Socioeconomic determinants of childhood cancer outcomes in a large contemporary cohort

摘要 尽管在过去的几十年里儿童癌症生存率的提高， 结果方面的社会经济差距依然存在。与非西班牙裔白色儿童相比， 西班牙裔儿童在许多癌症中的存活率较低，包括白血病， 儿童癌症诊断这些生存差异的根本原因知之甚少， 可能因癌症类型而异，并且已经提出了生物学和社会经济学途径。最近 有证据表明，较低的社会经济地位（SES）与儿童时期的生存有关 癌的儿童肿瘤组（COG）是一个国际临床试验合作组织， 这些医院总共治疗了90%以上被诊断患有儿童癌症的儿童和青少年 在美国和加拿大。2007年，COG开设了儿童癌症登记网络（CCRN; COG方案ACCRN 07）以创建研究登记。共有超过56，000例儿童癌症病例 在ACCRN 07上入组，直至2017年12月8日入组结束。所有儿童和家长报名参加 ACCRN 07提供了诊断时的最新地址信息。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ACCRN 07患者进行地理编码， 结合社会经济状况数据，并将小地区的社会经济状况数据返回给人口与发展委员会进行传播。我们 将使用以下七个变量，在块级别将每个地理编码地址与人口普查数据联系起来 数据，我们将使用因子分析得出一个五个层次的SES指标。然后，我们将研究SES的影响 诱导治疗结束时最小残留疾病、复发、其他严重毒性和 > 9，500例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人 具有有效地址的ACCRN 07患者也将根据COG方案接受治疗。我们的将是第一个 一项评估SES作为儿童癌症预后预测因子的研究， 肿瘤学小组，并将包括每个肿瘤的详细细胞遗传学和分子特征。此外，本发明还 据我们所知，这将是第一次分析SES短期治疗毒性的预测因子。我们将创建 一个非常有用的资源，在大规模的当代队列的儿童癌症患者。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量身定制的 对低资源患者群体的干预措施。此外，该队列的效用将超出结果 通过与国家死亡指数（NDI）的联系，获得死亡率数据。我们 长期目标是了解导致儿童癌症复发，生存， 以及幸存者的发病率负担。因此，这一努力将为有针对性的后续行动建议提供信息， 降低风险的干预措施。

ABSTRACT Despites 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 to 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.