Childhood, Youth Cancer Survival Factors Vary by Race, Follow-Up Care

ORLANDO, Fla., Dec. 11  /PRNewswire/ -- Cancer is the leading cause of disease-related death among children in the U.S.  The numbers of newly diagnosed patients across the major childhood cancers, such as leukemia and lymphoma, continue to escalate.  But new research shows that mortality rates are improving and long-term survival rates for childhood cancers are steadily on the rise.  Despite these successes in young children, we are still faced with low survival rates and low clinical trial accrual in older adolescents and young adults, particularly in blood disorders such as leukemia and lymphoma.  Two studies being presented today at the 48th Annual Meeting of the American Society of Hematology (ASH(TM)) address the need for more research in evaluating leukemia and lymphoma survivorship among youths of varying ages and races.
"Even with the growing annual rates of new childhood cancer cases, medical research offers a positive outlook on future survival rates," said Kenneth Kaushansky, MD, Vice President of ASH and Helen M. Ranney Professor and Chair of the Department of Medicine, University of California, San Diego.  "By focusing research on promising new targets and making significant scientific advances to improve the survival rate among adolescents and young adults afflicted by leukemia and lymphoma, we hope to provide a paradigm for treating other cancers.  Finally, by remaining attentive to outcome disparities in subsets of patients, we should make certain that all our patients can benefit from these medical advances."
The Racial Disparity Gap in Pediatric Leukemia and Lymphoma Survival Has Been Eliminated in Children but Not in Older Adolescents and Young Adults [Abstract #76]
*This abstract is being presented on Sunday, December 10, 5:15 p.m. (EST) prior to Monday's press conference at 11:00 a.m.  It is embargoed for release until the time of initial presentation.
Racial disparities continue to be at the forefront of controversial health issues, making it even more challenging to achieve and maintain successful research and treatment of patients from socioeconomically disadvantaged minority groups, and more studies are now being conducted to investigate the factors associated with disparities in various races for a number of specific diseases.  Leukemia and lymphoma survival rates have gradually improved among all age groups from 0-29.  Disparities in success rates between racial groups, however, although improved in the age range of 0-19, became more pronounced among young adults, ages 20-29.  New research into pediatric leukemia and lymphoma survival addresses the problem of racial disparity among older adolescents and provides a platform for physicians to overcome this longstanding barrier.
African Americans face a higher likelihood of developing and dying from each of the four most common cancers in the United States (lung, colon, breast, and prostate), and have also shown worse outcomes in pediatric leukemia and lymphoma.  Through scientific advancements, the Children's Oncology Group (COG) has worked with U.S. physicians to fight racial disparities among leukemia and lymphoma patients and, as a result, has significantly reduced the deficit in pediatric patients.  Researchers are optimistic that they will be able to follow this model to reduce the racial deficit in leukemia and lymphoma survivors among older adolescents and young adults.
Aspiring to mirror the success of COG, cancer experts examined national survey data from the U.S. Surveillance, Epidemiology, and End Results (SEER) program for trends in survival differences between whites and blacks with leukemia and lymphoma, related to their age at time of diagnosis.  SEER results provided the most comprehensive data of leukemia and lymphoma incidence and survival over the past several decades.
Survey results detailed the annual five-year relative survival rate trends between 1975 and 2000 for all leukemia and lymphoma cases.  For patients younger than 10 years of age, five-year survival rates among white and black children were similar.  Comparable trends were displayed for white and black patients between the ages of 10 and 19.  However, data revealed that outcomes for black patients were progressively worse than those for whites among patients between the ages of 20 and 29 years.  As of 2000, the projected survival deficit between blacks and whites in the 20- to 29-year age group was 20-25 percent among acute myelogenous leukemia patients, and 5-10 percent for other leukemia and lymphoma cases.
"Leukemia and lymphoma continue to attack America's youth, and as survival rates slowly improve, the racial disparity gap between children and young adults only seems to be more apparent," said Aaron Viny, BS, Cleveland Clinic Lerner College of Medicine, Ohio, and lead author of the study.  "If COG is able to successfully reduce the racial disparity among pediatric patients, there is a great opportunity to duplicate that success with older adolescents and young adults.  By examining clinical trials data through COG or other relevant databases, researchers will be one step closer to eliminating that gap."
Twenty Years of Follow-Up Among Survivors of Childhood and Young Adult Acute Myeloid Leukemia (AML): A Report from the Childhood Cancer Survivor Study (CCSS) [Abstract #560]
Leukemias are the most common cancer affecting children and young adults, accounting for nearly one-third of all cancers in children under age 15 and a quarter of cancers occurring before age 20.  Acute myeloid leukemia (AML, a cancer of the blood and bone marrow) accounts for approximately 25 percent of childhood leukemias, with an increased incidence in the adolescent and young adult age group.
AML remains a challenging disease to successfully treat; however, national clinical trials have greatly advanced pediatric AML therapy, increased remission rates, and improved survival among childhood and young adult patients.  Despite this improvement, little information exists concerning the late medical and social effects experienced by these aggressively treated patients.  A comprehensive twenty-year analysis of survival, medical late effects, marriage, education, and employment rates among survivors of AML and a sibling control group provided a wealth of data about the long-term quality of life for these individuals.
Experts in the field of pediatric cancer evaluated 272 survivors of AML participating in the Childhood Cancer Survivor Study (CCSS), all of whom had survived at least five years from the time of diagnosis, were less than 21 years old at diagnosis, were treated between 1970 and 1986, and were not treated with a blood or marrow transplant.  Comparisons were made to a sibling control group.  Among these five-year survivors, 97 percent were still alive 10 years later and 94 percent were alive after 20 years (25 years post- diagnosis).  Six patients reported disease recurrences, two died from relapse, one from congestive heart failure, and one from a myocardial infarction.  The incidence of recurrent AML was 1.8 percent at 10 years and 3.7 percent at 20 years, suggesting treatment success in five-year AML survivors.
Study results also showed that AML survivors were successful in their lives:
  * Among those 25 years or older, marriage rates were similar between AML    survivors and the general U.S. population at 59 percent, but lower    compared to the sibling comparison group at 69 percent.  * College graduation rates were lower among survivors (42 percent) when    compared to siblings (52 percent), but higher than the general    population (34 percent).  * All survivors and siblings were employed and most had health insurance    (93 percent vs. 90 percent).
"We are encouraged by the favorable survival rates among children and young adults living more than five years from their diagnosis of AML. However, late-occurring medical sequelae remain an area of concern, and it is crucial that these patients continue to be evaluated in a long-term follow-up clinic, where a physician familiar with the unique issues of cancer survivors can review their prior treatment and screen for late effects of cancer therapy," said Daniel A. Mulrooney, MD, University of Minnesota Medical School in Minneapolis.  "On social measures, AML survivors may not be doing as well as their siblings or socioeconomic group.  Fortunately, however, they are doing just as well, or better, when compared to the general U.S. population."
American Society of Hematology