Socioeconomic determinants of childhood cancer outcomes in a large contemporary cohort - diversity supplement

当代大型队列中儿童癌症结果的社会经济决定因素 - 多样性补充

• 批准号: 10596849
• 负责人: Erin Marcotte
• 金额: $ 3.47万
• 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/10596849
• 关键词: Acute Lymphocytic Leukemia; Address; Adolescent; Adverse event; Area; Biological; Canada; Cancer Patient; Cancer Relapse; Censuses; Cessation of life; Child; Clinical Trials Cooperative Group; Cytogenetics; Data; Development; Diagnosis; Enrollment; Factor Analysis; Goals; Hispanic; Hospitals; International; Intervention; Malignant Childhood Neoplasm; Malignant Neoplasms; Malignant neoplasm of brain; Minnesota; Molecular; Morbidity - disease rate; Neoadjuvant Therapy; Neuroblastoma; Not Hispanic or Latino; Outcome; Parents; Pathway interactions; Patients; Pediatric Oncology Group; Population; Predisposition; Protocols documentation; Recommendation; Registries; Relapse; Research; Research Personnel; Residual Tumors; Resources; Risk; Socioeconomic Status; Survivors; Time; Toxic effect; Treatment-related toxicity; United States; Work; cancer diagnosis; cancer survival; cancer type; cohort; ethnic disparity; experience; follow-up; indexing; leukemia; low socioeconomic status; mortality; patient population; racial disparity; risk prediction; socioeconomic disparity; socioeconomics; survivorship; therapy outcome; translational potential; tumor

Abstract Despite 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 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 尽管过去几十年儿童癌症生存率有所提高，但种族、民族和 结果的社会经济差异依然存在。与非西班牙裔白人儿童相比，非西班牙裔黑人儿童 西班牙裔儿童的许多癌症的生存率较低，包括白血病，这是最常见的癌症 诊断出儿童癌症。人们对这些生存差异的根本原因知之甚少，并且 可能因癌症类型而异，并且已经提出了生物学和社会经济途径。最近的 有证据表明，较低的社会经济地位（SES）与某些童年时期的生存有关 癌症。儿童肿瘤学组（COG）是一个由200多个成员组成的国际临床试验合作组织 治疗 90% 以上被诊断患有儿童癌症的儿童和青少年的医院 在美国和加拿大。 2007 年，COG 开设了儿童癌症登记网络 (CCRN； COG 协议 ACCRN07) 创建研究注册表。总共治疗了超过 56,000 例儿童癌症病例 截至 2017 年 12 月 8 日注册结束，已在 ACCRN07 上注册。所有儿童和家长均在 ACCRN07 上注册 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研究人员对所有具有有效美国地址的 ACCRN07 患者进行地理编码， 与社会经济状况数据结合起来，并将小区域 SES 数据返回给 COG 进行传播。我们 将使用其中的七个变量将每个地理编码地址与块级别的人口普查数据进行关联 数据我们将使用因子分析来得出五级SES指标。然后我们将考察SES的影响 诱导治疗结束时出现最小残留疾病、复发、其他严重毒性和 超过 9,500 名急性淋巴细胞白血病 (ALL) 患者的不良事件和生存率。超过 9,500 全部 ACCRN07 上具有有效地址的患者也将接受 COG 方案的治疗。我们的将是第一个 研究评估 SES 作为儿童肿瘤学中大规模儿童癌症结果的预测因子 组，并将包括每个肿瘤的详细细胞遗传学和分子特征。另外，对于我们的 据了解，这将是首次对短期治疗毒性的 SES 预测因子进行分析。我们将创建一个 对于当代儿童癌症患者群体来说是非常有用的资源。我们的研究结果将 具有转化潜力，因为与 SES 相关的结果可能表明需要开发定制的 对资源匮乏的患者群体进行干预。此外，该群体的效用将超越结果 治疗和生存情况，并与国家死亡指数 (NDI) 联系起来，以获得死亡率数据。我们的 长期目标是了解导致儿童癌症复发、生存、 以及幸存者的发病负担。因此，这项工作将为有针对性的后续建议和 降低风险的干预措施。