhood cancer survivors. (C) Cumulative incidence of subsequent neoplasm (SN) categories (subsequent malignant neoplasm [SMN], nonmalignant meningioma, nonmelanoma skin cancer [NMSC], and other SN) by race/ethnicity among childhood cancer survivors.
Fig A1.
Fig A1.
Mean cumulative count (MCC) per 100 survivors of subsequent neoplasm (SN) categories (subsequent malignant neoplasm [SMNs], nonmalignant meningioma, nonmelanoma skin cancer [NMSC], and other SN) by race/ethnicity.
Fig A2.
Fig A2.
Cumulative incidence (%) of specific types of subsequent malignant neoplasm by race/ethnicity. AML, acute lymphoblastic leukemia; STS, soft tissue sarcoma.
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