Neuroblastoma survival in South African children is more influenced by biological than socioeconomic factors

Abstract

Background: Optimal management of neuroblastoma depends on accurate risk stratification at diagnosis. Many low- and middle-income countries lack access to specific genetic tests used globally for this purpose.Aim: To determine whether socioeconomic factors predict prognosis in neuroblastoma and could therefore provide alternative measures for risk stratification in resource-constrained settings.Setting: The three main paediatric oncology units in Johannesburg, South Africa: Charlotte Maxeke Johannesburg Academic Hospital, Chris Hani Baragwanath Academic Hospital and Wits Donald Gordon Medical Centre.Methods: This retrospective record review included 145 patients presenting with biopsy-proven neuroblastoma between 01 January 2000 and 31 December 2018. Kaplan–Meier survival analysis was performed in relation to biological and socioeconomic factors, the latter including parental employment status, nationality, and distance of residence from treating facility. Cox proportional hazards regression analysis assessed the significance and effect of these prognostic factors.Results: Factors with significant effect on survival were age below 18 months (p 0.0001), extra-abdominal primary tumour site (p = 0.02), lower stage (p 0.001), serum ferritin level 0.0001) and favourable International Neuroblastoma Pathological Committee histology (p 0.0001), race (p = 0.005), nationality (p = 0.05) and paternal employment (p = 0.02). The association between distance from treating facility and stage at diagnosis was not significant (Tb = 0.108, p = 0.06).Conclusion: Biological factors exert a great influence on neuroblastoma survival than the socioeconomic factors analysed. This suggests that tumour biology exerts an overriding influence on prognosis in neuroblastoma.

Socioeconomic status significantly impacts childhood cancer survival in South Africa

“…An institutional single‐disease cohort study from South Africa ( n = 145) examined the impact of SES factors in patients with neuroblastoma and found that race significantly impacted outcome. White children faired significantly better than Black children (OS 65.3% vs. 29.7%, p = .0005) 26 . However, only certain SES parameters showed a significant impact on outcome, namely, paternal employment ( p = .02) and South African nationality ( p = .05).…”

“…There was no relationship reported between race and household income (or any other SES measure) to show a correlation between race and any SES factor, but it was hypothesised that the reported differences in outcome due to race were more likely reflecting real differences in socioeconomics given the stark differences in the documented household income between Black and White homes. 26 By comparison, in a study in Finland, high parental income and education still positively influenced childhood cancer outcome despite a high-quality public health system. 27 Lower health literacy and increased out-of-hospital expenses were proffered as possible reasons accounting for the differences seen in parents with lower incomes and lower levels of education.…”

“…However, only certain SES parameters showed a significant impact on outcome, namely, paternal employment ( p = .02) and South African nationality ( p = .05). There was no relationship reported between race and household income (or any other SES measure) to show a correlation between race and any SES factor, but it was hypothesised that the reported differences in outcome due to race were more likely reflecting real differences in socioeconomics given the stark differences in the documented household income between Black and White homes 26 …”

“…24 A large population-based study from the United States has shown SES to be a significant mediator of racial (physical traits) and ethnic (religion, language, culture, 29.7%, p = .0005). 26 However, only certain SES parameters showed a significant impact on outcome, namely, paternal employment (p = .02)…”