Year: 2017
Type: editorial
Study design: Observational Study
Abstract: Pediatric cancer outcomes have improved significantly over the past several decades; however, a group of patients still die very early in their disease course.Patients may have severe complications from their disease by the time they present to care, or have early complications from treatment.Some of these patients are too ill to be able to participate in clinical trials, thus this group is not well characterized in the literature.Understanding more about this population may lead to improved outcomes for all childhood cancer patients.We performed a retrospective analysis on 36,337 cancer patients ages 0-19 years old using 13 SEER registries from 1992-2011 [1].Early death, which we defined as a death within a month of diagnosis, did not affect all diagnoses, demographics, or socioeconomic groups equally.These children were more likely to be younger (< 1 year of age) and of black race or Hispanic ethnicity.Those with early death and hematologic malignancies were more likely to live in low-income counties.Certain tumor types were over-represented, including AML, infant ALL, hepatoblastoma, and malignant brain tumors.Although the percentage of early deaths declined over time (APC -2.5; 95% CI, -3.9 to -1.1), the incidence of early deaths is still high (1.5% overall incidence, representing 7.5% of total deaths in the cohort), especially when compared to published clinical trial data.Compared to SEER-derived, cancer subtypematched data from the same time period, cooperative group clinical trials reported early death rates ranging from 50% to more than 90% lower [1].This cohort is the largest to date describing early death in childhood cancer.However, there are multiple limitations to this study.One is the retrospective nature, and due to the coding of data within SEER, we cannot parse out when death occurred during that first month.The reason for death is not fully captured in this dataset.In addition, data from these registries may not be fully representative of the United States, or other countries, both with regards to socioeconomic status and access to care.Two previous studies looking at this population have identified overlapping risk factors for early death, including young age and certain cancer types; these prior studies did not identify demographic or socioeconomic factors as a risk factors [2, 3].However, there has been increasing interest in the effect of socioeconomic disparities on cancer outcomes, with lower socioeconomic www.impactjournals.
Source: Oncotarget
Institutions: Children's Hospital Colorado, University of Colorado Anschutz
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2766934696