0
February 22, 1995, Vol 273, No. 8 >
ARTICLE | February 22, 1995

Outcome of Treatment for Childhood Cancer in Black as Compared With White Children: Title and subTitle BreakThe St Jude Children's Research Hospital Experience, 1962 Through 1992 FREE

Ching-Hon Pui, MD; James M. Boyett, PhD; Michael L. Hancock, MS; Charles B. Pratt, MD; William H. Meyer, MD; William M. Crist, MD
[+] Author Affiliations

Reprint requests to St Jude Children's Research Hospital, 332 N Lauderdale St, PO Box 318, Memphis, TN 38101-0318 (Dr Pui).


JAMA. 1995;273(8):633-637. doi:10.1001/jama.1995.03520320043039
Text Size: A A A
Published online
Article
References

Objective.  —To determine whether there is a racial difference in prognosis among childhood cancers.

Design.  —An overall (30-year) survival analysis by race was followed by separate studies for "early" and "recent" treatment eras, defined by time points at which significantly improved outcome was demonstrated for specific tumor types. Stratified analyses were performed to adjust for recognized prognostic features.

Setting.  —Pediatric oncology research and treatment center.

Patients.  —The study included 798 black and 4507 white children with newly diagnosed malignancies treated from January 1962 through June 1992. These patients were accepted for treatment regardless of their financial status and were enrolled on disease-specific protocols.

Results.  —Across the 30-year study period, black children had a significantly poorer rate of survival than white children (P<.001, log-rank test). In the early treatment era, a significant difference was seen for all forms of cancer combined (P<.001), with 10-year Kaplan-Meier estimates (±SE) of 37%±3% for black children and 50%±1% for white children. This difference largely reflected the poorer prognosis of black children with the most common childhood cancer, acute lymphoblastic leukemia. In the recent treatment era, there were no significant differences in treatment outcome by race for specific disease categories or for all forms of cancer combined. Ten-year survival rates were 67±6% for black children and 66%±3% for white children, indicating a significantly greater improvement in the former group.

Conclusion.  —With equal access to effective contemporary treatment, black children with cancer fare as well as white children when treated with protocol-based therapy at a pediatric oncology research center.(JAMA. 1995;273:633-637)

REFERENCES

1 +
Boring CC, Squires TS, Heath CW Jr.  Cancer statistics for African Americans. CA Cancer J Clin . 1992;;42:7-17.
2 +
Boring CC, Squires TS, Tong T.  Cancer statistics, 1992. CA Cancer J Clin . 1992;;42:19-38.
3 +
Aziz H, Rotman M, Thelmo W, et al.  Radiation-treated carcinoma of prostate: comparison of survival of black and white patients by Gleason's Grading System. Am J Clin Oncol . 1988;;11:166-171.
4 +
Dayal HH, Power RN, Chiu C.  Race and socioeconomic status in survival from breast cancer. J Chronic Dis . 1982;;35:675-683.
5 +
Ownby HE, Frederick J, Russo J, et al.  Racial differences in breast cancer patients. J Natl Cancer Inst . 1985;;75:55-60.
6 +
Bain RP, Greenberg RS, Whitaker JP.  Racial differences in survival of women with breast cancer. J Chronic Dis . 1986;;39:631-642.
7 +
Bassett MT, Krieger N.  Social class and black-white differences in breast cancer survival. Am J Public Health . 1986;;76:1400-1403.
8 +
Dansey RD, Hessel PA, Browde S, et al.  Lack of a significant independent effect of race on survival in breast cancer. Cancer . 1988;;61:1908-1912.
9 +
Dayal H, Polissar L, Yang CY, Dahlberg S.  Race, socioeconomic status, and other prognostic factors for survival from colo-rectal cancer. J Chronic Dis . 1987;;40:857-864.
10 +
Howard J, Hankey BF, Greenberg RS, et al.  A collaborative study of differences in the survival rates of black patients and white patients with cancer. Cancer . 1992;;69:2349-2360.
11 +
Steinhorn SC, Myers MH, Hankey BF, Pelham VF.  Factors associated with survival differences between black women and white women with cancer of the uterine corpus. Am J Epidemiol . 1986;; 124:85-93.
12 +
Bain RP, Greenberg RS, Chung KC.  Racial differences in survival of women with endometrial cancer. Am J Obstet Gynecol . 1987;;157:914-923.
13 +
Klingemann H-G, Deeg HJ, Self S, Thomas ED, Storb R.  Is race a risk factor for allogeneic marrow transplantation? Bone Marrow Transplant . 1986;;1: 87-94.
14 +
Reintgen DS, McCarty KM Jr, Cox E, Seigler HF.  Malignant melanoma in black American and white American populations. JAMA . 1982;;248:1856-1859.
15 +
Ragland KE, Selvin S, Merrill DW.  Black-white differences in stage-specific cancer survival: analysis of seven selected sites. Am J Epidemiol . 1991;; 133:672-682.
16 +
Broder S.  The challenge of cancer research. Stem Cells . 1993;;11:3-8.
17 +
Walters TR, Bushore M, Simone J.  Poor prognosis in negro children with acute lymphocytic leukemia. Cancer . 1972;;29:210-214.
18 +
Reaman GH, Leikin SL.  Racial variation in the frequency of immunological subtypes of childhood acute lymphoblastic leukemia. Prog Cancer Res Ther . 1984;;27:163-168.
19 +
Sather H, Honour R, Sposto R, Level C, Hammond D.  Differences in the presentation of acute lymphoblastic leukemia and non-Hodgkin's lymphoma in black children and white children: a report from the Epidemiology Committee of the Children's Cancer Study Group. Prog Cancer Res Ther . 1984;;27:179-187.
20 +
Falletta JM, Boyett J, Pullen DJ, et al.  Clinical and phenotypic features of childhood acute lymphocytic leukemia in whites, blacks, and Hispanics: a Pediatric Oncology Group study. Prog Cancer Res Ther . 1984;;27:191-195.
21 +
Kalwinsky DK, Rivera G, Dahl GV, et al.  Variation by race in presenting clinical and biologic features of childhood acute lymphoblastic leukaemia: implications for treatment outcome. Leuk Res . 1985;; 9:817-823.
22 +
Young JL, Ries LG, Silverberg E, Horm JW, Miller RW.  Cancer incidence, survival, and mortality for children younger than age 15 years. Cancer . 1986;;58:598-602.
23 +
Birch JM, Marsden HB, Morris Jones PH, Pearson D, Blair V.  Improvements in survival from childhood cancer: results of a population based survey over 30 years. BMJ . 1988;;296:1372-1376.
24 +
Pediatric Oncology Group.  Progress against childhood cancer: the Pediatric Oncology Group experience. Pediatrics . 1992;;89:597-600.
25 +
Cox DR, Lewis PAW. The Statistical Analysis of Series of Events . London, England: Methuen & Co Ltd; 1968;:229-237.
26 +
Kaplan EL, Meier P.  Nonparametric estimation from incomplete observations. J Am Stat Assoc . 1958;;53:457-481.
27 +
Peto R, Pike MC, Armitage P, et al.  Design and analysis of randomized clinical trials requiring prolonged observation of each patient, II: analysis and examples. Br J Cancer . 1977;;35:1-39.
28 +
Mantel N, Haenszel W.  Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst . 1958;;22:719-748.
29 +
Early Breast Cancer Trialists' Collaborative Group. Treatment of Early Breast Cancer: Worldwide Evidence 1985-1990 . New York, NY: Oxford University Press Inc; 1990:1.
30 +
Miller RW.  Frequency and environmental epidemiology of childhood cancer.  In: Pizzo RA, Poplack DG, eds. Principles and Practice of Pediatric Oncology . Philadelphia, Pa: JB Lippincott; 1989;:3-18.
31 +
Pui C-H, Behm FG, Crist WM.  Clinical and biologic relevance of immunologic marker studies in childhood acute lymphoblastic leukemia. Blood . 1993;;82:343-362.
32 +
Pui C-H, Crist WM, Look AT.  Biology and clinical significance of cytogenetic abnormalities in childhood acute lymphoblastic leukemia. Blood . 1990;; 76:1449-1463.
33 +
Pui C-H, Ribeiro RC, Hancock ML, et al.  Acute myeloid leukemia in children treated with epipodophyllotoxins for acute lymphoblastic leukemia. N Engl J Med . 1991;;325:1682-1687.
34 +
Evans WE, Rodman J, Relling MV, et al.  Individualized dosages of chemotherapy as a strategy to improve response for acute lymphocytic leukemia. Semin Hematol . 1991;;28:15-21.
35 +
Rivera GK, Pinkel D, Simone JV, Hancock ML, Crist WM.  Treatment of acute lymphoblastic leukemia: 30 years' experience at St. Jude Children's Research Hospital. N Engl J Med . 1993;;329:1289-1295.
36 +
Kitagawa EM, Hauser PM. Differential Mortality in the United States: A Study in Socioeconomic Epidemiology . Cambridge, Mass: Harvard University Press; 1973;.
37 +
Pappas G, Queen S, Hadden W, Fisher G.  The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med . 1993;;324:103-109.
38 +
Lipshultz SE, Colan SD, Gelber RD, Perez-Atayde AR, Sallan SE, Sanders SP.  Late cardiac effects of doxorubicin therapy for acute lymphoblastic leukemia in childhood. N Engl J Med . 1991;; 324:808-815.
39 +
Neglia JP, Meadows AT, Robison LL, et al.  Second neoplasms after acute lymphoblastic leukemia in childhood. N Engl J Med . 1991;;325:1330-1336.
40 +
Blatt J, Olshan A, Gula MJ, Dickman PS, Zaranek B.  Second malignancies in very-long-term survivors of childhood cancer. Am J Med . 1992;;93: 57-60.
41 +
Meadows AT, Kramer S, Hopson R, Lustbader E, Jarrett P, Evans AE.  Survival in childhood acute lymphocytic leukaemia: effect of protocol and place of treatment. Cancer Invest . 1983;;1:49-55.
42 +
Kramer S, Meadows AT, Pastore G, Jarrett P, Bruce D.  Influence of place of treatment on diagnosis, treatment and survival in three pediatric solid tumors. J Clin Oncol . 1984;;2:917-923.
43 +
Lennox EL, Stiller CA, Morris Jones PH, Kinnier LWM.  Nephroblastoma: treatment during 1970-3 and the effect on survival of inclusion in the first MRC trial. BMJ . 1979;;2:567-569.
44 +
Stiller CA.  Centralisation of treatment and survival rates for cancer. Arch Dis Child . 1988;;63:23-30.
45 +
Angell M.  Privilege and health—what is the connection? N Engl J Med . 1993;;329:126-127.
46 +
Novakovic B.  U.S. childhood cancer survival, 1973-1987. Med Pediatr Oncol . 1994;;23:480-486.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Boring CC, Squires TS, Heath CW Jr.  Cancer statistics for African Americans. CA Cancer J Clin . 1992;;42:7-17.
2 +
Boring CC, Squires TS, Tong T.  Cancer statistics, 1992. CA Cancer J Clin . 1992;;42:19-38.
3 +
Aziz H, Rotman M, Thelmo W, et al.  Radiation-treated carcinoma of prostate: comparison of survival of black and white patients by Gleason's Grading System. Am J Clin Oncol . 1988;;11:166-171.
4 +
Dayal HH, Power RN, Chiu C.  Race and socioeconomic status in survival from breast cancer. J Chronic Dis . 1982;;35:675-683.
5 +
Ownby HE, Frederick J, Russo J, et al.  Racial differences in breast cancer patients. J Natl Cancer Inst . 1985;;75:55-60.
6 +
Bain RP, Greenberg RS, Whitaker JP.  Racial differences in survival of women with breast cancer. J Chronic Dis . 1986;;39:631-642.
7 +
Bassett MT, Krieger N.  Social class and black-white differences in breast cancer survival. Am J Public Health . 1986;;76:1400-1403.
8 +
Dansey RD, Hessel PA, Browde S, et al.  Lack of a significant independent effect of race on survival in breast cancer. Cancer . 1988;;61:1908-1912.
9 +
Dayal H, Polissar L, Yang CY, Dahlberg S.  Race, socioeconomic status, and other prognostic factors for survival from colo-rectal cancer. J Chronic Dis . 1987;;40:857-864.
10 +
Howard J, Hankey BF, Greenberg RS, et al.  A collaborative study of differences in the survival rates of black patients and white patients with cancer. Cancer . 1992;;69:2349-2360.
11 +
Steinhorn SC, Myers MH, Hankey BF, Pelham VF.  Factors associated with survival differences between black women and white women with cancer of the uterine corpus. Am J Epidemiol . 1986;; 124:85-93.
12 +
Bain RP, Greenberg RS, Chung KC.  Racial differences in survival of women with endometrial cancer. Am J Obstet Gynecol . 1987;;157:914-923.
13 +
Klingemann H-G, Deeg HJ, Self S, Thomas ED, Storb R.  Is race a risk factor for allogeneic marrow transplantation? Bone Marrow Transplant . 1986;;1: 87-94.
14 +
Reintgen DS, McCarty KM Jr, Cox E, Seigler HF.  Malignant melanoma in black American and white American populations. JAMA . 1982;;248:1856-1859.
15 +
Ragland KE, Selvin S, Merrill DW.  Black-white differences in stage-specific cancer survival: analysis of seven selected sites. Am J Epidemiol . 1991;; 133:672-682.
16 +
Broder S.  The challenge of cancer research. Stem Cells . 1993;;11:3-8.
17 +
Walters TR, Bushore M, Simone J.  Poor prognosis in negro children with acute lymphocytic leukemia. Cancer . 1972;;29:210-214.
18 +
Reaman GH, Leikin SL.  Racial variation in the frequency of immunological subtypes of childhood acute lymphoblastic leukemia. Prog Cancer Res Ther . 1984;;27:163-168.
19 +
Sather H, Honour R, Sposto R, Level C, Hammond D.  Differences in the presentation of acute lymphoblastic leukemia and non-Hodgkin's lymphoma in black children and white children: a report from the Epidemiology Committee of the Children's Cancer Study Group. Prog Cancer Res Ther . 1984;;27:179-187.
20 +
Falletta JM, Boyett J, Pullen DJ, et al.  Clinical and phenotypic features of childhood acute lymphocytic leukemia in whites, blacks, and Hispanics: a Pediatric Oncology Group study. Prog Cancer Res Ther . 1984;;27:191-195.
21 +
Kalwinsky DK, Rivera G, Dahl GV, et al.  Variation by race in presenting clinical and biologic features of childhood acute lymphoblastic leukaemia: implications for treatment outcome. Leuk Res . 1985;; 9:817-823.
22 +
Young JL, Ries LG, Silverberg E, Horm JW, Miller RW.  Cancer incidence, survival, and mortality for children younger than age 15 years. Cancer . 1986;;58:598-602.
23 +
Birch JM, Marsden HB, Morris Jones PH, Pearson D, Blair V.  Improvements in survival from childhood cancer: results of a population based survey over 30 years. BMJ . 1988;;296:1372-1376.
24 +
Pediatric Oncology Group.  Progress against childhood cancer: the Pediatric Oncology Group experience. Pediatrics . 1992;;89:597-600.
25 +
Cox DR, Lewis PAW. The Statistical Analysis of Series of Events . London, England: Methuen & Co Ltd; 1968;:229-237.
26 +
Kaplan EL, Meier P.  Nonparametric estimation from incomplete observations. J Am Stat Assoc . 1958;;53:457-481.
27 +
Peto R, Pike MC, Armitage P, et al.  Design and analysis of randomized clinical trials requiring prolonged observation of each patient, II: analysis and examples. Br J Cancer . 1977;;35:1-39.
28 +
Mantel N, Haenszel W.  Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst . 1958;;22:719-748.
29 +
Early Breast Cancer Trialists' Collaborative Group. Treatment of Early Breast Cancer: Worldwide Evidence 1985-1990 . New York, NY: Oxford University Press Inc; 1990:1.
30 +
Miller RW.  Frequency and environmental epidemiology of childhood cancer.  In: Pizzo RA, Poplack DG, eds. Principles and Practice of Pediatric Oncology . Philadelphia, Pa: JB Lippincott; 1989;:3-18.
31 +
Pui C-H, Behm FG, Crist WM.  Clinical and biologic relevance of immunologic marker studies in childhood acute lymphoblastic leukemia. Blood . 1993;;82:343-362.
32 +
Pui C-H, Crist WM, Look AT.  Biology and clinical significance of cytogenetic abnormalities in childhood acute lymphoblastic leukemia. Blood . 1990;; 76:1449-1463.
33 +
Pui C-H, Ribeiro RC, Hancock ML, et al.  Acute myeloid leukemia in children treated with epipodophyllotoxins for acute lymphoblastic leukemia. N Engl J Med . 1991;;325:1682-1687.
34 +
Evans WE, Rodman J, Relling MV, et al.  Individualized dosages of chemotherapy as a strategy to improve response for acute lymphocytic leukemia. Semin Hematol . 1991;;28:15-21.
35 +
Rivera GK, Pinkel D, Simone JV, Hancock ML, Crist WM.  Treatment of acute lymphoblastic leukemia: 30 years' experience at St. Jude Children's Research Hospital. N Engl J Med . 1993;;329:1289-1295.
36 +
Kitagawa EM, Hauser PM. Differential Mortality in the United States: A Study in Socioeconomic Epidemiology . Cambridge, Mass: Harvard University Press; 1973;.
37 +
Pappas G, Queen S, Hadden W, Fisher G.  The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med . 1993;;324:103-109.
38 +
Lipshultz SE, Colan SD, Gelber RD, Perez-Atayde AR, Sallan SE, Sanders SP.  Late cardiac effects of doxorubicin therapy for acute lymphoblastic leukemia in childhood. N Engl J Med . 1991;; 324:808-815.
39 +
Neglia JP, Meadows AT, Robison LL, et al.  Second neoplasms after acute lymphoblastic leukemia in childhood. N Engl J Med . 1991;;325:1330-1336.
40 +
Blatt J, Olshan A, Gula MJ, Dickman PS, Zaranek B.  Second malignancies in very-long-term survivors of childhood cancer. Am J Med . 1992;;93: 57-60.
41 +
Meadows AT, Kramer S, Hopson R, Lustbader E, Jarrett P, Evans AE.  Survival in childhood acute lymphocytic leukaemia: effect of protocol and place of treatment. Cancer Invest . 1983;;1:49-55.
42 +
Kramer S, Meadows AT, Pastore G, Jarrett P, Bruce D.  Influence of place of treatment on diagnosis, treatment and survival in three pediatric solid tumors. J Clin Oncol . 1984;;2:917-923.
43 +
Lennox EL, Stiller CA, Morris Jones PH, Kinnier LWM.  Nephroblastoma: treatment during 1970-3 and the effect on survival of inclusion in the first MRC trial. BMJ . 1979;;2:567-569.
44 +
Stiller CA.  Centralisation of treatment and survival rates for cancer. Arch Dis Child . 1988;;63:23-30.
45 +
Angell M.  Privilege and health—what is the connection? N Engl J Med . 1993;;329:126-127.
46 +
Novakovic B.  U.S. childhood cancer survival, 1973-1987. Med Pediatr Oncol . 1994;;23:480-486.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems