Daniel J Zheng1,2, Anran Li3, Clement Ma4,5, Karina B Ribeiro6, Lisa Diller1,4,5, Kira Bona1,4,5,7, Jonathan M Marron1,4,5,7,8. 1. Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA. 2. Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA. 3. University of Michigan Medical School, Ann Arbor, Michigan, USA. 4. Harvard Medical School, Boston, Massachusetts, USA. 5. Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA. 6. Department of Social Medicine, Faculdade de Ciencias Médicas da Santa Casa de São Paulo, Sao Paulo, Brazil. 7. Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA. 8. Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA.
Abstract
BACKGROUND: Modern therapeutic advances in high-risk neuroblastoma have improved overall survival (OS), but it is unclear whether these survival gains have been equitable. This study examined the relationship between socioeconomic status (SES) and overall survival (OS) in children with high-risk neuroblastoma and whether SES-associated disparities have changed over time. PROCEDURE: In this population-based cohort study, children <18 years diagnosed with high-risk neuroblastoma (diagnosis at age ≥12 months with metastatic disease) from 1991 to 2015 were identified through the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Associations of county-level SES variables and OS were tested with univariate Cox proportional hazards regression. For a subcohort diagnosed after 2007, insurance status was examined as an individual-level SES variable. Multivariable regression analyses with treatment era and interaction terms were performed when SES variables reached near-significance (p ≤ .1) in univariate and bivariate modeling with treatment era. RESULTS: Among 1217 children, 2-year OS improved from 53.0 ± 3.4% in 1991-1998 to 76.9 ± 2.9% in 2011-2015 (p < .001). In univariate analyses, children in high-poverty counties (hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.17-2.60, p = .007), and those with Medicaid (HR = 1.40, 95% CI = 1.05-1.86, p = .02) experienced an increased hazard of death. No interactions between treatment era and SES variables were statistically significant in multivariable analyses, indicating that differences in the OS between SES groups did not change over time. CONCLUSIONS: Survival disparities among children with high-risk neuroblastoma have not widened over time, suggesting equitable access to and benefit from therapeutic advances. However, children of low SES experience persistently inferior survival. Interventions to narrow this disparity are paramount.
BACKGROUND: Modern therapeutic advances in high-risk neuroblastoma have improved overall survival (OS), but it is unclear whether these survival gains have been equitable. This study examined the relationship between socioeconomic status (SES) and overall survival (OS) in children with high-risk neuroblastoma and whether SES-associated disparities have changed over time. PROCEDURE: In this population-based cohort study, children <18 years diagnosed with high-risk neuroblastoma (diagnosis at age ≥12 months with metastatic disease) from 1991 to 2015 were identified through the National Cancer Institute's Surveillance, Epidemiology, and End Results database. Associations of county-level SES variables and OS were tested with univariate Cox proportional hazards regression. For a subcohort diagnosed after 2007, insurance status was examined as an individual-level SES variable. Multivariable regression analyses with treatment era and interaction terms were performed when SES variables reached near-significance (p ≤ .1) in univariate and bivariate modeling with treatment era. RESULTS: Among 1217 children, 2-year OS improved from 53.0 ± 3.4% in 1991-1998 to 76.9 ± 2.9% in 2011-2015 (p < .001). In univariate analyses, children in high-poverty counties (hazard ratio [HR] = 1.74, 95% confidence interval [CI] = 1.17-2.60, p = .007), and those with Medicaid (HR = 1.40, 95% CI = 1.05-1.86, p = .02) experienced an increased hazard of death. No interactions between treatment era and SES variables were statistically significant in multivariable analyses, indicating that differences in the OS between SES groups did not change over time. CONCLUSIONS: Survival disparities among children with high-risk neuroblastoma have not widened over time, suggesting equitable access to and benefit from therapeutic advances. However, children of low SES experience persistently inferior survival. Interventions to narrow this disparity are paramount.
Authors: Julie R Park; Susan G Kreissman; Wendy B London; Arlene Naranjo; Susan Lerner Cohn; Michael D Hogarty; Sheena C Tenney; Daphne Haas-Kogan; Peter John Shaw; Jacqueline M Kraveka; Stephen S Roberts; James Duncan Geiger; John J Doski; Stephan D Voss; John M Maris; Stephan A Grupp; Lisa Diller Journal: JAMA Date: 2019-08-27 Impact factor: 56.272
Authors: Susan L Cohn; Andrew D J Pearson; Wendy B London; Tom Monclair; Peter F Ambros; Garrett M Brodeur; Andreas Faldum; Barbara Hero; Tomoko Iehara; David Machin; Veronique Mosseri; Thorsten Simon; Alberto Garaventa; Victoria Castel; Katherine K Matthay Journal: J Clin Oncol Date: 2008-12-01 Impact factor: 44.544
Authors: Navin R Pinto; Mark A Applebaum; Samuel L Volchenboum; Katherine K Matthay; Wendy B London; Peter F Ambros; Akira Nakagawara; Frank Berthold; Gudrun Schleiermacher; Julie R Park; Dominique Valteau-Couanet; Andrew D J Pearson; Susan L Cohn Journal: J Clin Oncol Date: 2015-08-24 Impact factor: 44.544
Authors: Lucy E Marcil; Michael K Hole; Larissa M Wenren; Megan S Schuler; Barry S Zuckerman; Robert J Vinci Journal: Pediatrics Date: 2018-05-18 Impact factor: 7.124
Authors: Ruth Ladenstein; Ulrike Pötschger; Andrew D J Pearson; Penelope Brock; Roberto Luksch; Victoria Castel; Isaac Yaniv; Vassilios Papadakis; Geneviève Laureys; Josef Malis; Walentyna Balwierz; Ellen Ruud; Per Kogner; Henrik Schroeder; Ana Forjaz de Lacerda; Maja Beck-Popovic; Pavel Bician; Miklós Garami; Toby Trahair; Adela Canete; Peter F Ambros; Keith Holmes; Mark Gaze; Günter Schreier; Alberto Garaventa; Gilles Vassal; Jean Michon; Dominique Valteau-Couanet Journal: Lancet Oncol Date: 2017-03-02 Impact factor: 41.316
Authors: Michael Roth; Amy Berkman; Clark R Andersen; Branko Cuglievan; J Andrew Livingston; Michelle Hildebrandt; Archie Bleyer Journal: Oncologist Date: 2022-03-04 Impact factor: 5.837