Black Children More Likely to Die From Neuroblastoma, Study Finds

Physorg.com, November 22, 2010

Black, Asian, and Native American children are more likely than white and Hispanic children to die after being treated for neuroblastoma, according to new research on the pediatric cancer. The study, of more than 3,500 patients with the disease, is the largest ever to look at racial disparities in risk and survival for the most common solid cancer found in young children.

The study also found that black and Native American children are more likely to have the high-risk form of the disease and show signs of resistance to modern treatment. Those biological characteristics suggest that genetic factors contribute to the outcome disparities found for neuroblastoma.

“Disparities in outcome according to race do exist in neuroblastoma,” said Susan Cohn, MD, professor of pediatrics at Comer Children’s Hospital at the University of Chicago Medical Center and senior author of the study. “There are racial cohorts of patients who do more poorly than the white population.”

The analysis, published online November 22 by the Journal of Clinical Oncology, uses data collected by the Children’s Oncology Group (COG), a partnership of more than 200 clinical sites in North America. {snip}

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“By definition, if you are older and have advanced stage disease, you are at high risk for relapse and more difficult to cure,” Cohn said. “The major reason why the black patients do worse is because there are more of them in this high-risk group.”

Another disparity emerged when researchers looked at the timing of post-treatment events such as cancer relapse or progression. After two event-free years following diagnosis, black patients with high-risk disease were significantly more likely to suffer a “late-occurring” event than white patients. This observation suggests black patients are more likely to have residual cancer after therapy, Cohn said.

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The study also offers a potentially unique example of a disparity due primarily to biological, rather than socioeconomic factors. In many adult cancer types, the survival gap between white and minority patients is often attributed to factors such as diminished access to health care, delayed diagnosis, and poorer quality treatment.

But in neuroblastoma, this is less likely to be an issue. Low-risk cancers rarely progress to a higher risk with time, Cohn said, making a delayed diagnosis less likely to affect outcome. Furthermore, treatment for high-risk neuroblastoma–including intravenous chemotherapy, stem cell transplant, and radiation–is largely administered in a hospital setting, removing the effect of compliance, such as missing oral doses of medications at home.

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[The full text of “Antitumor Activity of Hu14.18-IL2 in Patients With Relapsed/Refractory Neuroblastoma: A Children’s Oncology Group (COG) Phase II Study” can be read here. There is a charge.]

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