Disparities in cancer outcomes: Lessons learned from children with cancer

Disparities in cancer burden by race/ethnicity have been reported, primarily in adults with cancer. However, there appear to be gaps in the pediatric oncology literature with regards to a comprehensive overview on this topic. Extant literature is used to highlight the results of studies focusing on racial and ethnic disparities in outcome observed in selected childhood cancers. A comprehensive approach is utilized to understand possible underlying causes of disparities in cancer outcomes, and to highlight the gaps that currently exist. This review helps define areas of future research that could help develop targeted, disease‐specific approaches to eliminate the disparities. Pediatr Blood Cancer 2011;56:994–1002. © 2011 Wiley‐Liss, Inc.

[1]  M. Hudson,et al.  Childhood cancer survivors' knowledge about their past diagnosis and treatment: Childhood Cancer Survivor Study. , 2002, JAMA.

[2]  A. Look,et al.  Outcomes of children with intermediate-risk neuroblastoma after treatment stratified by MYCN status and tumor cell ploidy. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[3]  Stephen D. Smith,et al.  A reliable method for evaluating drug compliance in children with cancer , 1979, Cancer.

[4]  M. Relling,et al.  Prognostic importance of 6-mercaptopurine dose intensity in acute lymphoblastic leukemia. , 1999, Blood.

[5]  S. Bhatia,et al.  Racial and ethnic disparities in disease presentation and survival among children with neuroblastoma (NBL): A Children's Oncology Group (COG) study. , 2010 .

[6]  G. Koren,et al.  Electronic measurement of compliance with mercaptopurine in pediatric patients with acute lymphoblastic leukemia. , 1998, Medical and pediatric oncology.

[7]  R. Weinshilboum,et al.  Genetic variation in response to 6-mercaptopurine for childhood acute lymphoblastic leukaemia , 1990, The Lancet.

[8]  K. Matthay,et al.  Long-term results for children with high-risk neuroblastoma treated on a randomized trial of myeloablative therapy followed by 13-cis-retinoic acid: a children's oncology group study. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[9]  Ruth Ladenstein,et al.  Excellent outcome with reduced treatment for infants with disseminated neuroblastoma without MYCN gene amplification. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  M. Relling,et al.  Polymorphism of the thiopurine S-methyltransferase gene in African-Americans. , 1999, Human molecular genetics.

[11]  M. Hudson,et al.  Minority adult survivors of childhood cancer: a comparison of long-term outcomes, health care utilization, and health-related behaviors from the childhood cancer survivor study. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  G. Draper,et al.  Treatment centre size, entry to trials, and survival in acute lymphoblastic leukaemia. , 1989, Archives of disease in childhood.

[13]  B. Smedley,et al.  The unequal burden of cancer : an assessment of NIH research and programs for ethnic minorities and the medically underserved , 1999 .

[14]  J. Buckley,et al.  A comparison of allogeneic bone marrow transplantation, autologous bone marrow transplantation, and aggressive chemotherapy in children with acute myeloid leukemia in remission. , 2001, Blood.

[15]  N. Heerema,et al.  Racial and ethnic differences in survival of children with acute lymphoblastic leukemia. , 2002, Blood.

[16]  M. Zevon,et al.  Compliance of pediatric and adolescent cancer patients , 1986, Cancer.

[17]  J. Lilleyman,et al.  Mercaptopurine metabolism and risk of relapse in childhood lymphoblastic leukaemia , 1994, The Lancet.

[18]  L. Capps.  Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare , 2003 .

[19]  R. Cooper,et al.  Commentary: considerations for use of racial/ethnic classification in etiologic research. , 2001, American journal of epidemiology.

[20]  R. Ragusa,et al.  6-Mercaptopurine cumulative dose: a critical factor of maintenance therapy in average risk childhood acute lymphoblastic leukemia. , 1994, Pediatric hematology and oncology.

[21]  J. Shuster,et al.  Racial differences in the survival of childhood B-precursor acute lymphoblastic leukemia: a Pediatric Oncology Group Study. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[22]  J. Young,et al.  Racial/ethnic diversity in children's oncology clinical trials , 2009, Cancer.

[23]  E. Franco,et al.  Diagnosis delays in childhood cancer , 2007, Cancer.

[24]  C. Pui,et al.  Effect of race on the outcome of pediatric patients with Hodgkin's lymphoma. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[25]  H. McLeod,et al.  Ethnic differences in thiopurine methyltransferase pharmacogenetics: evidence for allele specificity in Caucasian and Kenyan individuals. , 1999, Pharmacogenetics.

[26]  Mph Saro H. Armenian DO,et al.  Chronic Health Conditions in Childhood Cancer Survivors: Is it All Treatment-Related—or Do Genetics Play a Role? , 2009, Journal of General Internal Medicine.

[27]  H. Freeman.  Cancer in the socioeconomically disadvantaged , 1989, CA: a cancer journal for clinicians.

[28]  J. Poole,et al.  Pattern of 6‐Mercaptopurine Urinary Excretion in Children with Acute Lymphoblastic Leukemia: Urinary Assays as a Measure of Drug Compliance , 1992, Therapeutic Drug Monitoring.

[29]  James R. Anderson,et al.  Children from ethnic minorities have benefited equally as other children from contemporary therapy for rhabdomyosarcoma: a report from the Intergroup Rhabdomyosarcoma Study Group. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[30]  Mark L. Greenberg,et al.  Systemic exposure to mercaptopurine as a prognostic factor in acute lymphocytic leukemia in children. , 1990, The New England journal of medicine.

[31]  Barbara Hero,et al.  The International Neuroblastoma Risk Group (INRG) classification system: an INRG Task Force report. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[32]  T. Byers,et al.  The American Cancer Society challenge goals , 1999, Cancer.

[33]  J. Downing,et al.  Results of therapy for acute lymphoblastic leukemia in black and white children. , 2003, JAMA.

[34]  J. Berg,et al.  Ethnic variation of thiopurine S-methyltransferase activity: a large, prospective population study. , 2008, Pharmacogenomics.

[35]  M. Schrappe,et al.  Polymorphisms within glutathione S-transferase genes (GSTM1, GSTT1, GSTP1) and risk of relapse in childhood B-cell precursor acute lymphoblastic leukemia: a case-control study. , 2000, Blood.

[36]  S. Meshinchi,et al.  Ethnicity and survival in childhood acute myeloid leukemia: a report from the Children's Oncology Group. , 2006, Blood.

[37]  J. Lilleyman,et al.  Intracellular metabolites of mercaptopurine in children with lymphoblastic leukaemia: a possible indicator of non-compliance? , 1995, British Journal of Cancer.

[38]  M. Loh,et al.  Cytogenetics of Hispanic and White Children with Acute Lymphoblastic Leukemia in California , 2006, Cancer Epidemiology Biomarkers & Prevention.

[39]  M. Relling,et al.  Mercaptopurine therapy intolerance and heterozygosity at the thiopurine S-methyltransferase gene locus. , 1999, Journal of the National Cancer Institute.

[40]  S. Levitus,et al.  US Government Printing Office , 1998 .

[41]  C. Pui,et al.  Effect of race on outcome of white and black children with acute myeloid leukemia: The St. Jude experience , 2007, Pediatric blood & cancer.

[42]  Leslie Bernstein,et al.  Childhood cancer patients' access to cooperative group cancer programs , 2003, Cancer.

[43]  B. Stanton,et al.  Pediatric brain tumors in Non-Hispanics, Hispanics, African Americans and Asians: differences in survival after diagnosis , 2005, Cancer Causes & Control.

[44]  C. Pui,et al.  Thiopurine methyltransferase activity in American white subjects and black subjects , 1994, Clinical pharmacology and therapeutics.

[45]  J. Lilleyman,et al.  Variable mercaptopurine metabolism in children with leukaemia: a problem of non-compliance? , 1993, BMJ.

[46]  A. Green,et al.  Hypertension in multicultural and minority populations: Linkin communication to compliance , 1999, Current hypertension reports.

[47]  K. Ness,et al.  Survival variability by race and ethnicity in childhood acute lymphoblastic leukemia. , 2003, JAMA.

[48]  D. Stram,et al.  Biologic factors determine prognosis in infants with stage IV neuroblastoma: A prospective Children's Cancer Group study. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[49]  S. Bhatia,et al.  Racial and ethnic disparities in risk and survival in children with neuroblastoma: a Children's Oncology Group study. , 2011, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[50]  J. Lilleyman,et al.  6-Mercaptopurine dose escalation and its effect on drug tolerance in childhood lymphoblastic leukaemia , 1996, Cancer Chemotherapy and Pharmacology.

[51]  S. Swindells,et al.  Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy. , 1999, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[52]  W. Hadden,et al.  The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. , 1993, The New England journal of medicine.

[53]  C. Pui,et al.  Outcome of treatment for childhood cancer in black as compared with white children. The St Jude Children's Research Hospital experience, 1962 through 1992. , 1995, JAMA.

[54]  D. Collier,et al.  The frequency and distribution of thiopurine methyltransferase alleles in Caucasian and Asian populations. , 1999, Pharmacogenetics.

[55]  J. Ross,et al.  Childhood and adolescent cancer survival in the US by race and ethnicity for the diagnostic period 1975‐1999 , 2008, Cancer.

[56]  H. Freeman.  Commentary on the meaning of race in science and society. , 2003, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[57]  H. Freeman.  Cancer in the economically disadvantaged , 1989, Cancer.

[58]  A. Lippman.  Adherence to medication. , 2005, The New England journal of medicine.

[59]  R. Arceci,et al.  Prognostic factors and risk-based therapy in pediatric acute myeloid leukemia , 2003, Current oncology reports.

[60]  C. Stiller.  Centralisation of treatment and survival rates for cancer. , 1988, Archives of disease in childhood.