Racial/ethnic differences in adverse outcomes among childhood cancer survivors

The childhood cancer survivor study

Qi Liu, Wendy M. Leisenring, Kirsten K. Ness, Leslie L. Robison, Gregory Armstrong, Yutaka Yasui, Smita Bhatia

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Purpose Childhood cancer survivors carry a high burden of treatment-related morbidity; however, race/ ethnicity-specific risks of adverse outcomes are not well understood. Methods Data from the Childhood Cancer Survivor Study, a cohort of survivors of at least 5 years, were used to compare Hispanic (n = 750, 5.4%) and non-Hispanic black (NHB: n = 694, 5.0%) survivors to non- Hispanic white patients (NHW: n = 12,397, 89.6%) for late mortality, subsequent neoplasms, and chronic health conditions. Results NHBs and Hispanics reported lower socioeconomic status (SES) and higher prevalence of obesity, and NHBs reported higher prevalence of hypertension. NHBs had higher rate of all-cause mortality (relative rate [RR], 1.4; 95% CI, 1.1 to 1.9; P = .008), which was abrogated (RR, 1.0; 95% CI, 0.8 to 1.4; P = .9) after adjusting for SES. Nonmelanoma skin cancer was not observed among irradiated NHBs, and the risk was lower among Hispanic survivors (RR, 0.3; 95% CI, 0.1 to 0.7) compared with NHWs. Both NHBs and Hispanics demonstrated elevated risks for diabetes; these risks persisted after adjusting for SES and obesity (NHBs: RR, 2.8; 95% CI, 1.1 to 6.7; Hispanics: RR, 3.1; 95% CI, 1.5 to 6.4). NHBs were more likely to report cardiac conditions (RR, 1.8; 95% CI, 1.1 to 2.7), but the risk was attenuated after adjusting for cardiovascular risk factors. Therapeutic exposures did not affect racial/ethnic differences in mortality (all cause or cause specific), chronic health conditions, or subsequent neoplasms. Conclusion By and large, NHB and Hispanic childhood cancer survivors experience a comparable burden of morbidity and mortality to theirNHWcounterparts. The few differences in risk were explained by the racial/ethnic differences in socioeconomic status and/or cardiovascular risk factors.

Original languageEnglish (US)
Pages (from-to)1634-1643
Number of pages10
JournalJournal of Clinical Oncology
Volume34
Issue number14
DOIs
StatePublished - May 10 2016

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Hispanic Americans
Survivors
Social Class
Neoplasms
Mortality
Obesity
Morbidity
Health
Skin Neoplasms
Cohort Studies
Hypertension
Therapeutics

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Racial/ethnic differences in adverse outcomes among childhood cancer survivors : The childhood cancer survivor study. / Liu, Qi; Leisenring, Wendy M.; Ness, Kirsten K.; Robison, Leslie L.; Armstrong, Gregory; Yasui, Yutaka; Bhatia, Smita.

In: Journal of Clinical Oncology, Vol. 34, No. 14, 10.05.2016, p. 1634-1643.

Research output: Contribution to journalArticle

Liu, Qi ; Leisenring, Wendy M. ; Ness, Kirsten K. ; Robison, Leslie L. ; Armstrong, Gregory ; Yasui, Yutaka ; Bhatia, Smita. / Racial/ethnic differences in adverse outcomes among childhood cancer survivors : The childhood cancer survivor study. In: Journal of Clinical Oncology. 2016 ; Vol. 34, No. 14. pp. 1634-1643.
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abstract = "Purpose Childhood cancer survivors carry a high burden of treatment-related morbidity; however, race/ ethnicity-specific risks of adverse outcomes are not well understood. Methods Data from the Childhood Cancer Survivor Study, a cohort of survivors of at least 5 years, were used to compare Hispanic (n = 750, 5.4{\%}) and non-Hispanic black (NHB: n = 694, 5.0{\%}) survivors to non- Hispanic white patients (NHW: n = 12,397, 89.6{\%}) for late mortality, subsequent neoplasms, and chronic health conditions. Results NHBs and Hispanics reported lower socioeconomic status (SES) and higher prevalence of obesity, and NHBs reported higher prevalence of hypertension. NHBs had higher rate of all-cause mortality (relative rate [RR], 1.4; 95{\%} CI, 1.1 to 1.9; P = .008), which was abrogated (RR, 1.0; 95{\%} CI, 0.8 to 1.4; P = .9) after adjusting for SES. Nonmelanoma skin cancer was not observed among irradiated NHBs, and the risk was lower among Hispanic survivors (RR, 0.3; 95{\%} CI, 0.1 to 0.7) compared with NHWs. Both NHBs and Hispanics demonstrated elevated risks for diabetes; these risks persisted after adjusting for SES and obesity (NHBs: RR, 2.8; 95{\%} CI, 1.1 to 6.7; Hispanics: RR, 3.1; 95{\%} CI, 1.5 to 6.4). NHBs were more likely to report cardiac conditions (RR, 1.8; 95{\%} CI, 1.1 to 2.7), but the risk was attenuated after adjusting for cardiovascular risk factors. Therapeutic exposures did not affect racial/ethnic differences in mortality (all cause or cause specific), chronic health conditions, or subsequent neoplasms. Conclusion By and large, NHB and Hispanic childhood cancer survivors experience a comparable burden of morbidity and mortality to theirNHWcounterparts. The few differences in risk were explained by the racial/ethnic differences in socioeconomic status and/or cardiovascular risk factors.",
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T1 - Racial/ethnic differences in adverse outcomes among childhood cancer survivors

T2 - The childhood cancer survivor study

AU - Liu, Qi

AU - Leisenring, Wendy M.

AU - Ness, Kirsten K.

AU - Robison, Leslie L.

AU - Armstrong, Gregory

AU - Yasui, Yutaka

AU - Bhatia, Smita

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N2 - Purpose Childhood cancer survivors carry a high burden of treatment-related morbidity; however, race/ ethnicity-specific risks of adverse outcomes are not well understood. Methods Data from the Childhood Cancer Survivor Study, a cohort of survivors of at least 5 years, were used to compare Hispanic (n = 750, 5.4%) and non-Hispanic black (NHB: n = 694, 5.0%) survivors to non- Hispanic white patients (NHW: n = 12,397, 89.6%) for late mortality, subsequent neoplasms, and chronic health conditions. Results NHBs and Hispanics reported lower socioeconomic status (SES) and higher prevalence of obesity, and NHBs reported higher prevalence of hypertension. NHBs had higher rate of all-cause mortality (relative rate [RR], 1.4; 95% CI, 1.1 to 1.9; P = .008), which was abrogated (RR, 1.0; 95% CI, 0.8 to 1.4; P = .9) after adjusting for SES. Nonmelanoma skin cancer was not observed among irradiated NHBs, and the risk was lower among Hispanic survivors (RR, 0.3; 95% CI, 0.1 to 0.7) compared with NHWs. Both NHBs and Hispanics demonstrated elevated risks for diabetes; these risks persisted after adjusting for SES and obesity (NHBs: RR, 2.8; 95% CI, 1.1 to 6.7; Hispanics: RR, 3.1; 95% CI, 1.5 to 6.4). NHBs were more likely to report cardiac conditions (RR, 1.8; 95% CI, 1.1 to 2.7), but the risk was attenuated after adjusting for cardiovascular risk factors. Therapeutic exposures did not affect racial/ethnic differences in mortality (all cause or cause specific), chronic health conditions, or subsequent neoplasms. Conclusion By and large, NHB and Hispanic childhood cancer survivors experience a comparable burden of morbidity and mortality to theirNHWcounterparts. The few differences in risk were explained by the racial/ethnic differences in socioeconomic status and/or cardiovascular risk factors.

AB - Purpose Childhood cancer survivors carry a high burden of treatment-related morbidity; however, race/ ethnicity-specific risks of adverse outcomes are not well understood. Methods Data from the Childhood Cancer Survivor Study, a cohort of survivors of at least 5 years, were used to compare Hispanic (n = 750, 5.4%) and non-Hispanic black (NHB: n = 694, 5.0%) survivors to non- Hispanic white patients (NHW: n = 12,397, 89.6%) for late mortality, subsequent neoplasms, and chronic health conditions. Results NHBs and Hispanics reported lower socioeconomic status (SES) and higher prevalence of obesity, and NHBs reported higher prevalence of hypertension. NHBs had higher rate of all-cause mortality (relative rate [RR], 1.4; 95% CI, 1.1 to 1.9; P = .008), which was abrogated (RR, 1.0; 95% CI, 0.8 to 1.4; P = .9) after adjusting for SES. Nonmelanoma skin cancer was not observed among irradiated NHBs, and the risk was lower among Hispanic survivors (RR, 0.3; 95% CI, 0.1 to 0.7) compared with NHWs. Both NHBs and Hispanics demonstrated elevated risks for diabetes; these risks persisted after adjusting for SES and obesity (NHBs: RR, 2.8; 95% CI, 1.1 to 6.7; Hispanics: RR, 3.1; 95% CI, 1.5 to 6.4). NHBs were more likely to report cardiac conditions (RR, 1.8; 95% CI, 1.1 to 2.7), but the risk was attenuated after adjusting for cardiovascular risk factors. Therapeutic exposures did not affect racial/ethnic differences in mortality (all cause or cause specific), chronic health conditions, or subsequent neoplasms. Conclusion By and large, NHB and Hispanic childhood cancer survivors experience a comparable burden of morbidity and mortality to theirNHWcounterparts. The few differences in risk were explained by the racial/ethnic differences in socioeconomic status and/or cardiovascular risk factors.

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