Advances and disparities in survival of childhood and adolescent cancers

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Abstract
Background: We analyzed trends in survival of children and adolescents diagnosed with cancer in the United States from 1975 to 2022 using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) 8 and 17 databases. Our goal was to provide an updated overview of outcomes and highlight disparities to guide future research. Methods: Data were obtained from the SEER 8 and 17 registries for patients diagnosed at ages 0-19 years. Overall survival was stratified by race and ethnicity, diagnosis, and population density. Temporal trends in 5-year overall survival were evaluated using the National Cancer Institute Joinpoint Regression Program. Kaplan–Meier survival curves with log-rank tests assessed survival differences across subgroups. Multivariable Cox proportional hazards models evaluated overall survival, adjusted for age, decade of diagnosis, and race and ethnicity. Results: A total of 52 165 patients were diagnosed with cancer in SEER 8 and 100 110 in SEER 17. Five-year overall survival for all cancers improved from 60% (95% CI = 56% to 64%) in 1975 to 90% (95% CI = 88% to 91%) in 2017. Survival gains were greatest in acute lymphoblastic leukemia, with more modest improvements in solid tumors. Mortality beyond 20 years persisted for some cancers, including Hodgkin lymphoma. Survival differed statistically by race and ethnicity (P < .001), with non-Hispanic Black patients experiencing the lowest 5-year overall survival across multiple cancers, even after adjusting for age and decade of diagnosis. Conclusions: Survival for childhood and adolescent cancers has markedly improved over the past 5 decades, yet progress remains uneven across cancer types and race and ethnicity. Understanding drivers of disparities is essential to achieve equitable outcomes for all young cancer patients.
Funding Information
  • National Cancer Institute (L40CA274778 to L.F.S., grant numbers R01CA255269, R01CA284748, R01CA268143 to T.O.H.)
  • the National Center for Advancing Translational Sciences at the National Institutes of Health (KLTR002387 to A.W.)
  • U.S. Department of War (CA240267 to L.F.S., W81XWH-22-1-0654 to T.W.L.)
  • Alex's Lemonade Stand Foundation for Childhood Cancer
  • the National Clinical Trials Network Operations Center Grant (U10CA180886)

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