Childhood cancer survival reaches nearly 90%, yet disparities remain

Nearly nine in 10 young people with cancer were alive five years after diagnosis by 2017 – up from six in 10 in 1975, according to first comprehensive update of U.S. childhood cancer survival statistics in over a decade published in the Journal of the National Cancer Institute.

But this immense progress did not reach everyone equally. Some cancers, like certain leukemias and bone/soft tissue cancers (called sarcomas), have improved much less than others. Also, Black children and teenagers had worse survival across most cancer types.

Our study shows that childhood cancer is one of modern medicine's greatest success stories. Molecularly targeted agents and immunotherapies have increasingly been integrated into treatment and may have improved survival among young patients not cured with conventional chemotherapy while reducing late mortality from toxic treatments. Survival gains also likely have been driven by advances in precision diagnostics, risk stratification and inclusive cooperative group trials. Our findings, however, also point to where children and families still need us to do better."

Lindsay Schwartz, MD, MS, lead author, pediatric oncologist at Ann & Robert H. Lurie Children's Hospital of Chicago and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine

Dr. Schwartz and colleagues examined registry data covering more than 100,000 children and teenagers (ages 0–19 years) diagnosed with cancer in the U.S. between 1975 and 2022. They used data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) 8 and 17 databases. Researchers evaluated trends in five-year overall survival among different sociodemographic groups.

From 2000 to 2017 for all cancer types combined, five-year overall survival was 88% for non-Hispanic White patients, 84.5% for Hispanic patients, 85.6% for patients of other races and ethnicities, and 80.8% for non-Hispanic Black patients.

Disparities in survival also emerged by cancer type. Whereas five-year survival for acute lymphoblastic leukemia (ALL), the most common childhood cancer, rose from 43% in 1975 to 95% in 2017, survival for acute myeloid leukemia (AML) is still around 72%, and for sarcomas around 74%.

"For AML, sarcomas and high-risk neuroblastoma, children still need new and better treatments, and research on them should be a priority," said Dr. Schwartz.

"We still need to learn why survival gaps persist," she said. "The reasons for these gaps are probably a mix of factors – access to care, insurance, where families live, how the cancer itself behaves biologically and treatment side effects. Learning which of these matters most is key to making sure every child benefits from medical advances."

Survival at five years was also not the whole story – some survivors, especially young people treated for Hodgkin lymphoma decades ago, die at higher rates 20-30 years after their cancer was cured, often from long-term effects of treatment. People treated for Hodgkin lymphoma in the 1970s and early 1980s had 87% survival at five years post-diagnosis, but only 63% at 30 years post-diagnosis.

"Families and doctors should know that lifelong follow-up care after cancer matters, including screening for second cancers and heart problems," stressed Dr. Schwartz. "Collectively, our findings underscore the need for continued progress not only in developing effective and less toxic therapies but also in ensuring these advances are accessible to every child and adolescent with cancer."

This work was supported by the National Cancer Institute at the National Institutes of Health (NIH), the National Center for Advancing Translational Sciences at the NIH, the U.S. Department of Defense, Alex's Lemonade Stand Foundation and the National Clinical Trials Network Operations Center Grant for the Children's Oncology Group.