||1R01CA266105-01 Interpret this number
||University Of Minnesota
||Socioeconomic Determinants of Childhood Cancer Outcomes in a Large Contemporary Cohort
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
An updated assessment of 43,110 patients enrolled in the Childhood Cancer Research Network: A Children's Oncology Group report.
, Sok P.
, Scheurer M.E.
, Rabin K.R.
, Marcotte E.L.
, Hawkins D.S.
, Spector L.G.
, Lupo P.J.
Cancer, 2022-07-15; 128(14), p. 2760-2767.