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Hunleth J, Burack S, Kaufman L, Mohrmann C, Shato T, Wiedenman E, Njelesani J. Inequities in childhood cancer research: A scoping review. EJC PAEDIATRIC ONCOLOGY 2024; 4:100171. [PMID: 38948690 PMCID: PMC11210713 DOI: 10.1016/j.ejcped.2024.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
An integral part of understanding and then designing programs to reduce childhood cancer inequities includes adequate representation of people with cancer in research, including children. A scoping review was carried out to understand how cancer research is oriented toward inequities and to identify who has participated in childhood qualitative cancer research. A systematic search identified 119 qualitative studies that met inclusion criteria, with most studies taking place in high-income countries (n=84). Overall, data were lacking on social determinants of health at multiple levels-structural, household, child, and guardian. Only 29 studies reported on race and/or ethnicity, with the majority of those including predominantly or all white children. Six articles included socioeconomic information, and across most articles, attention was absent to the financial ramifications of cancer care. Limited reporting of sociodemographics highlights a broader issue of neglecting key demographics and social factors that contribute to inequities.
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Affiliation(s)
- Jean Hunleth
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Sarah Burack
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Lindsey Kaufman
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
| | - Caroline Mohrmann
- Division of Pediatric Hematology/Oncology, Washington University in St. Louis, USA
| | - Thembekile Shato
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, USA
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, St. Louis, USA
| | - Eric Wiedenman
- Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Janet Njelesani
- Department of Occupational Therapy, New York University, New York, USA
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Wellbrock M, Voigt M, Ronckers C, Grabow D, Spix C, Erdmann F. Registration, incidence patterns, and survival trends of central nervous system tumors among children in Germany 1980-2019: An analysis of 40 years based on data from the German Childhood Cancer Registry. Pediatr Blood Cancer 2024; 71:e30954. [PMID: 38532243 DOI: 10.1002/pbc.30954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Tumors of the central nervous system (CNS) are the second most common type of pediatric cancer in Germany. We aimed to describe registration practice, incidence, and survival patterns for childhood CNS tumors in Germany for the past 40 years. PROCEDURE Including all CNS tumor cases in children diagnosed at ages 0-14 years registered at the German Childhood Cancer Registry (GCCR) in 1980-2019 (for survival analysis 1980-2016), we calculated age-specific and age-standardized incidence rates (ASIR) over time, average annual percentage changes (AAPC), and 1- and 5-year overall survival. RESULTS While we observed a pronounced increase in ASIR after the establishment of the GCCR during the 1980s, ASIR for all pediatric CNS tumors combined continued to increase markedly from 28.6 per million in 1990-1999 to 43.3 in 2010-2019 (AAPC = 2.7% in 1991-2010, AAPC = 0.3% in 2010-2019). The 5-year overall survival from CNS tumors improved from 63% in the 1980s, 70% in the 1990s to 79% in 2010-2016. These improvements have occurred across all age groups. Children diagnosed with ependymomas and choroid plexus tumors experienced the strongest increase (from 54% to 81%). CONCLUSIONS Observed increases in incidence rates for pediatric CNS tumors are likely only partially caused by actual increasing case numbers. The majority is a function of improved registration and, to a minor extent, improvements in diagnostics. Survival from pediatric CNS tumors has, by and large, improved consistently, leading to a growing population of childhood cancer survivors with diverse health biographies and risk of lifelong adverse impact on health and wellbeing.
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Affiliation(s)
- Maike Wellbrock
- Research Group Aetiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Mathias Voigt
- German Childhood Cancer Registry/Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Cecile Ronckers
- German Childhood Cancer Registry/Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Desiree Grabow
- German Childhood Cancer Registry/Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Claudia Spix
- German Childhood Cancer Registry/Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Friederike Erdmann
- Research Group Aetiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Mogensen H, Erdmann F, Mader L, Vrelits Sørensen G, Talbäck M, Tjørnelund Nielsen T, Hasle H, Heyman M, Winther JF, Feychting M, Tettamanti G, Kenborg L. Early mortality in children with cancer in Denmark and Sweden: The role of social background in a setting with universal healthcare. Int J Cancer 2024; 154:1719-1730. [PMID: 38259167 DOI: 10.1002/ijc.34851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/06/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024]
Abstract
Socioeconomic differences in overall survival from childhood cancer have been shown previously, but the underlying mechanisms remain unclear. We aimed to investigate if social inequalities were seen already for early mortality in settings with universal healthcare. From national registers, all children diagnosed with cancer at ages 0-19 years, during 1991-2014, in Sweden and Denmark, were identified, and information on parental social characteristics was collected. We estimated odds ratios (OR) and 95% confidence intervals (CI) of early mortality (death within 90 days after cancer diagnosis) by parental education, income, employment, cohabitation, and country of birth using logistic regression. For children with acute lymphoblastic leukaemia (ALL), clinical characteristics were obtained. Among 13,926 included children, 355 (2.5%) died within 90 days after diagnosis. Indications of higher early mortality were seen among the disadvantaged groups, with the most pronounced associations observed for maternal education (ORadj_Low_vs_High 1.65 [95% CI 1.22-2.23]) and income (ORadj_Q1(lowest)_vs_Q4(highest) 1.77 [1.25-2.49]). We found attenuated or null associations between social characteristics and later mortality (deaths occurring 1-5 years after cancer diagnosis). In children with ALL, the associations between social factors and early mortality remained unchanged when adjusting for potential mediation by clinical characteristics. In conclusion, this population-based cohort study indicated differences in early mortality after childhood cancer by social background, also in countries with universal healthcare. Social differences occurring this early in the disease course requires further investigation, also regarding the timing of diagnosis.
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Affiliation(s)
- Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Cancer Registry Bern-Solothurn, University of Bern, Bern, Switzerland
| | - Gitte Vrelits Sørensen
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mats Heyman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Giorgio Tettamanti
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Line Kenborg
- Childhood Cancer Research Group, Danish Cancer Institute, Copenhagen, Denmark
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Kilic M, Gunen Yilmaz S, Kockopru ZM. Evaluation of oral health-related quality of life in children with acute lymphocytic leukemia/acute myelocytic leukemia: A cross-sectional study. Oral Dis 2024; 30:2663-2669. [PMID: 37203435 DOI: 10.1111/odi.14614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 02/03/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Chemotherapy and radiotherapy, used to treat childhood hematological malignancies (acute lymphocytic leukemia [ALL] and acute myelocytic leukemia [AML]) can negatively affect oral tissues and organs. This study aimed to evaluate the oral health-related quality of life in children with ALL/AML. MATERIALS AND METHODS A total of 99 children, including 49 undergoing ALL/AML (41 with ALL and eight with AML) and 50 healthy volunteers, were included in this cross-sectional study. The mean age of the entire study group was 78.63 ± 34.41 months. The mean age of the ALL/AML and control groups was 87.12 ± 35.04 and 70.95 ± 34.85 months, respectively. The Simplified Oral Hygiene Index (SOHI), the Decayed, Missing, and Filled Teeth (DMFT/dmft) index, and the Turkish version of the Early Childhood Oral Health Impact Scale (ECOHIS-T) were administered to all children. The data were analyzed using SPSS software (version 22.0). The Pearson chi-square and Fisher's exact tests were used to compare demographic data. RESULTS The age and gender distributions of the two groups were similar. According to ECOHIS-T, the children in the ALL/AML group had significantly more loss of function (eating, drinking, sleeping, etc.) than those in the control group. CONCLUSIONS Oral health and self-care were negatively affected by childhood ALL/AML and its treatment.
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Affiliation(s)
- Munevver Kilic
- Department of Pedodontics, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Sevcihan Gunen Yilmaz
- Department of Maxillofacial Radiology, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
| | - Zehra Merve Kockopru
- Department of Pedodontics, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
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Jeon KH, Shin DW, Lee JW, Baek HJ, Chung NG, Sung KW, Song YM. Parent caregivers' preferences and satisfaction with currently provided childhood cancer survivorship care. J Cancer Surviv 2024; 18:617-630. [PMID: 36396908 DOI: 10.1007/s11764-022-01287-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to investigate the level of satisfaction of parent caregivers of childhood cancer survivors (CCSs) with currently provided survivorship care and their preferences for survivorship care provider. METHODS Study subjects were parent caregivers recruited at three hospitals in Korea. Study data were collected from self-administered questionnaires and medical records. We assessed parent caregivers' levels of satisfaction with specific survivorship care contents and preferred types of survivorship care provider among oncologists, primary care physicians (PCPs), and institutional general physicians (IGPs). Factors associated with parent caregivers' preferences for survivorship care provider were evaluated by multiple logistic regression analysis. RESULTS 680 parent caregivers (mother 62.1% and father 37.9%) of 487 CCSs (mean age at diagnosis: 6.9 ± 5.1 years; mean time since treatment completion 5.4 ± 4.4 years) were included. Parent caregivers' dissatisfaction was the highest with screening for second primary cancer, followed by psychosocial problem management. Higher educational level of parent caregiver, parent caregiver's higher level of dissatisfaction with currently provided care, higher age of CCSs at cancer diagnosis, history of receiving hematopoietic stem cell transplant, and longer time lapse after cancer treatment were significantly associated with parent caregivers' higher preference for PCPs or IGPs than oncologists. Parent caregiver's multiple comorbidities and higher fear of cancer recurrence were associated with parent caregivers' higher preference for oncologists than PCPs or IGPs. Around 80% of parent caregivers recognized that a shared care system was helpful for promoting the health of CCSs. CONCLUSION Parent caregivers were substantially dissatisfied with currently provided care, especially regarding the health issues not directly associated with the primary cancer. Parent caregivers' preferences for survivorship care provider is influenced by multiple factors, including age and survival time of CCSs, characteristics of parent caregivers, satisfaction level with care, and specific survivorship care contents. IMPLICATIONS FOR CANCER SURVIVORS The findings of our study suggest that shared survivorship care for CCSs with consideration of specific care contents can complement the current oncologist-led survivorship care system.
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Affiliation(s)
- Keun Hye Jeon
- Department of Family Medicine, CHA Gumi Medical Center, CHA University, Gumi, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jo Baek
- Department of Pediatrics, Chonnam National University Hwasun Hospital, Donggu, Gwangju, Republic of Korea
| | - Nack-Gyun Chung
- Department of Pediatrics, the Catholic University of Korea School of Medicine, Seoul St. Mary's Hospital, Seoul, South Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun-Mi Song
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
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Okada H, Irie W, Sugahara A, Nagoya Y, Saito M, Sasahara Y, Yoshimoto Y, Iwasaki F, Inoue M, Sato M, Ozawa M, Kusuki S, Kamizono J, Ishida Y, Suzuki R, Nakajima-Yamaguchi R, Shiwaku H. Factors associated with employment status among mothers of survivors of childhood cancer: a cross-sectional study. Support Care Cancer 2023; 31:168. [PMID: 36781507 PMCID: PMC9925358 DOI: 10.1007/s00520-023-07623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE To identify the factors associated with employment status among mothers of childhood cancer survivors (CCSs). METHODS We conducted a questionnaire survey on mothers of survivors of childhood cancer to clarify practical factors such as care demands, psychological factors such as motivation to work, and support. After calculating descriptive statistics for all variables, binary logistic regression analysis was performed. RESULTS Of 171 mothers, 129 (75.4%) were employed. The most common form of employment was non-regular (n = 83; 48.5%), including part-time, dispatched, and fixed-term workers. At the time of the survey, compared with nonworking mothers, working mothers tended to be more motivated to work and have lower scores for "Long-term Uncertainty" on the Parent Experience of Child Illness Scale. The results of the binary logistic regression analysis indicated that employment was related to higher motivation to work, the continuation of employment during treatment, more outpatient visits, and a higher amount of support. CONCLUSION As employment of CCSs' mothers is associated with psychological factors such as motivation to work and long-term uncertainty, psychological support for CCSs' mothers might promote employment. In addition, because the continuation of employment during treatment affects the employment of mothers after the end of cancer treatment, a leave system that covers the treatment period for childhood cancer needs to be established.
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Affiliation(s)
- Hiromi Okada
- Department of Child Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan. .,Faculty of Healthcare, Tokyo Healthcare University, 4-1-17 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8648, Japan.
| | - Wataru Irie
- Department of Child Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Akiko Sugahara
- Department of Child Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yuko Nagoya
- Department of Child Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Nursing, Miyagi University, Sendai, Miyagi, Japan
| | - Masayo Saito
- Department of Child Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Nursing, School of Health Science, Akita University Graduate School of Medicine and Faculty of Medicine, Akita, Akita, Japan
| | - Yoji Sasahara
- Department of Pediatrics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | | | - Fuminori Iwasaki
- Division of Hematology and Oncology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Masami Inoue
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Maho Sato
- Department of Hematology/Oncology, Osaka Women's and Children's Hospital, Izumi, Osaka, Japan
| | - Miwa Ozawa
- Department of Pediatrics, St. Luke's International Hospital, Chuo-Ku, Tokyo, Japan
| | | | - Junji Kamizono
- Children's Medical Center, Kitakyushu City Yahata Hospital, Kitakyushu, Fukuoka, Japan
| | - Yasushi Ishida
- Pediatric Medical Center, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Ryoko Suzuki
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Hitoshi Shiwaku
- Department of Child Health Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Jensen A, Greisen G, Stensballe LG. Socioeconomic background affects mortality in Danish children with severe chronic disease. Acta Paediatr 2022; 111:2393-2399. [PMID: 36093628 PMCID: PMC9825841 DOI: 10.1111/apa.16540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 01/11/2023]
Abstract
AIM To assess the association between socioeconomic factors and mortality in Danish children diagnosed with different types of severe chronic disease, including cancer. METHODS National cohort study 1994-2020 including Danish children with chronic disease. Inclusion was based on diagnoses in The National Patient Register, socioeconomic information was obtained from Statistics Denmark and mortality was ascertained from the Cause of Death Register. Hazard ratios (HR) with 95% confidence intervals (CIs) were based on Cox regression. The factors were combined in one common risk score and the association with disease-specific mortality was analysed overall and by ethnicity status. RESULTS Overall, non-Danish ethnicity (HR = 1.96 (95% CI 1.69-2.28)) was associated with all-cause mortality in 128 129 children (69 435 male and 58 694 female) with chronic disease. Median age at first diagnosis was 1.42 years (range 0-18 years). Low family income was associated with mortality regardless of ethnicity status, and young maternal age was also a notable risk factor across ethnicities. The socioeconomic association was more pronounced in children with cancer. CONCLUSION In the high-income setting of Denmark, ethnicity and differences in socioeconomic background were associated with child mortality even among children with severe chronic disease. The pattern was more pronounced in paediatric cancer patients.
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Affiliation(s)
- Andreas Jensen
- Department of Paediatrics and Adolescent MedicineRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Gorm Greisen
- Department of Intensive Care of Newborns and Small ChildrenRigshospitalet, Copenhagen University HospitalCopenhagenDenmark,Institute of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Lone Graff Stensballe
- Department of Paediatrics and Adolescent MedicineRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
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Chalfant V, Riveros C, Stec AA. Effect of social disparities on 10 year survival in pediatric patients with Wilms' tumor. Cancer Med 2022; 12:3452-3459. [PMID: 35946133 PMCID: PMC9939224 DOI: 10.1002/cam4.5124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/12/2022] [Accepted: 07/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To stratify 10-year survival outcomes by degree of social disparities in pediatric Wilms' tumor patients. We applied the Social Deprivation Index (SDI) to survival outcomes from the national SEER database to elucidate the effects of lower socioeconomics on cancer survival. METHODS A retrospective cohort study was performed using the national Surveillance, Epidemiology, and End Results (SEER) oncology registry from 1975 to 2016 based on county-level data. Pediatric patients (<18 years old) with a diagnosis of WT (C64.9) and confirmed based on histology codes (8960/8963) were included. SDI scores were calculated for each patient and initially divided into quintiles. Patients were delineated into high-risk (>60th percentile/more deprived) or low-risk (<60th percentile/less deprived) groups. Statistics were assessed using Fisher's exact test, Student's t-test, and Kaplan-Meier assessed survival differences with log-rank test for trend. RESULTS A total of 3406 patients were included with 1366 patients reported in the high-risk group and 2040 patients in the low-risk group. Quintile data demonstrated a stratification in survival based on socioeconomic status. Patients in more socially deprived counties were significantly (p = 0.035) more likely to have worse overall survival compared with those living in less deprived areas at 10-year (87.3% vs 89.3%) follow-up. CONCLUSIONS 10-year overall and cancer-specific survival data for patients with Wilms' tumor stratify by socioeconomic lines. This represents an area that needs to be addressed in this pediatric oncologic population. Patients from more socially deprived areas have significantly worse 10-year overall survival rates and noticeably different 10-year cancer-specific survival rates.
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Affiliation(s)
- Victor Chalfant
- Department of UrologyCreighton University School of MedicineOmahaNebraskaUSA
| | - Carlos Riveros
- Department of UrologyUniversity of Florida HealthJacksonvilleFloridaUSA
| | - Andrew A. Stec
- Division of UrologyNemours Children's HealthJacksonvilleFloridaUSA
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Outcomes of Lymphoma Among American Adolescent and Young Adult Patients Varied by Health Insurance-A SEER-based Study. J Pediatr Hematol Oncol 2022; 44:e403-e412. [PMID: 34486562 DOI: 10.1097/mph.0000000000002314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/06/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Impacts of health insurance status on survival outcomes among adolescent and young adult (AYA, 15 to 39 years of age) patients with lymphoma in the United States are insufficiently known. This study aimed to clarify associations between health insurance status and overall survival (OS) estimates in this population. MATERIALS AND METHODS We examined 18 Surveillance, Epidemiology, and End Results registries in the United States and analyzed American AYA patients with lymphoma diagnosed during January 2007 and December 2016. Health insurance status was categorized, and Kaplan-Meier and multifactor Cox regressions were adopted using hazard ratio and 95% confidence interval. Probable baseline confounding was modulated by multiple propensity score. RESULTS A total of 21,149 patients were considered; ~28% were 18 to 25 years old, and 63.5% and 7.5% had private and no insurance, respectively. Private insurance rates increased in the 18 to 25 age group (60.1% to 6.1%, P<0.001) following the 2010 Patient Protection and Affordable Care Act (ACA), and lymphoma survival rates improved slightly 1 to 5 years postdiagnosis. Five-year OS rates decreased with age (93.9%, 90.4%, and 87.0% at 15 to 17, 18 to 25, and 26 to 39, respectively) and differed among insurance conditions (81.7%, 79.2%, 89.2%, and 92.0% for uninsured, Medicaid, insured, and insured/no specifics, respectively). Risk of death was significantly higher for those with Medicaid or no insurance than for those with private insurance in multiple propensity score-adjusted models (hazard ratio [95% confidence interval]=1.07 [1.03-1.12]), independent of stage at diagnosis. CONCLUSIONS No or insufficient insurance was linked to poor OS in our sample in exposure-outcome association analysis. Insurance coverage and health care availability may enhance disparate outcomes of AYAs with cancer. The ACA has improved insurance coverage and survival rates for out sample. Nevertheless, strategies are needed to identify causality and eliminate disparities.
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Adel Fahmideh M, Schraw JM, Chintagumpala M, Lupo PJ, Oluyomi AO, Scheurer ME. Neighborhood Socioeconomic Deprivation and Mortality in Children with Central Nervous System Tumors. Cancer Epidemiol Biomarkers Prev 2021; 30:2278-2285. [PMID: 34620627 PMCID: PMC9058976 DOI: 10.1158/1055-9965.epi-21-0368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/29/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although there is evidence of socioeconomic disparities in survival of children diagnosed with central nervous system (CNS) tumors, the impact of neighborhood socioeconomic deprivation on the survival of these malignancies has not been adequately studied. We investigated the association between area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, and pediatric CNS tumor survival. METHODS Demographic and clinical characteristics, geocoded addresses at diagnosis, and vital status of pediatric CNS tumor cases (n = 5,477) for the period 1995 to 2017 were obtained from the Texas Cancer Registry. ADI scores were computed for census tracts in Texas using the U.S. Census Bureau 2010 geography. Tracts were classified into quartiles as least, third-most, second-most, and most disadvantaged. Children were mapped to quartiles based on residency at diagnosis. The adjusted hazard ratio (HR) and 95% confidence interval (CI) were calculated. RESULTS The results showed a significantly increased HR for death among children in the most (HR, 1.29; 95% CI, 1.09-1.51), second-most (HR, 1.18; 95% CI, 1.01-1.38), and third-most disadvantaged census tracts (HR, 1.18; 95% CI, 1.02-1.37) compared with children in the least disadvantaged tracts. CONCLUSIONS Children living in the most disadvantaged neighborhoods experienced a significantly higher risk of mortality, indicating the important role of socioeconomic disparities in the survival of pediatric CNS tumors. IMPACT The demographic and socioeconomic disparities identified by this study should be considered when planning treatment strategies for these susceptible groups and thus, lead to a better outcome in socioeconomically disadvantaged children diagnosed with CNS tumors.
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Affiliation(s)
- Maral Adel Fahmideh
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas.
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston Texas
| | - Jeremy M Schraw
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston Texas
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
| | - Murali Chintagumpala
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
| | - Philip J Lupo
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston Texas
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
| | - Abiodun Olufemi Oluyomi
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Michael E Scheurer
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston Texas
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, Texas
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11
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Sylvest R, Vassard D, Schmidt L, Schmiegelow K, Macklon KT, Forman JL, Pinborg A. Family Formation and Socio-Economic Status among 35-Year-Old Men Who Have Survived Cancer in Childhood and Early Adulthood: A Register-Based Cohort Study. Oncol Res Treat 2021; 45:102-111. [PMID: 34823245 DOI: 10.1159/000520365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The number of children and young adults who survive cancer has steadily increased over the past decades. Consequently, life circumstances after cancer have gained increasing importance. The aim of this study was to explore family formation and socio-economic status among 35-year-old men having survived cancer in childhood or early adulthood compared to an age-matched comparison group. METHODS This study is a national, register-based cohort study among 35-year-old men. Men diagnosed with cancer in childhood and early adulthood were registered between 1978 and 2016. At the time of diagnosis, each patient was randomly matched with 150 men without cancer from the background population within the same birth year. Those still alive at the age of 35 years were included in the study population. RESULTS The study population consisted of 4,222 men diagnosed with cancer in childhood or early adulthood and 794,589 men in the age-matched comparison group. Men who have survived cancer during childhood or early adulthood have a reduced probability of having children, and lower probability of getting married or of cohabitation than those from an age-matched comparison group. Men who have survived CNS cancer also have a lower probability of having a higher education than high school and a higher probability of being outside the workforce than those from an age-matched comparison group. DISCUSSION/CONCLUSION Many men who have survived cancer during childhood or early adulthood are influenced by their cancer later in life, which was apparent in family formation, educational achievements, and labour market attachment. Continued focus on rehabilitation and needs for support among the male survivors of childhood and youth cancer is warranted.
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Affiliation(s)
- Randi Sylvest
- Department of Obstetrics and Gynaecology, Fertility Clinic Section 455, Hvidovre University Hospital, Hvidovre, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ditte Vassard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Schmidt
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten Tryde Macklon
- The Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Julie Lyng Forman
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anja Pinborg
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,The Fertility Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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12
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Molcho M, Thomas AA, Walsh PM, Skinner R, Sharp L. Social inequalities in treatment receipt for childhood cancers in Ireland: A population-based analysis. Int J Cancer 2021; 150:941-951. [PMID: 34706069 DOI: 10.1002/ijc.33856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 09/26/2021] [Accepted: 10/04/2021] [Indexed: 11/08/2022]
Abstract
Treatment advances over the past five decades have resulted in significant improvements in survival from childhood cancer. Although survival rates are relatively high, social disparities in outcomes have been sometimes observed. In a population-based study, we investigated social inequalities by sex and deprivation in treatment receipt in childhood cancer in Ireland. Cancers incident in people aged 0 to 19 during 1994 to 2012 and treatments received were abstracted from the National Cancer Registry Ireland. Multivariable modified Poisson regression with robust error variance (adjusting for age, and year) was used to assess associations between sex and deprivation category of area of residence at diagnosis and receipt of cancer-directed surgery, chemotherapy or radiotherapy. Three thousand seven hundred and four childhood cancers were included. Girls were significantly less likely than boys to receive radiotherapy for leukemia overall (relative risk [RR] = 0.70; 95% confidence interval [CI] = 0.50-0.98), and acute lymphoblastic leukemia specifically (RR = 0.54; 95% CI = 0.36-0.79), and surgery for central nervous system (CNS) overall (RR = 0.83; 95% CI = 0.74-0.93) and other CNS (RR = 0.76; 95% CI = 0.60-0.96). Girls were slightly less likely to receive chemotherapy for non-Hodgkin lymphoma and surgery for Hodgkin lymphoma (HL), but these results were not statistically significant. Children residing in more deprived areas were significantly less likely to receive chemotherapy for acute myeloid leukemia or surgery for lymphoma overall and HL, but more likely to receive chemotherapy for medulloblastoma. These results may suggest social inequalities in treatment receipt for childhood cancers. Further research is warranted to explore whether similar patterns are evident in other childhood cancer populations and to better understand the reasons for the findings.
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Affiliation(s)
| | - Audrey A Thomas
- School of Education, NUI Galway, Galway, Ireland.,Division of Undergraduate Education, UC Berkeley, Berkeley, California, USA
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Wolfson Childhood Cancer Research Centre, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
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13
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Pedersen LH, Erdmann F, Aalborg GL, Hjalgrim LL, Larsen HB, Schmiegelow K, Winther JF, Dalton SO. Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark: a nationwide register study. BMC Cancer 2021; 21:1104. [PMID: 34649500 PMCID: PMC8518314 DOI: 10.1186/s12885-021-08837-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022] Open
Abstract
Background While underlying mechanisms and pathways of social inequalities in cancer survival have been extensively examined in adults, this is less so for children with cancer. Hypothesized mechanisms include prediagnostic utilization of and navigation through the health care system, which may differ by socioeconomic resources of the families. In this nationwide register-based study we investigated the association between measures of family socioeconomic position in relation to prediagnostic health care contacts and stage of disease at diagnosis in children with cancer in Denmark. Methods We identified all children diagnosed with a cancer at ages 0–15 years in 1998–2016 (N = 3043) from the Danish Childhood Cancer Registry. We obtained comprehensive information on measures of socioeconomic position, parental health and prediagnostic contacts to both general practitioners and hospitals 24 months prior to diagnosis from various national registries. We fitted multivariable conditional logistic regression models for the association of family socioeconomic and health-related variables with firstly, frequent health care contacts and secondly, advanced stage. Results We found higher odds ratios (OR) of frequent both overall and emergency health care contacts in the last 3 months before diagnosis in children from households with short parental education and mixed affiliation to work market, when compared to children with high family socioeconomic position. Further, children of parents with depression or of non-Western origin, respectively, had higher OR for frequent overall and emergency contacts. We found no association between socioeconomic position, parental health and stage of disease. Conclusion Families with socioeconomic disadvantage, non-Western origin or depression more frequently utilize prediagnostic health care services, both generally and in the acute setting, indicating that some disadvantaged families may struggle to navigate the health care system when their child is sick. Reassuringly, this was not reflected in disparities in stage at diagnosis. In order to improve the diagnostic process and potentially reduce health care contacts, attention and support should be given to families with a high number of health care contacts over a short period of time. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08837-x.
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Affiliation(s)
- Line Hjøllund Pedersen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark. .,Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.
| | - Friederike Erdmann
- Division of Childhood Cancer Epidemiology, Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gitte Lerche Aalborg
- Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Lisa Lyngsie Hjalgrim
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
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14
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Poulalhon C, Goujon S, Marquant F, Faure L, Guissou S, Bonaventure A, Désandes E, Rios P, Lacour B, Clavel J. Factors associated with 5- and 10-year survival among a recent cohort of childhood cancer survivors (France, 2000-2015). Cancer Epidemiol 2021; 73:101950. [PMID: 34214767 DOI: 10.1016/j.canep.2021.101950] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Childhood cancer survival currently exceeds 80 % five years after diagnosis in high-income countries. In this study, we aimed to describe long-term trends and to investigate socioeconomic and spatial disparities in childhood cancer survival. METHODS The study included 28,073 cases recorded in the French National Registry of Childhood Cancers from 2000 to 2015. Contextual census data (deprivation indices, population density, spatial accessibility to general practitioners) were allocated to each case based on the residence at diagnosis. Overall survival (OS) and conditional 10-year OS for 5-year survivors were estimated for all cancers combined and by diagnostic group and subgroup. Comparisons were conducted by sex, age at diagnosis, period of diagnosis, and contextual indicators. Hazard ratios for death were estimated using Cox models. RESULTS All cancers combined, the OS reached 82.8 % [95 % CI: 82.4-83.3] at 5 years and 80.8 % [95 % CI: 80.3-81.3] at 10 years. Conditional 10-year OS of 5-year survivors reached 97.5 % [95 % CI: 97.3-97.7] and was higher than 95 % for all subgroups except osteosarcomas and most subgroups of the central nervous system. In addition to disparities by sex, age at diagnosis, and period of diagnosis, we observed a slight decrease in survival for cases living in the most deprived areas at diagnosis, not consistent across diagnostic groups. CONCLUSION Our results confirm the high 5-year survival for childhood cancer and show an excellent 10-year conditional survival of 5-year survivors. Additional individual data are needed to clarify the factors underlying the slight decrease in childhood cancer survival observed in the most deprived areas.
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Affiliation(s)
- Claire Poulalhon
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France.
| | - Stéphanie Goujon
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Fabienne Marquant
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Laure Faure
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Sandra Guissou
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Audrey Bonaventure
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France
| | - Emmanuel Désandes
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Paula Rios
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France
| | - Brigitte Lacour
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Jacqueline Clavel
- Epidémiologie des Cancers des Enfants et des Adolescents (EPICEA), Centre de Recherche en Epidémiologie et Statistiques (CRESS), INSERM, UMR 1153, Université de Paris, France; Registre National des Cancers de l'Enfant, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, and Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
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15
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Mogensen H, Modig K, Talbäck M, Erdmann F, Heyman M, Feychting M, Tettamanti G. Number of siblings and survival from childhood leukaemia: a national register-based cohort study from Sweden. Br J Cancer 2021; 125:112-118. [PMID: 33854211 PMCID: PMC8257570 DOI: 10.1038/s41416-021-01374-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Previous studies suggest worse leukaemia survival for children with siblings, but the evidence is sparse, inconsistent and does not consider clinical factors. We explored the associations between number of siblings in the household, birth order and survival from childhood acute lymphoid leukaemia (ALL) and acute myeloid leukaemia (AML). METHODS In this nationwide register-based study we included all children aged 1-14, diagnosed with ALL and AML between 1991-mid-2015 in Sweden (n = 1692). Using Cox regression models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) according to number of siblings and birth order, adjusting for known prognostic and sociodemographic factors. RESULTS A tendency towards better ALL survival among children with one, or ≥2, siblings was observed, adjHRs (95% CI): 0.73 (0.49-1.10) and 0.63 (0.40-1.00), respectively. However, this was mainly limited to children with low risk profiles. An indication of better AML survival among children with siblings was seen, adjHRs (95% CI) 0.68 (0.36-1.29) and 0.71 (0.34-1.48) but diminished after adjusting for birth order. CONCLUSION Our results do not support previous findings that a larger number of siblings is associated with poorer survival. Inconsistencies might be explained by underlying mechanisms that differ between settings, but chance cannot be ruled out.
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Affiliation(s)
- Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Modig
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Talbäck
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Friederike Erdmann
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Mats Heyman
- Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Giorgio Tettamanti
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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16
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Pedersen LH, Wahlberg A, Cordt M, Schmiegelow K, Dalton SO, Larsen HB. Parent's perspectives of the pathway to diagnosis of childhood cancer: a matter of diagnostic triage. BMC Health Serv Res 2020; 20:969. [PMID: 33092610 PMCID: PMC7584100 DOI: 10.1186/s12913-020-05821-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Early diagnosis is crucial for the treatment of childhood cancer as it in some cases can prevent progression of disease and improve prognoses. However, childhood cancer can be difficult to diagnose and barriers to early diagnosis are multifactorial. New knowledge about factors influencing the pathway to diagnosis contribute to a deeper understanding of the mechanisms that influence this time span. Qualitative research in the field is sparse but can be expected to lead to additional useful insights that could contribute to efforts shorten time to diagnosis. The purpose of this study was to explore parents' experiences of the pathway to diagnosis in the time between their noticing bodily or behavioural changes and their child's diagnosis. METHODS The study is a qualitative interview study carried out in large Danish hospital. Thirty-two interviews with a total of 46 parents of children with cancer were included for analysis. The children were diagnosed with haematological cancers (n = 17), solid tumours (n = 9) or brain tumours (n = 6). Data were analysed applying the theoretical model of pathways to treatment and an inductive-deductive approach. A revised 'diagnostic triage' model was developed and validated by member checking. RESULTS The pathway to diagnosis was influenced by various factors which we present as consistent parts of a new diagnostic triage model. Each factor impacts the level of urgency assigned to bodily and behavioural changes by parents, general practitioners and specialists. The model of diagnostic triage was developed and validated to understand mechanisms influencing time from the point parents notice changes in their child to diagnosis. The model identifies dynamic movement between parental triage in everyday life and professional triage in a healthcare system, both affecting appraisal and case escalation according to: 1) the nature of bodily and behavioural changes, 2) parental intuition, 3) social relations, 4) professional-child-parent interaction, and 5) specialist-child-parent interaction. CONCLUSIONS Diagnostic triage is a model which explains mechanisms that shape the pathway to diagnosis. It is a contribution aimed at supporting the clinical diagnostic process, that ultimately could ensure more timely testing, referral and diagnosis, and also a novel theoretical framework for future research on diagnostic pathways.
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Affiliation(s)
| | - Ayo Wahlberg
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Marie Cordt
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Danish Cancer Society Research Centre, Survivorship and Inequality in Cancer, Danish Cancer Society, Copenhagen, Denmark.,Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Hanne Bækgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
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17
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Risk stratification of young adult survivors of cancer to estimate hospital morbidity burden: applicability of a pediatric therapy-based approach. J Cancer Surviv 2020; 15:452-460. [PMID: 32939686 PMCID: PMC8134299 DOI: 10.1007/s11764-020-00939-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/05/2020] [Indexed: 11/05/2022]
Abstract
Purpose Children and young adults (CYA) are at risk of late morbidity following cancer treatment, with risk varying by disease type and treatment received. Risk-stratified levels of aftercare which stratify morbidity burden to inform the intensity of long-term follow-up care, are well established for survivors of cancer under the age of 18 years, utilizing the National Cancer Survivor Initiative (NCSI) approach. We investigated the applicability of risk-stratified levels of aftercare in predicting long-term morbidity in young adults (YA), aged 18–29 years. Methods Long-term CYA survivors followed-up at a regional center in the North of England were risk-stratified by disease and treatments received into one of three levels. These data were linked with local cancer registry and administrative health data (Hospital Episode Statistics), where hospital activity was used as a marker of late morbidity burden. Results Poisson modelling with incident rate ratios (IRR) demonstrated similar trends in hospital activity for childhood (CH) and YA cancer survivors across NCSI risk levels. NCSI levels independently predicted long-term hospitalization risk in both CH and YA survivors. Risk of hospitalization was significantly reduced for levels 1 (CH IRR 0.32 (95% CI 0.26–0.41), YA IRR 0.06 (95% CI 0.01–0.43)) and 2; CH IRR 0.46 (95% CI 0.42-0.50), YA IRR 0.49 (95% CI 0.37-0.50)), compared with level 3. Conclusions The NCSI pediatric late-effects risk stratification system can be effectively and safely applied to cancer patients aged 18–29, independent of ethnicity or socioeconomic position. Implications for Cancer Survivors To enhance quality of care and resource utilization, long-term aftercare of survivors of YA cancer can and should be risk stratified through adoption of approaches such as the NCSI risk-stratification model. Electronic supplementary material The online version of this article (10.1007/s11764-020-00939-y) contains supplementary material, which is available to authorized users.
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18
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Schraw JM, Peckham-Gregory EC, Rabin KR, Scheurer ME, Lupo PJ, Oluyomi A. Area deprivation is associated with poorer overall survival in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2020; 67:e28525. [PMID: 32573920 DOI: 10.1002/pbc.28525] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/29/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Few studies have evaluated social determinants of outcomes disparities for children with acute lymphoblastic leukemia (ALL). We investigated the association of area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, with overall survival (OS) among children and adolescents with ALL. PROCEDURE We obtained demographic and clinical data, geocoded addresses at diagnosis, and vital status on all Texas children diagnosed with ALL from 1995 to 2011 (N = 4104). Using the US Census Bureau 2010 geography, we computed ADI scores for all census tracts in Texas and grouped the tracts into quartiles: least, third-most, second-most, and most disadvantaged. We mapped children to ADI quartiles based on residence at diagnosis, and estimated OS using Cox regression adjusting for sex, race/ethnicity, age, and metropolitan/nonmetropolitan residence. RESULTS Five-year OS ranged from 89% (95% confidence interval [CI] 87-91%) for children in the least disadvantaged tracts to 79% (95% CI 76-81%) for children in the most disadvantaged tracts (P = 4E-7). An elevated hazard ratio (HR) for death was observed for children in the most disadvantaged tracts (HR 1.57, 95% CI 1.23-2.00), and trends toward increased mortality were observed in the third-most and second-most disadvantaged tracts (HR 1.23, 95% CI 0.97-1.57 and HR 1.27, 95% CI 0.99-1.62, respectively). In stratified analyses, area disadvantage was more strongly associated with OS in males than females. CONCLUSIONS Neighborhood socioeconomic disadvantage is associated with inferior OS in this analysis of over 4100 children with ALL, highlighting the substantial contributions of social-environmental factors to childhood cancer survival. This association was stronger in males than females.
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Affiliation(s)
- Jeremy M Schraw
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas
| | - Erin C Peckham-Gregory
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas
| | - Karen R Rabin
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas
| | - Michael E Scheurer
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas
| | - Philip J Lupo
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas
| | - Abiodun Oluyomi
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas
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19
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Erdmann F, Frederiksen LE, Bonaventure A, Mader L, Hasle H, Robison LL, Winther JF. Childhood cancer: Survival, treatment modalities, late effects and improvements over time. Cancer Epidemiol 2020; 71:101733. [PMID: 32461035 DOI: 10.1016/j.canep.2020.101733] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/01/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022]
Abstract
Since the 1960s, paediatric oncologists have gradually become better organised in large study groups and participation in clinical trials is today considered as the standard of care, with most children with cancer in Europe and North America being enrolled on available treatment protocols. Chemotherapy is nowadays the main element of therapy, but irradiation is still required for some patients. With the advent of multimodality therapy and supportive care, five-year cancer survival exceeds 80 % in most European and North American countries today. The substantial improvements in survival led to a constantly growing population of childhood cancer survivors. Concerns regarding the risk of late effects of the intensive cancer treatment at a young age, together with increasing numbers of survivors, have directed attention towards survivorship research. Survivors of childhood cancer are at longstanding risk of various severe somatic and mental health conditions attributable to the cancer and its treatment, as well as adverse social and socioeconomic consequences, and diminished psychological well-being and quality of life. It is, however, important to stress that some survivors have no or very mild adverse health conditions. Nevertheless, joint efforts are warranted for the care and long-term follow-up of childhood cancer patients. With this article, we provide a comprehensive overview of improvements in survival and treatment modalities over time, as well as the related somatic and mental late effects, and social and socioeconomic difficulties that these children might encounter later in life.
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Affiliation(s)
- Friederike Erdmann
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Denmark; German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Germany.
| | | | - Audrey Bonaventure
- Epidemiology of Childhood and Adolescent Cancer Team, Centre of Research in Epidemiology and Statistics, University of Paris, UMR 1153 INSERM, France
| | - Luzius Mader
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Denmark; Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - Henrik Hasle
- Department of Paediatrics, Aarhus University Hospital, Denmark
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, 38105, United States
| | - Jeanette Falck Winther
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Denmark
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Hao L, Shi C, Xu Y. Comparison Between Primary and Secondary Pediatric Mucoepidermoid Carcinoma of the Head and Neck. Front Pediatr 2020; 8:473. [PMID: 32974245 PMCID: PMC7468489 DOI: 10.3389/fped.2020.00473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives: Secondary mucoepidermoid carcinoma (MEC) of the head and neck is occasionally observed in childhood cancer survivors. The goal of this research was to compare the demographic and pathologic characteristics, as well as survival between primary and secondary MEC in children and adolescent patients. Methods: Pediatric patients (younger than 19 years old) with surgically treated MEC of the head and neck were retrospectively enrolled at the Affiliated Children's Hospital of Zhengzhou University and divided into two groups based on their cancer history. Demographic, pathologic, and survival characteristics between the two groups were compared. The main study interests were recurrence-free survival (RFS), overall survival (OS), and disease-specific survival (DSS). Results: The primary and secondary groups consisted of 63 and 15 patients, respectively. The two groups had similar distributions in terms of age, sex, tumor stage, neck lymph node stage, perineural invasion, lymphovascular invasion, p53, Bcl-2, proliferating cell nuclear antigen, carcinoembryonic antigen, and Ki-67 index. The 10-year RFS rates for the primary group and secondary group were 80 and 71%, respectively, and this difference was not significant (p = 0.464). The 10-year DSS rates for the primary group and secondary group were 83 and 82%, respectively, and this difference was also not significant (p = 0.649). The 10-year OS rates for the primary group and secondary group were 74 and 51%, respectively; this difference was significant (p = 0.023). Further Cox model analysis confirmed the independence of a previous cancer history (p = 0.043) in decreasing OS. Conclusions: Pediatric patients with secondary MEC exhibit similar demographic, pathologic, and molecular characteristics as primary patients but worse OS. These findings indicate that special disease management approaches might be needed for secondary patients.
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Affiliation(s)
- Li Hao
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Children Hospital of Zhengzhou University, Henan Children Hospital, Zhengzhou, China
| | - Caixiao Shi
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Children Hospital of Zhengzhou University, Henan Children Hospital, Zhengzhou, China
| | - Ying Xu
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Children Hospital of Zhengzhou University, Henan Children Hospital, Zhengzhou, China
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Yavvari S, Makena Y, Sukhavasi S, Makena MR. Large Population Analysis of Secondary Cancers in Pediatric Leukemia Survivors. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E130. [PMID: 31795500 PMCID: PMC6956149 DOI: 10.3390/children6120130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/07/2019] [Accepted: 11/26/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Survivors of childhood cancer have an increased risk of developing a subsequent secondary malignant neoplasm (SMN). Among five-year survivors of primary cancer, SMNs account for nearly half of non-relapse deaths, which make them the most frequent cause of non-relapse mortality. Leukemia is the most common childhood cancer and the five-year survival rate of leukemia has drastically improved over the past two decades. Therefore, the chances of developing SMNs are higher in pediatric (0-19 years) leukemia survivors. METHODS The US based Surveillance, Epidemiology, and End Results (SEER-18) database (1973-2014) was probed for SMNs in the pediatric population (age ≤ 19). Variables Sequence-number central, primary site and ICCC3WHO were used to identify the first and second cancers among patients who developed SMN. RESULTS Our SEER database analysis found 99,380 cases of pediatric primary malignancies (0-19 years), of which 1803 (1.81%) patients developed SMN. The breakdown of SMNs in pediatric leukemia survivors (n = 251) showed thyroid carcinoma (18.33% of cases) as the most common second cancer, followed by sarcoma (15.14%), astrocytoma (10.36%), lymphoma (9.56%), salivary gland carcinoma (7.17%), melanoma (4.38%), and breast cancer (3.98%). Interestingly, we found that over 76% of SMNs that were developed by leukemia patients occurred within 20 years after initial leukemia diagnosis. However, some SMNs occur during later age, for example, the mean age for breast cancer occurrence in leukemia survivors is 26.20 ± 8.53 years after initial leukemia diagnosis. CONCLUSIONS Our study presented comprehensive rates of SMNs among pediatric cancers survivors, and the potential SMNs for pediatric leukemia survivors. This information could we used by oncologists, patients, patient families, and cancer researchers to understand the long-term risks that are associated with the development of SMNs in pediatric leukemia survivors.
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Affiliation(s)
- Siddhartha Yavvari
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Yasaswi Makena
- Department of Biotechnology, GITAM University, Visakhapatnam, AP 530045, India;
| | - Sahithi Sukhavasi
- Center for Distance Learning, GITAM University, Visakhapatnam, AP 530045, India;
| | - Monish Ram Makena
- Department of Physiology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Mitchell HK, Morris M, Ellis L, Abrahão R, Bonaventure A. Racial/ethnic and socioeconomic survival disparities for children and adolescents with central nervous system tumours in the United States, 2000-2015. Cancer Epidemiol 2019; 64:101644. [PMID: 31783249 DOI: 10.1016/j.canep.2019.101644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/08/2019] [Accepted: 11/17/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Central nervous system (CNS) malignancy is the commonest cause of cancer death in children and adolescents (0-19 years) in high-income settings. There is limited data on survival inequalities by race/ethnicity and socioeconomic position (SEP), for young patients, we aim to analyse their influence on survival from childhood CNS tumour. METHODS 9577 children and adolescents diagnosed with primary malignant CNS tumours during 2000-2015, followed up until Dec 31 st, 2015, and reported to cancer registries (Surveillance, Epidemiology and End Results programme) were included in the analysis. Cox regression models estimated the hazard ratios for race/ethnicity, SEP, and individual insurance status, adjusting for sex, age, diagnostic period, and tumour type. Individual-level insurance status data were available from 2007. RESULTS 62.5 % children and adolescents were non-Hispanic White, 10.6 % were non-Hispanic Black and 26.9 % were Hispanic. Race/ethnicity was strongly associated with survival (p < 0.001), even after adjusting for SEP, with Black (HR = 1.39 [95 %CI 1.23-1.58]) and Hispanic children (HR = 1.40 [95 %CI 1.28-1.54]) having higher hazards of death than White children. This association remained after adjusting for insurance status. There was an apparent positive association between SEP and survival that was largely attenuated after adjustment for insurance status (p = 0.20). Survival was comparable between those privately and Medicaid-insured. CONCLUSIONS Non-Hispanic Black and Hispanic children had lower survival than their White counterparts. This association, not fully explained by differences in SEP, tumour subtype or health insurance, could be related to racially/ethnically-driven barriers to optimal healthcare, warranting further investigation.
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Affiliation(s)
- Hannah K Mitchell
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK; Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, 19104, PA, USA.
| | - Melanie Morris
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Libby Ellis
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK
| | - Renata Abrahão
- Brazilian Cancer Foundation, R. dos Inválidos, 212 - Centro, Rio de Janeiro - RJ, 20231-048, Brazil; Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, 4610 X St, Sacramento, 95817, CA, USA
| | - Audrey Bonaventure
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT, UK; Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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Effect of Peer Education on the Resilience of Mothers of Children with Leukemia: A Clinical Trial. ACTA ACUST UNITED AC 2019. [DOI: 10.5812/msnj.92686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Erdmann F, Feychting M, Mogensen H, Schmiegelow K, Zeeb H. Social Inequalities Along the Childhood Cancer Continuum: An Overview of Evidence and a Conceptual Framework to Identify Underlying Mechanisms and Pathways. Front Public Health 2019; 7:84. [PMID: 31106186 PMCID: PMC6492628 DOI: 10.3389/fpubh.2019.00084] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/26/2019] [Indexed: 12/13/2022] Open
Abstract
Inequalities in health according to social conditions are regarded as unnecessary and unjust. There is a large body of evidence on inequalities in adult cancer, observable throughout the societies on a national level as well as on a global scale. Socioeconomic influences on health matter at all ages including childhood, for which childhood cancer is the leading cause of disease related death in high-income countries (HICs). Substantial differences in the reported incidence of childhood cancers have been observed globally by socioeconomic development of a population. This is reflected in the higher incidence rates reported for HICs, particularly for acute lymphoblastic leukemia, and for cancer in infants (below 1 year), compared to low- and middle-income countries (LMICs). Considerable inequalities between populations and degree of socioeconomic development are also noted for survival from childhood cancer, with substantially lower survival rates seen in most LMICs compared to HICs. With respect to inequalities by socioeconomic position (SEP) within countries, findings of an association between SEP and childhood cancer risk are diverse and limited to studies from HICs. On the contrary, observations on social inequalities in survival within countries are accumulating and indicate that survival inequalities do not only concern resource-poor countries but also high-income populations including European countries. In turn, a childhood cancer diagnosis in itself may have implications on the parents' socioeconomic situation as well as on the later socioeconomic life after having survived the disease. The underlying mechanisms and causal pathways of these empirically demonstrated social inequalities are poorly understood, although it is of significant public health relevance for any actions or strategies to reduce childhood cancer-related inequity. We propose a conceptual framework on potential underlying mechanism and pathways specifically addressing social inequalities in childhood cancer and after childhood cancer to (i) illustrate potential pathways by which social determinants may create health inequities at different points of the childhood cancer continuum; (ii) illustrate potential pathways by which a childhood cancer diagnosis may impact the socioeconomic situation of the concerned family or the later life of a childhood survivor; and (iii) point out how major determinants may relate to each other.
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Affiliation(s)
- Friederike Erdmann
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), Lyon, France
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Childhood Cancer Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz - Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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