Researchers Uncover Racial Disparities in Brain Cancer Outcomes

March 16, 2020 - Black and Hispanic pediatric patients fared worse than non-Hispanic white patients during brain cancer treatment and follow-up, indicating that racial disparities have a significant impact on post-diagnosis care, according to a study published in the journal Scientific Reports.

Brain cancers recently overtook leukemia as the number-one cause of childhood cancer fatalities, despite being less common, researchers noted. Although overall leukemia survival rates have improved, children of lower socioeconomic status have benefitted less than their higher income counterparts.

“Length of time to diagnosis and treatment modalities influence survival of children with various cancers. Additionally, treatment factors such as extent of tumor resection, tumor location, age, and year of diagnosis have been shown to be associated with survival in pediatric glioblastoma patients,” researchers said.

“However, little attention has been devoted to specific demographic and socioeconomic risk factors contributing to survival of childhood brain cancers as a group, and how these factors may influence survival.”

The team set out to examine the impact of socioeconomic and demographic risk factors on pediatric brain cancer survival rates. Researchers evaluated overall survival and stage at diagnosis for patients 0-19 years of age based on race, ethnicity, socioeconomic status, and demographic variables to determine risk factors and mechanisms of poorer outcomes in this group.

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Of 1,881 patients under age 19 diagnosed with cancers of the brain and central nervous system between 2000 and 2015, 52 percent of white patients lived five years from diagnosis, while just 44 percent of African American patients and 45 percent of Hispanic patients reached a similar milestone.

These findings suggest that while there were no disparities at the point of diagnosis, black and Hispanic patients went on to fare worse than non-Hispanic white patients. The study indicates that brain cancer disparities arise during the process of treatment and follow-up rather than the process of diagnosis.

“We were surprised,” said the study’s senior author, Adam Green, MD, CU Cancer Center investigator and pediatric brain cancer specialist at Children’s Hospital Colorado.

“In general, we expect these disparities to be multi-factorial and have pre- and post-diagnosis components, but these findings suggest these patients are able to get diagnosed appropriately, but after that, treatment and follow up may be where the disparities lie.”

The study highlights the racial and ethnic disparities that still persist in cancer care, researchers said.

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“If we look overall in pediatric brain and central nervous system cancers, black and Hispanic patients have a higher risk of dying from these tumors compared with non-Hispanic white patients,” Green said. “Even when they presented with similar stage disease as their white counterparts, they still did worse.”

Previous research has attempted to uncover the reasons behind disparities in cancer care. A recent study from University of North Carolina (UNC) School of Medicine aimed to find the root causes of cancer care gaps.

“We found what seems to be implicit bias with some clinicians that made them less willing to take the same risks with patients that were different from them,” said Samuel Cykert MD, professor of medicine at the UNC School of Medicine and co-principal investigator of the study.

“A black and a white patient of the same age could require the same surgery, have the same comorbidities, have the same income and insurance, yet white patients were more likely to receive the surgery and get their cancer treated.”

The team on the pediatric brain cancer study pointed out that there are several factors contributing to unequal outcomes, all of which should be addressed in healthcare.

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“One thing we don’t talk about enough in cancer is how much of a burden going through treatment is on families – financial resources, transportation resources, time resources, shelter and lodging resources, etc.,” Green said.

“We can plan an effective treatment, but if there are life factors that make it more challenging for some families to get that entire course of treatment successfully, then all the planning we do isn’t going to make the treatment as effective as we would like it to be.”

Future research will focus on more closely identifying the source of these disparities. Researchers suggested that due to the complexity of these cases, young patients with brain cancer should be seen at centers that offer multi-disciplinary care, allowing patients to have access to experts across a wide range of medical fields.

“It’s incumbent on us to make sure these families have access to the resources they need to ensure that their children are able to get the highest quality care,” Green said.