Co-Authors:
Helen Parsons, Logan Spector, Christopher Moertel

Advisor:
Dr. Helen Parsons

Educational Objectives:
Describe how race impacts treatment outcomes of pediatric brain and CNS tumors in the United States after accounting for SES.

Keywords:
Pediatric Cancer, Racial disparities

Abstract

Background: Despite improvements in survival for pediatric cancers, treatment disparities remain for racial/ethnic minorities compared to non-Hispanic whites; however, the impact of race/ethnicity on outcomes for pediatric brain and central nervous system (CNS) tumors are not well-known.

Methods: We included children aged 0 – 19 years diagnosed with primary, malignant brain and CNS tumors between 2000 – 2015 in the Surveillance, Epidemiology and End Results Program. We used Chi-square tests to assess sociodemographic and cancer characteristics by race/ethnicity (non-Hispanic Whites, non-Hispanic Blacks, Hispanics and other racial groups). We then used Kaplan–Meier curves and Cox proportional hazards models to examine differences in 10-year survival by race/ethnicity, adjusting for socio-demographics, cancer and treatment characteristics.

Results: Among 8,713 children with brain and CNS tumors, 56.75% were non-Hispanic White, 9.59% non-Hispanic Black, 25.46% Hispanic, and 8.19% were from other racial/ethnic groups. Median unadjusted survival for all pediatric brain tumors was 53 months, but varied significantly by race/ethnicity (median survival: 62 months for Non-Hispanic whites, 41 months for Non-Hispanic blacks, and 40 months for Hispanics/Other race/ethnicities). Adjusting for socio-demographics, cancer and treatment characteristics, minority racial groups continued to have significantly higher hazard of death than Non-Hispanic whites; Hispanic [aHR 1.25(1.18- 1.31)]; Non-Hispanic black [aHR 1.12(1.04-1.21)]; Other [aHR 1.22(1.12- 1.32)]. Results were consistent when stratified by tumor histology.

Discussion: We identified continued disparities in survival among racial/ethnic minorities with pediatric brain and CNS tumor survival, with Hispanic patients having the highest risk of mortality. Eliminating these disparities requires continued commitment towards promoting equity in healthcare delivery.