Complex Racial and Ethnic Disparities in Childhood Cancer Survival Interview with:
Rebecca D. Kehm, PhD
Division of Epidemiology and Community Health
University of Minnesota School of Public Health
Minneapolis, MN What is the background for this study? What are the main findings? 

Response: Racial and ethnic differences in childhood cancer survival have long been known, and there has been some research indicating that SES could explain disparities. However, our study is the first to use statistical methods that put numbers to the relative contribution of SES to survival disparities for different types of childhood cancer. We set out to investigate whether racial and ethnic disparities in childhood cancer survival are attributed to underlying differences in socioeconomic status, defined as one’s social and economic position in relation to others based on income, education, and occupation, which scientists abbreviate as SES. Our findings provide evidence that SES does in fact contribute to racial and ethnic disparities in survival for some types of childhood cancer. Specifically, we found that SES accounted for 28-73% of the racial and ethnic survival disparity for acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and non-Hodgkin lymphoma. However, SES did not significantly contribute to racial and ethnic disparities in survival for other types of childhood cancer including central nervous system tumors, soft tissue sarcomas, Hodgkin lymphoma, Wilms tumor, and germ cell tumors. These tumor-specific results help inform where to place resources to best reduce racial and ethnic survival disparities for each of the major types of childhood cancer. What should readers take away from your report?

Response: Our study results underscore the fact that the causes of racial and ethnic disparities in childhood cancer survival are likely complex and not easily disentangled. Our findings suggest that, at least for some types of childhood cancer, racial and ethnic survival disparities could be addressed through initiatives that reduce social and economic barriers to effective care such as expanded health insurance coverage, improved patient care coordination, increased health literacy, and supplementation of transportation and childcare cost during treatment. This is important because these types of initiatives are feasible and can be implemented at the clinic or community level.  For other types of childhood cancer, the biology of drug processing or tumor biology that differs by ancestry may be more important, and we should devote more resources to studying these differences to reduce disparities. These and other intervention efforts should be considered in the future as potential opportunities to improve cancer survival for all children. What recommendations do you have for future research as a result of this work?

Response: First and foremost, our findings point to the need for continued research that is focused on understanding and, ultimately, addressing racial and ethnic disparities in childhood cancer survival. We as a research community need to devote more resources and attention to the social determinants of health. We need to prioritize research that is focused on understanding how social factors, such as access to high quality health care and health literacy, contribute to health and health disparities. We also need to invest in developing effective intervention strategies that are both disease-specific and population-specific.

For cancers in which SES significantly contributes to racial and ethnic survival disparities, behavioral and supportive interventions that address social and economic barriers to effective care are warranted. For cancers in which survival is less influenced by SES, more research is need on underlying differences in tumor biology and drug processing. Is there anything else you would like to add?

Response: We used population-based cancer registry data from the Surveillance Epidemiology and End Results (SEER) Program to conduct our analysis. SEER is supported by the Surveillance Research Program (SRP) in the National Cancer Institute’s Division of Cancer Control and Population Sciences (DCCPS). We do not have anything to disclose.


“Does Socioeconomic Status Account for Racial and Ethnic Disparities in Childhood Cancer Survival?” Rebecca D. Kehm, Logan G. Spector, Jenny N. Poynter, David M. Vock, Sean F. Altekruse, and Theresa L. Osypuk. CANCER; Published Online: August 20, 2018 (DOI: 10.1002/cncr.31560). 

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Last Updated on August 20, 2018 by Marie Benz MD FAAD