Socioeconomic determinants of childhood cancer outcomes in a large contemporary cohort

当代大型队列中儿童癌症结果的社会经济决定因素

• 批准号: 10339085
• 负责人: Erin Marcotte
• 金额: $ 57.97万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10339085
• 关键词: Acute Lymphocytic Leukemia; Address; Adolescent; Adverse event; Area; Biological; Canada; Cancer Patient; Cancer Relapse; Caring; Censuses; Central Nervous System Neoplasms; Cessation of life; Child; Clinical Trials Cooperative Group; Collection; Common Terminology Criteria for Adverse Events; Cytogenetics; Data; Diagnosis; Enrollment; Ethnic Origin; Factor Analysis; Fever; Future; Goals; Hispanic; Hospitals; Infection; Institution; Insurance Coverage; International; Intervention; Location; Logistic Regressions; Lymphoma; Malignant Childhood Neoplasm; Malignant Neoplasms; Measures; Mediating; Mediation; Methods; Minnesota; Molecular; Morbidity - disease rate; Necrosis; Neoadjuvant Therapy; Neuropathy; Neutropenia; Not Hispanic or Latino; Odds Ratio; Outcome; Outcome Study; Parents; Pathway interactions; Patients; Pediatric Oncology Group; Population; Primary Neoplasm; Protocols documentation; Race; Recommendation; Registries; Relapse; Research; Research Personnel; Residual Tumors; Resources; Risk; Serious Adverse Event; Socioeconomic Factors; Socioeconomic Status; Solid Neoplasm; Standardization; Survival Rate; Survivors; Therapeutic Trials; Time; Toxic effect; Treatment-related toxicity; United States; Work; adverse outcome; base; cancer diagnosis; cancer survival; cancer type; cohort; comorbidity; ethnic disparity; experience; follow-up; hazard; improved; indexing; leukemia; low socioeconomic status; mortality; outcome prediction; patient population; racial and ethnic disparities; racial disparity; relapse risk; risk stratification; sex; socioeconomic disparity; socioeconomics; survivorship; therapy outcome; tool; translational potential; tumor

ABSTRACT Despites improvements in childhood cancer survival in the last several decades, marked racial, ethnic, and socioeconomic disparities in outcomes persist. Compared with non-Hispanic white children, non-Hispanic black and Hispanic children experience lower survival from many cancers, including leukemia, the most commonly diagnosed cancer in children. The underlying causes of these survival differences are poorly understood and may vary by cancer type, and both biological and socioeconomic pathways have been proposed. Recent evidence has suggested that lower socioeconomic status (SES) is associated with survival from some childhood cancers. The Children's Oncology Group (COG) is an international clinical trial cooperative group of over 200 hospitals which together treat more than 90% of all children and adolescents diagnosed with childhood cancer in the United States and Canada. In 2007 the COG opened the Childhood Cancer Registration Network (CCRN; COG protocol ACCRN07) to create a research registry. A total of over 56,000 childhood cancer cases were enrolled on ACCRN07 through the end of enrollment on December 8, 2017. All children and parents enrolled on ACCRN07 provided address information which was current at the time of diagnosis. We will work with investigators at the Minnesota Population Center to geocode all ACCRN07 patients with a valid U.S. address, contextualize with socioeconomic status data, and return small-area SES data to COG for dissemination. We will contextualize each geocoded address with Census data at the block level using seven variables from these data we will use factor analysis to derive a five-level SES indicator. We will then examine the influence of SES on risk of minimum residual disease at the end of induction therapy, relapse, other serious toxicities and adverse events, and survival in >9,500 acute lymphoblastic leukemia (ALL) patients. Over 9,500 ALL patients on ACCRN07 with a valid address will also have been treated on COG protocols. Ours will be the first study to evaluate SES as a predictor of childhood cancer outcomes on a large scale within the Children's Oncology Group, and will include detailed cytogenetic and molecular characterization of each tumor. Additionally, to our knowledge, this will be the first analysis of SES predictors of short-term treatment toxicities. We will create a highly useful resource on a large scale for a contemporary cohort of childhood cancer patients. Our findings will have translational potential in that outcomes related to SES may indicate the need to develop tailored interventions for low-resource patient populations. Additionally, this cohort's utility will extend beyond outcomes of therapy and into survivorship with linkages to the National Death Index (NDI) to obtain mortality data. Our long-term goal is to understand the factors that contribute to disparities in childhood cancer relapse, survival, and the burden of morbidity in survivors. Thus, this effort will inform targeted follow-up recommendations and risk-reducing interventions.

抽象的 在过去的几十年中，在童年癌症生存中的持久改善，标志着种族，种族和种族 结局中的社会经济差异持续存在。与非西班牙裔白人，非西班牙裔黑人相比 西班牙裔孩子的生存率较低，包括白血病，最常见的白血病 诊断为儿童的癌症。这些生存差异的根本原因知之甚少， 可能因癌症类型而有所不同，并且已经提出了生物学和社会经济途径。最近的 证据表明，较低的社会经济地位（SES）与某个童年的生存有关 癌症。儿童肿瘤学小组（COG）是一个国际临床试验合作小组，该小组超过200个 在所有被诊断出患有儿童癌症的儿童和青少年中，有90％以上的医院 在美国和加拿大。 2007年，COG开设了儿童癌症注册网络（CCRN； COG协议ACCRN07）创建研究注册表。共有56,000多个儿童癌症病例 在2017年12月8日入学到招生结束之前就注册了ACCRN07。所有儿童和父母都参加了 ACCRN07提供了诊断时最新的地址信息。我们将与 明尼苏达州人口中心的调查人员地理位置所有ACCRN07患者，具有有效的美国地址， 通过社会经济状况数据进行上下文化，并将小区域SES数据返回到COG中以进行传播。我们 将使用其中的七个变量将每个地理编码的地址与每个地理编码地址进行上下语 数据我们将使用因子分析来得出五级SES指标。然后，我们将检查SES的影响 在归纳疗法，复发，其他严重毒性和 不良事件，以及> 9,500个急性淋巴细胞白血病（所有）患者的生存。超过9,500个 具有有效地址的ACCRN07的患者也将在COG方案上进行治疗。我们将是第一个 研究将SES评估为儿童癌症结局的预测指标 肿瘤学组，并将包括每个肿瘤的细胞遗传学和分子表征。此外， 据我们所知，这将是对短期治疗毒性的SES预测指标的首次分析。我们将创建 对于当代儿童癌症患者，大规模的非常有用的资源。我们的发现 将具有转化潜力，因为与SES相关的结果可能表明需要开发量身定制的 低资源患者人群的干预措施。此外，该队列的实用程序将超越结果 与国家死亡指数（NDI）联系以获取死亡率数据的联系和生存。我们的 长期目标是了解导致儿童癌症复发，生存的差异的因素， 以及幸存者的发病率负担。因此，这项努力将为有针对性的后续建议提供信息，并且 降低风险的干预措施。