Racial and ethnic disparities in neurocognitive, emotional, and quality‐of‐life outcomes in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study

Abstract

BACKGROUND: Survivors of childhood cancer are at risk of neurocognitive impairment, emotional distress, and poor health-related quality of life (HRQOL); however, the effect of race/ethnicity is understudied. The objective of this study was to identify race/ ethnicity-based disparities in neurocognitive, emotional, and HRQOL outcomes among survivors of childhood cancer. METHODS: Self-reported measures of neurocognitive function, emotional distress (the Brief Symptom Inventory-18), and HRQOL (the Medical Outcomes Study Short Form-36 health survey) were compared between minority (Hispanic, n = 821; non-Hispanic black [NHB], n = 600) and non-Hispanic white (NHW) (n = 12,287) survivors from the Childhood Cancer Survivor Study (median age, 30.9 years; range, 16.0-54.1 years). By using a sample of 3055 siblings, the magnitude of same-race/same-ethnicity survivor-sibling differences was compared between racial/ethnic groups, adjusting for demographic and treatment characteristics and current socioeconomic status (SES). RESULTS: No clear pattern of disparity in neurocognitive outcomes by race/ethnicity was observed. The magnitude of the survivor-sibling difference in the mean score for depression was greater in Hispanics than in NHWs (3.59 vs 1.09; P = .004). NHBs and Hispanics had greater survivor-sibling differences in HRQOL than NHWs for mental health (NHBs: −5.78 vs −0.69; P = .001; Hispanics: −3.87 vs −0.69; P = .03), and social function (NHBs: −7.11 vs −1.47; P < .001; Hispanics: −5.33 vs −1.47; P = .001). NHBs had greater survivor-sibling differences in physical subscale scores for HRQOL than NHWs. In general, the findings were not attenuated by current SES. CONCLUSIONS: Although no pattern of disparity in neurocognitive outcomes was observed, differences across many HRQOL outcomes among minorities compared with NHWs, not attenuated by current SES, were identified. This suggests that further research into environmental and sociocultural factors during and immediately after treatment is needed. Cancer 2019;125:3666-3677.

Quantitative MRI outcomes in child and adolescent leukemia survivors: Evidence for global alterations in gray and white matter

“…We must also consider the possibility of participation bias, both in the CTL and ALL groups, particularly regarding our evidence that full-scale IQ contributes to brain outcomes. While inclusion of the NIH neuroimaging repository mitigated some of this concern, innovative recruitment strategies are required for comprehensive investigation of neurocognitive late effects in ALL survivors ( Dixon et al, 2019 ). Additionally, we found that intracranial volume was significantly reduced in ALL survivors relative to controls.…”

Social‐ecological predictors of school functioning in Hispanic children treated for cancer with central nervous system–directed therapies

“…Established risk factors for long‐term functional impairments include a brain tumor diagnosis, central nervous system (CNS)–directed chemotherapy and/or cranial radiation, younger age at diagnosis, and longer time since treatment 8‐11 . Some research, but not all, from our group and others suggests that CCSs from ethnic minority and/or lower socioeconomic backgrounds are at further risk for worse cognitive and health‐related quality of life (HRQOL) outcomes following cancer 12‐17 . The Hispanic population is now the largest ethnic or racial minority in the United States and it is estimated that Hispanic people will account for close to one‐third (29%) of the population by 2060 18 .…”

“…[8][9][10][11] Some research, but not all, from our group and others suggests that CCSs from ethnic minority and/or lower socioeconomic backgrounds are at further risk for worse cognitive and health-related quality of life (HRQOL) outcomes following cancer. [12][13][14][15][16][17] The Hispanic population is now the largest ethnic or racial minority in the United States and it is estimated that Hispanic people will account for close to one-third (29%) of the population by 2060. 18 While social-ecological factors appear especially relevant for CCSs from socioeconomically disadvantaged groups, they have not been studied, despite the potential to inform tailored intervention approaches to improve outcomes.…”

Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review

“…In the context of oncology, health disparities in the US are significantly different in the rates of cancer screening, incidence, survival, treatment-related complications, and quality-of-life (7). Although the 5-yr relative cancer survival rates of childhood cancer have reached 94% among the child and 85% among adolescent survivors (8), there is evidence of lower patient-reported outcomes and survival rates (9)(10)(11) in minority vs. non-Hispanic White survivors. Furthermore, the mechanisms behind these disparities are understudied.…”