Pediatric cancer mortality and survival in the United States, 2001-2016

Abstract

Background: Although pediatric cancer mortality and survival have improved in the United States over the past 40 years, differences exist by age, race/ethnicity, cancer site, and economic status. To assess progress, this study examined recent mortality and survival data for individuals younger than 20 years.

Methods: Age-adjusted death rates were calculated with the National Vital Statistics System for 2002-2016. Annual percent changes (APCs) and average annual percent changes (AAPCs) were calculated with joinpoint regression. Five-year relative survival was calculated on the basis of National Program of Cancer Registries data for 2001-2015. Death rates and survival were estimated overall and by sex, 5-year age group, race/ethnicity, cancer type, and county-based economic markers.

Results: Death rates decreased during 2002-2016 (AAPC, -1.5), with steeper declines during 2002-2009 (APC, -2.6), and then plateaued (APC, -0.4). Leukemia and brain cancer were the most common causes of death from pediatric cancer, and brain cancer surpassed leukemia in 2011. Death rates decreased for leukemia and lymphoma but were unchanged for brain, bone, and soft-tissue cancers. From 2001-2007 to 2008-2015, survival improved from 82.0% to 85.1%. Survival was highest in both periods among females, those aged 15 to 19 years, non-Hispanic Whites, and those in counties in the top 25% by economic status. Survival improved for leukemias, lymphomas, and brain cancers but plateaued for bone and soft-tissue cancers.

Conclusions: Although overall death rates have decreased and survival has increased, differences persist by sex, age, race/ethnicity, cancer type, and economic status. Improvements in pediatric cancer outcomes may depend on improving therapies, access to care, and supportive and long-term care.

Keywords: cancer; epidemiology; mortality; pediatric; survival.

FIGURE 1.

Trends in age-adjusted cancer death rates in persons younger than 20 years at death by (A) sex and (B) race/ethnicity (National Vital Statistics System, United States, 2002–2016). The source for the data is the National Vital Statistics System (National Center for Health Statistics, Centers for Disease Control and Prevention). Rates are per 1 million persons and are age-adjusted to the 2000 US standard population. Trends were measured with AAPCs in rates and were considered to increase or decrease if P was <.05; otherwise, trends were considered stable. Trends were calculated with joinpoint regression, which allowed different slopes for as many as 3 different periods. White, Black, AI/AN, and API persons were non-Hispanic. Hispanic persons might be of any race; 77 cases of unknown ethnicity during 2002–2016 were excluded. *Indicates a significant AAPC during 2002–2016. **Indicates a significant segment APC as listed on the corresponding segment in the figure. AAPC indicates average annual percent change; AI/ AN, American Indian/Alaska Native; APC, annual percent change; API, Asian/Pacific Islander.

FIGURE 2.

Trends in age-adjusted cancer death rates in persons younger than 20 years at death by the 7 cancer types with the highest death rates (National Vital Statistics System, United States, 2002–2016): (A) cancer types with stable death rates by AAPC, (B) cancer types with significantly decreasing death rates by AAPC, and (C) death rate trends for leukemia (all types combined) and brain cancer. The source for the data is the National Vital Statistics System (National Center for Health Statistics, Centers for Disease Control and Prevention). Rates are per 1 million persons and are age-adjusted to the 2000 US standard population. Trends were measured with AAPCs in rates and were considered to increase or decrease if P was <.05; otherwise, trends were considered stable. Trends were calculated with joinpoint regression, which allowed different slopes for as many as 3 different periods. Causes of death were grouped by site codes. Not all causes of death by cancer type are listed here by type. Endocrine included 146 endocrine tumors located in the brain (pituitary, craniopharyneal, or pineal; see https://wonder.cdc.gov/cancer.html). *Indicates a significant AAPC during 2002–2016. **Indicates a significant segment APC as listed on the corresponding segment in the figure. AAPC indicates average annual percent change; ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia; APC, annual percent change.