Advances and disparities in survival of childhood and adolescent cancers.

Abstract

We analyzed trends in survival of children and adolescents diagnosed with cancer in the United States from 1975 to 2022 using the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) 8 and 17 databases. Our goal was to provide an updated overview of outcomes and highlight disparities to guide future research. Data were obtained from the SEER 8 and 17 registries for patients diagnosed at 0 to 19 years. Overall survival (OS) was stratified by race/ethnicity, diagnosis, and population density. Temporal trends in five-year OS were evaluated using the NCI Joinpoint Regression Program. Kaplan-Meier survival curves with log-rank tests assessed survival differences across subgroups. Multivariable Cox proportional hazards models evaluated OS, adjusted for age, decade of diagnosis and race/ethnicity. A total of 52,165 patients were diagnosed with cancer in SEER 8, and 100,110 in SEER 17. Five-year OS for all cancers improved from 60% (95% CI:56 to 64%) in 1975 to 90% (95% CI : 88 to 91%) in 2017. Survival gains were greatest in acute lymphoblastic leukemia, with more modest improvements in solid tumors. Mortality beyond 20 years persisted for some cancers, including Hodgkin lymphoma. Survival differed significantly by race/ethnicity (p < 0.001), with non-Hispanic Black patients experiencing the lowest five-year OS across multiple cancers, even after adjusting for age/decade of diagnosis. Survival for childhood and adolescent cancers has markedly improved over the past five decades, yet progress remains uneven across cancer types and race/ethnicity. Understanding drivers of disparities is essential to achieve equitable outcomes for all young cancer patients.