Racial/Ethnic Disparities in Pediatric Patients with Brain Cancer

March 16, 2020

A population-based analysis found that racial and ethnic disparities in childhood central nervous system tumor survival seem to have their roots at least partially in post-diagnosis factors, possibly due to the lack of access to high quality care, leading to poorer overall outcomes.

A population-based analysis, published in Scientific Reports, found that racial and ethnic disparities in childhood central nervous system (CNS) tumor survival seem to have their roots at least partially in post-diagnosis factors, possibly due to the lack of access to high quality care, leading to poorer overall outcomes.1

Additionally, the study found that at the time of diagnosis, pediatric patients with brain tumors of all races and ethnicities presented with cancers of similar stage and aggressiveness, meaning that at the time of diagnosis, there were no disparities. However, black and Hispanic patients then went on to fare worse than their non-Hispanic white counterparts.

“We were surprised,” senior study author Adam Green, MD, CU Cancer Center investigator and pediatric brain cancer specialist at Children’s Hospital Colorado, said in a press release.2 “In general, we expect these disparities to be multi-factorial and have pre- and post-diagnosis components, but these findings suggest these patients are able to get diagnosed appropriately, but after that, treatment and follow up may be where the disparities lie.”

Overall, 1,881 patients with malignant tumors of the CNS, including both cranial and spinal neoplasms, were identified using the SEER database. Survival was found to be worse for black compared to white patients (hazard ratio [HR], 1.31; 95% CI, 1.08-1.58; P = 0.0064) and worse for Hispanic compared to non-Hispanic patients (HR, 1.25; 95% CI, 1.07-1.45; P = 0.0038). Additionally, areas of high poverty demonstrated worse overall survival (HR, 1.26; 95% CI, 1.09-1.46; P = 0.0019).

The risk of death was also greater in those with metastatic disease compared to localized, and ages 0 and 5-9 years compared to age 1-4 years. Moreover, the risk of death was lower in all tumor subtypes compared to gliomas and lower for patients who underwent surgery compared to those who did not. Tumor size, the remaining socioeconomic measures, and radiation administration did not show significant correlation with overall survival.

When performing multivariable analysis, the results were predominantly the same. After the researchers controlled for both treatment and socioeconomic characteristics, the HRs for both black (HR, 1.29; 95% CI, 1.04-1.59; P = 0.0206) and Hispanic (HR, 1.29; 95% CI, 1.08-1.53; P = 0.0051) patients decreased, but remained significant. Further, accounting for demographics, tumor type, and treatment modalities, those in the highest quartile for county-level percent below poverty had poorer survival (HR, 1.27; 95% CI, 1.03–1.57; P = 0.0282).

“If we look overall in pediatric brain and central nervous system cancers, black and Hispanic patients have a higher risk of dying from these tumors compared with non-Hispanic white patients,” Green said. “Even when they presented with similar stage disease as their white counterparts, they still did worse.” 

Future research is planned that will look deeper into the source of these disparities, however Green suggested there are factors that health care systems can work on now to ensure equal care and potentially more equal outcomes. 

“One thing we don’t talk about enough in cancer is how much of a burden going through treatment is on families – financial resources, transportation resources, time resources, shelter and lodging resources, etc.,” Green said. “We can plan on effective treatment, but if there are life factors that make it more challenging for some families to get that entire course of treatment successfully, then all the planning we do isn’t going to make the treatment as effective as we would like it to be.” 

The brain specialist also suggested that given the complexity of many of these cases, young patients with brain cancer should be seen at centers with experience treating these cancers and that offer multi-disciplinary care, allowing patients to access experts in a variety of fields including medical oncology, surgery, radiation, pathology, and supportive care such as palliative medicine and nutrition.

“It’s incumbent on us to make sure these families have access to the resources they need to ensure that their children are able to get the highest quality care,” said Green.

References:

1. Fineberg R, Zahedi S, Eguchi M, Hart M, Cockburn M, Green AL. Population-Based Analysis of Demographic and Socioeconomic Disparities in Pediatric CNS Cancer Survival in the United States. Scientific Reports. doi:10.1038/s41598-020-61237-2.

2. Treatment disparities drive worse outcomes for pediatric black, Hispanic brain cancer patients [news release]. Colorado. Published March 12, 2020. eurekalert.org/pub_releases/2020-03/uoca-tdd031220.php. Accessed March 13, 2020.