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1.26.2016

Study Shows Inferior Outcomes for African-American Pediatric Lymphoma Patients

Researchers from Sylvester Comprehensive Cancer Center have published a study showing that African-American pediatric Hodgkin lymphoma patients have inferior overall survival to their white and Hispanic peers. The findings, published in the journal Pediatric Blood & Cancer, are the largest study yet on racial and ethnic disparity in the pediatric Hodgkin lymphoma population.

“Little was known about the association between race, ethnicity and survival in the pediatric Hodgkin lymphoma population,” said Joseph Panoff, M.D., assistant professor of radiation oncology at Sylvester and lead author of the study. “Our study showed that African-American children and teenagers had worse overall survival than whites and Hispanics at 25 years after diagnosis. We also found that Hispanic males had inferior disease-specific survival compared to white males.”

In the United States, lymphoma — cancer of the lymphatic system — is the third most common malignancy in children and adolescents. Hodgkin lymphoma comprises roughly half of all lymphoma diagnoses. National outcomes for children with Hodgkin lymphoma are relatively favorable and have improved over the last few decades, with current five-year survival rates averaging 95 percent for patients 0 to 19 years of age.

Panoff and his colleagues analyzed Florida-specific data as well as national data from more than 7,800 patients, 0.1 to 21 years of age (average: 17 years), who were listed in the Florida Cancer Data System (FCDS) and the National Institutes of Health’s Surveillance, Epidemiology, and End Results Program (SEER). All Hispanics, non-Hispanic whites and non-Hispanic African-Americans were included in the analysis.

In the Florida (FCDS) cohort, which was significantly smaller than the SEER cohort (1,778 vs. 6,027), African-Americans had a 33 percent overall survival rate at 25 years compared to 49.2 percent for whites and 44.7 percent for Hispanics. Overall, patients in the FCDS cohort seemed to have worse overall survival than patients in the SEER cohort, indicating patients treated in Florida have worse outcomes when compared to the rest of the nation.

“Clearly, racial and ethnic disparities persist in the pediatric Hodgkin lymphoma population despite modern treatment, particularly in Florida,” Panoff said. “The underlying causes of these disparities are complex and need further explanation.”

As a next step, Panoff suggests identifying flaws within the diagnostic and treatment process with regard to African-American and Hispanic patients.

“It is important to identify sociocultural factors and health behaviors that negatively affect overall survival in African-American patients and disease-free survival in Hispanic males,” he said. “The fact that the entire Florida cohort seems to have worse overall survival than patients in the rest of the country is a new finding that requires further research.”

The research was partly funded by the Miami Clinical and Translational Science Institute at the University of Miami Miller School of Medicine.

The study was co-authored by W.R. Grubb, M.D., M.P.H., H.J. Neboori, M.D., and A.D. Diaz, M.D., all in the Department of Radiation Oncology; H. Li, M.D., Ph.D., M.S., in the Department of Public Health Sciences at the University of Miami Miller School of Medicine; and D. Kwon, Ph.D., associate scientist at Sylvester Comprehensive Cancer Center.

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