Factors Associated With Early Death in Childhood Cancer

Key Points

  • The risk for early death in childhood cancer was associated with specific diagnoses, age < 1 year, and minority race/ethnicity.
  • The risk for early death has decreased over time.

In a study reported in the Journal of Clinical Oncology, Green et al found that risk factors for death within 1 month of diagnosis of childhood cancer included age up to 1 year, specific diagnoses, and minority race/ethnicity.

The study involved analysis of data from SEER (Surveillance, Epidemiology, and End Results) 13 registries on 36,337 patients aged 0 to 19 years diagnosed with cancer between 1992 and 2011. Early death was defined as death within 1 month of diagnosis.

Risk Factors

Overall, 555 patients (1.5%) had early death over the 20-year study period, with early deaths representing 7.5% of the total deaths (n = 7,403). With neuroblastoma used as the reference group, diagnoses with a significantly increased risk for early death included acute myeloid leukemia (odds ratio [OR] = 5.19), infant acute lymphoblastic leukemia (OR = 4.42), hepatoblastoma (OR = 3.05), and malignant brain tumors, whereas diagnoses associated with a significantly lower risk included malignant melanoma (OR = 0.07), Hodgkin lymphoma (OR = 0.15), osteosarcoma (OR = 0.23), and low-grade glioma (OR = 0.32). Compared with patients with solid tumors (0.8% with early death), the risk of early death was higher in those with hematologic malignancies (1.8%; OR = 2.23, 95% confidence interval [CI] = 1.80–2.76) or central nervous system (CNS) tumors (2.3%; OR = 2.80, 95% CI = 2.21–3.56).

In multivariate analysis, significant predictors of early death follow: age < 1 year (OR = 4.32) or 15 to 19 years (OR = 1.76), Hispanic ethnicity (OR = 1.48), black race (OR = 1.68), and lower income (OR = 1.51) for hematologic tumors; age < 1 year (OR = 18.55), 1 to 4 years (OR = 2.84), or 15 to 19 years (OR = 2.10) and Hispanic ethnicity (OR = 1.66) for CNS tumors; and age < 1 year (OR = 5.34), black race (OR = 1.88), and distant spread of disease (OR = 7.37) for solid tumors.

Decreasing Frequency

The percentages of early death decreased significantly over the study period, showing an overall absolute percent change of –2.5 (95% CI = –3.9 to –1.1); this decrease included a significant decrease among hematologic malignancies (–3.5, 95% CI = –5.7 to –1.3) and nonsignificant decreases in solid tumors (–2.9, 95% CI = –6.1 to 0.3) and CNS tumors (–0.8, 95% CI = –4.3 to 2.8).

The investigators concluded: “Risk factors for early death in childhood cancer include an age younger than 1 year, specific diagnoses, minority race and ethnicity, and disadvantaged socioeconomic status. The population-based disease-specific percentages of early death were uniformly higher than those reported in cooperative clinical trials, suggesting that early death is underreported in the medical literature. Initiatives to identify those at risk and develop preventive interventions should be prioritized.”

The study was supported by the Luke’s Army Pediatric Cancer Research Fund St. Baldrick’s Fellowship and a Hyundai Hope on Wheels Young Investigator Award.

Adam L. Green, MD, of the University of Colorado Anschutz Medical Campus, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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