The association between socioeconomic status and survival among children with Hodgkin and non‐Hodgkin lymphomas in a universal health care system

Darmawikarta, Denise; Pole, Jason D.; Gupta, Sumit; Nathan, Paul C.; Greenberg, Mark

doi:10.1002/pbc.24386

Cited by 37 publications

(47 citation statements)

References 34 publications

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“…In our subanalyses for all hematological cancers and for acute lymphoblastic leukemia, we found no effect of socioeconomic position on survival. These results are in line with those of a large study in the US (subset of children 0-14 years; n ¼ 4158) [10], a smaller acute lymphoblastic leukemia study in Germany (n ¼ 788) [9], as well as a Canadian study of lymphomas (n ¼ 692) [11]. In contrast, four smaller European studies (n ¼ 714-1559) found associations between various proxies of parental socioeconomic position and survival after childhood acute lymphoblastic leukemia [5][6][7][8].…”

Section: Comparison With Other Studiessupporting

confidence: 80%

“…when contemporary cancer therapies were used. Some previous studies included only children with leukemia [5][6][7][8]10], acute lymphoblastic leukemia only [9] or lymphomas [11]. In our subanalyses for all hematological cancers and for acute lymphoblastic leukemia, we found no effect of socioeconomic position on survival.…”

Section: Comparison With Other Studiescontrasting

confidence: 32%

“…Few studies, however, have addressed the association between socioeconomic factors and survival after childhood cancer in high income countries. Most of the available studies included only children with acute lymphoblastic leukemia or hematological cancer in general, with inconsistent results for a range of socioeconomic position indicators; some finding differences in survival [5][6][7][8] and others no differences [9][10][11]. To our knowledge, the only previous study including childhood cancers at all sites was a Norwegian population-based study of 6280 childhood cancer patients with a mean follow-up of 6.7 years reporting reduced mortality rates from cancers that require lengthy treatment [tumors in the central nervous system (CNS), leukemia, neuroblastomas, and bone tumors] among children whose mothers had higher education or who had no siblings [12].…”

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confidence: 99%

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Effect of socioeconomic position on survival after childhood cancer in Denmark

et al. 2016

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Background One fifth of all deaths among children in Europe are accounted for by cancer. If this is to be reduced there is a need for studies on not only biology and treatment approaches but also on how social factors influence cure rates. We investigated how various socioeconomic characteristics were associated with survival after childhood cancer. Material and methods In a nationwide cohort of 3797 children diagnosed with cancer [hematological cancer, central nervous system (CNS) tumors, non-CNS solid tumors] before age 20 between 1990 and 2009 we identified parents and siblings and obtained individual level parental socioeconomic variables and vital status through 2012 by linkage to population-based registries. Hazard ratios (HR) and 95% confidence intervals (CI) for dying were estimated using multivariate Cox proportional hazard models. Results For all children with cancer combined, survival was slightly but not statistically significantly better the higher the education of the mother or the father, and with maternal income. Significantly better survival was observed when parents were living together compared to living alone and worse survival when the child had siblings compared to none. Young (<20) or older (40) maternal age showed nonsignificant associations, but based on small numbers. For hematological cancers, no significant associations were observed. For CNS tumors, better survival was seen with parents living together (HR 0.70, CI 0.51-0.97). For non-CNS solid tumors, survival was better with high education of the mother (HR 0.66, CI 0.44-0.99) compared to basic and worse for children with one (HR 1.45, CI 1.11-1.89) or two or more siblings (HR 1.29, CI 0.93-1.79) (p for trend 0.02) compared to none. Conclusion The impact of socioeconomic characteristics on childhood cancer survival, despite equal access to protocolled and free-of-charge treatment, warrants further and more direct studies of underlying mechanisms in order to target these as a means to improve survival rates.

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Section: Comparison With Other Studiessupporting

confidence: 80%

Section: Comparison With Other Studiescontrasting

confidence: 32%

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confidence: 99%

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Effect of socioeconomic position on survival after childhood cancer in Denmark

et al. 2016

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“…Differences in health care systems could, therefore, explain our different results, as the French universal health care system may be better able to obviate barriers to access necessary NHL care, as demonstrated in Canada by Darmawilarta et al . 38 and more recently, in Germany for patients with acute myeloid leukemia. 39 A Scandinavian study also found a relationship between low SES (specifically, educational level) and poor relative survival outcome of NHL patients overall, without any subtype analysis.…”

Section: Discussionmentioning

confidence: 99%

Factors related to the relative survival of patients with diffuse large B-cell lymphoma in a population-based study in France: does socio-economic status have a role?

et al. 2016

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The survival of patients with diffuse large B-cell lymphoma has increased during the last decade as a result of addition of anti-CD20 to anthracycline-based chemotherapy. Although the trend is encouraging, there are persistent differences in survival within and between the USA and European countries suggesting that non-biological factors play a role. Our aim was to investigate the influence of such factors on relative survival of patients with diffuse large B-cell lymphoma. We conducted a retrospective, multicenter, registry-based study in France on 1165 incident cases of diffuse large B-cell lymphoma between 2002 and 2008. Relative survival analyses were performed and missing data were controlled with the multiple imputation method. In a multivariate analysis, adjusted for age, sex and International Prognostic Index, we confirmed that time period was associated with a better 5-year relative survival. The registry area, the medical specialty of the care department (onco-hematology versus other), the time to travel to the nearest teaching hospital, the place of treatment (teaching versus not-teaching hospital -borderline significance), a comorbidity burden and marital status were independently associated with the 5-year relative survival. Adjusted for first-course treatment, inclusion in a clinical trial and treatment discussion in a multidisciplinary meeting were strongly associated with a better survival outcome. In contrast, socio-economic status (determined using the European Deprivation Index) was not associated with outcome. Despite therapeutic advances, various non-biological factors affected the relative survival of patients with diffuse large B-cell lymphoma. The notion of lymphoma-specific expertise seems to be essential to achieve optimal care management and reopens the debate regarding centralization of these patients’ care in hematology/oncology departments.

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“…However, most of these studies failed to account for environmental and socioeconomic differences between the groups. Only a few studies evaluated patients with solid tumors [7,8] and even fewer studies examined the impact of SES or access to care on pediatric cancer burden and outcome [3,9–12]. …”

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confidence: 99%

Health disparities are important determinants of outcome for children with solid tumor malignancies

Austin

Nguyen

Eberth

et al. 2015

Journal of Pediatric Surgery

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Purpose The purpose of this study was to identify health disparities in children with non-CNS solid tumor malignancies and examine their impact on disease presentation and outcome. Methods We examined the records of all children (age ≤ 18 years) diagnosed with a non-CNS solid tumor malignancy and enrolled in the Texas Cancer Registry between 1995 and 2009 (n = 4603). The primary outcome measures were disease stage and overall survival (OS). Covariates included gender, age, race/ethnicity, year of diagnosis, socioeconomic status (SES), and driving distance to the nearest pediatric cancer treatment facility. Statistical analyses included life table methods, logistic, and Cox regression. Statistical significance was defined as p < 0.05. Results Children with advanced-stage disease were more likely to be male, <10 years old, and Hispanic or non-Hispanic Blacks (all p < 0.05). Distance to treatment and SES did not impact stage of disease at presentation. However, Hispanic and non-Hispanic Blacks and patients in the lowest SES quartile had the worst 1- and 5-year survival (all p < 0.05). The adjusted OS differed by age, race, and stage, but not SES or distance to the nearest treatment facility. Conclusions Race/ethnicity plays an important role in survival for children with non-CNS solid tumor malignancies. Future work should better define these differences to establish mechanisms to decrease their impact.

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The association between socioeconomic status and survival among children with Hodgkin and non‐Hodgkin lymphomas in a universal health care system

Abstract: SES was not associated with risk of death among pediatric HL and NHL patients in Ontario. This was consistent through the cancer trajectory, including diagnosis, treatment, and survivorship.

Cited by 37 publications

References 34 publications

Effect of socioeconomic position on survival after childhood cancer in Denmark

Effect of socioeconomic position on survival after childhood cancer in Denmark

Factors related to the relative survival of patients with diffuse large B-cell lymphoma in a population-based study in France: does socio-economic status have a role?

Health disparities are important determinants of outcome for children with solid tumor malignancies

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