Survival in Childhood and Adolescent Cancers Improves, but Racial Disparities Persist

Five-year overall survival (OS) for children and adolescents with cancer in the US improved from 60% in 1975 to 90% in 2017, but progress was uneven across cancer types and racial and ethnic groups, according to an analysis of Surveillance, Epidemiology, and End Results (SEER) registry data published in the Journal of the National Cancer Institute.¹ Non-Hispanic Black patients had the lowest survival across multiple cancer types, even after adjustment for age and decade of diagnosis.

The analysis used 2 versions of the SEER database. SEER 8 draws on 8 registries covering about 8.3% of the US population and has the longest historical period (1975-2022), so investigators used it for long-term survival trends. SEER 17 draws on 17 registries covering about 27% of the population from 2000 to 2022, with broader national representation, and was used for the analyses by race, ethnicity, and population density.

What did the analysis show about survival trends?

Among 52,165 patients in SEER 8, 5-year OS for all childhood and adolescent cancers rose from 60% (95% CI, 56%-64%) in 1975 to 90% (95% CI, 88%-91%) in 2017. The largest gain was in acute lymphoblastic leukemia (ALL), from 43% (95% CI, 34%-52%) to 95% (95% CI, 92%-97%). Survival in Wilms tumor, Hodgkin lymphoma, and gonadal tumors plateaued at high levels.

By decade, 5-year OS reached 80% or higher for most cancer types in 2015 to 2022. Survival remained lower for acute myeloid leukemia (AML; 72%; 95% CI, 66%-76%) and sarcoma (74%; 95% CI, 70%-77%). For Hodgkin lymphoma diagnosed from 1975 to 1984, 5-year OS was 87% (95% CI, 85%-89%) but 30-year survival was 63% (95% CI, 59%-66%). For diagnoses from 1985 to 1994, those rates were 93% (95% CI, 90%-94%) and 79% (95% CI, 76%-82%).

How did survival differ by race and ethnicity?

In SEER 17, 5-year OS from 2000 to 2017 was 88.0% (95% CI, 87.7%-88.3%) for non-Hispanic White patients, 85.6% (95% CI, 84.8%-86.3%) for patients of other races and ethnicities, 84.5% (95% CI, 84.1%-84.9%) for Hispanic patients, and 80.8% (95% CI, 80.0%-81.7%) for non-Hispanic Black patients (P <.001). Differences persisted across subtypes except Wilms tumor (P = .0509) and gonadal tumors (P = .2269).

After adjustment, non-Hispanic Black patients had worse survival than non-Hispanic White patients in ALL (adjusted HR [aHR], 1.74), central nervous system (CNS) tumors (aHR, 1.40), neuroblastoma (aHR, 1.47), Hodgkin lymphoma (aHR, 1.59), and non-Hodgkin lymphoma (aHR, 1.48). No differences were seen in AML, Wilms tumor, or gonadal tumors. In ALL, the aHR was 1.90 (95% CI, 1.43-2.51) for 1975 to 1984 and 3.54 (95% CI, 1.96-6.40) for 2015 to 2022. Survival differed by population density only in Hodgkin lymphoma (P = .049) and neuroblastoma (P = .01).

How was the analysis conducted?

The retrospective analysis used SEER 8 (1975-2022; 52,165 patients; about 8.3% of the US population) for long-term trends and SEER 17 (2000-2022; 100,110 patients; about 27% of the population) for race, ethnicity, and population density analyses, based on the November 2024 submission. Patients were aged 0 to 19 years at diagnosis. Analyses covered 9 cancer types, other hematologic and solid tumors, and nonmalignant CNS tumors.

In SEER 8, 47% of patients were female, 64% were non-Hispanic White, and 60% received chemotherapy. Investigators assessed trends in 5-year OS with the Joinpoint Regression Program and compared survival by decade with Kaplan-Meier curves and log-rank tests. Cox models adjusted for age (ALL only), decade, cancer type, and race and ethnicity. Treatment variables were not included in survival analyses.

What limitations did the authors note?

SEER 8 and 17 cover about 8.3% and 27% of the US population, which may limit generalizability. SEER lacks detailed clinical, treatment, and patient-reported outcomes, and sociodemographic factors relied on area-level proxies. The authors said that drivers of the disparities are likely multifactorial and warrant further study.

References

Schwartz LF, Wesevich A, Englum BR, et al. Advances and disparities in survival of childhood and adolescent cancers. J Natl Cancer Inst. 2026;118(10):1919-1932. doi:10.1093/jnci/djag155