In what is believed to be the largest dataset study to date examining the role of race on survival outcome for pediatric patients with Hodgkin lymphoma, investigators at Rutgers Cancer Institute of New Jersey have found that black patients have significantly worse overall survival at five years than white patients when accounting for all available clinical variables. The work is being presented as part of a mini oral presentation at the Annual Meeting of the American Society for Radiation Oncology (ASTRO) in Chicago this week.
The National Cancer Database, which captures oncology data from more than 1,500 facilities accredited by the Commission on Cancer, was utilized in the study. Identified and evaluated was a final sample of 9,285 eligible patients aged 21 and younger with a diagnosis of stage 1 to stage 4 Hodgkin lymphoma from 2004 to 2015.
Eighty-three percent of patients were white, 12 percent black and five percent 'other.' Black patients were found to be younger (under age 15), at a lower stage of disease when diagnosed, less likely to have a sub-type of disease known as nodular-sclerosis, and more commonly to exhibit what are known as 'B symptoms' (fever with no infection, night sweats, unexplained weight loss). This population also was found to be of lower income and lower education status, and more likely to be under/uninsured. Similar among the races were treatment interventions, including use of chemotherapy, radiation therapy, or combined modality therapy (chemotherapy followed by radiation). Clinical features and survival outcomes were evaluated using various statistical tests and models.
Black patients experienced a five-year overall survival of 91.5 percent compared to 95.9 percent experienced by their white counterparts. This difference was seen across all stages of disease. There were also differences in stratification of risk factors by race. Specifically, under age 15, stage 4 disease, presence of 'B symptoms,' treatment with radiation, and income were prognostic factors for overall survival in white patients but not for black patients. Among the age groups 15 and younger, 16 to 18 years, and older than 18, poorer overall survival was associated for black patients compared to whites (95.4 percent versus 97.7 percent, 87.1 percent versus 96.1 percent, and 91.6 percent versus 94.6 percent respectively).
The race-based disparity demonstrated through this work transcends that of differences in socioeconomic status. Future research should focus on understanding the biological causes of this disparity and identifying ways to alleviate it."
Rahul Parikh, MD, Rutgers Cancer Institute radiation oncologist, director of the Laurie Proton Therapy Center at Robert Wood Johnson University Hospital and associate professor of radiation oncology at Rutgers Robert Wood Johnson Medical School