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Minority Adult Survivors of Childhood Cancer: A Comparison of Long-Term Outcomes, Health Care Utilization, and Health-Related Behaviors From the Childhood Cancer Survivor Study

From the Department of Pediatrics, East Tennessee State University Quillen College of Medicine, Johnson City, St Jude Children’s Research Hospital, Memphis, TN; Department of Pediatrics, University of California, Los Angeles, CA; Department of Pediatrics, University of Minnesota, Minneapolis, MN; Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Family and Community Medicine; Department of Pediatrics, The University of Texas Southwestern Medical Center at Dallas, TX; Department of Pediatrics, University of California, San Francisco, CA; Children's Hospital of Alabama Birmingham, AL; and the Children's Hospital of Philadelphia, PA

Address reprint requests to Sharon Castellino, MD, Department of Pediatrics, Wake Forest University, Health Sciences Building, Medical Center Blvd, Winston-Salem, NC 27157; e-mail: scastell{at}wfubmc.edu

PURPOSE: To determine the influence of race/ethnicity on outcomes in the Childhood Cancer Survivor Study (CCSS).

PATIENTS AND METHODS: Of CCSS adult survivors in the United States, 443 (4.9%) were black, 503 (5.6%) were Hispanic and 7,821 (86.6%) were white. Mean age at interview, 26.9 years (range, 18 to 48 years); mean follow-up, 17.2 years (range, 8.7 to 28.4 years). Late mortality, second malignancy (SMN) rates, health care utilization, and health status and behaviors were assessed for blacks and Hispanics and compared with white survivors.

RESULTS: Late mortality rate (6.5%) and 15-year cumulative incidence of SMN (3.5%) were similar across racial/ethnic groups. Minority survivors were more likely to have lower socioeconomic status (SES); final models were adjusted for income, education, and health insurance. Although overall health status was similar, black survivors were less likely to report adverse mental health (females: odds ratio [OR], 0.6; 95% CI, 0.4 to 0.9; males: OR, 0.5; 95% CI, 0.3 to 0.8). Differences in health care utilization and behaviors noted: Hispanic survivors were more likely to report a cancer center visit (females: OR, 1.5; 95% CI, 1.1 to 2.0; males: OR, 1.7; 95% CI, 1.2 to 2.3); black females were more likely (OR, 1.6; 95% CI, 1.1 to 2.4), and Hispanic females less likely to have a recent Pap smear (OR, 0.7; 95% CI, 0.5 to 1.0); black and Hispanic survivors were less likely to report smoking; black survivors were less likely to report problem drinking.

CONCLUSION: Adjusted for SES, adverse outcomes in CCSS were not associated with minority status. Importantly, black survivors reported less risky behaviors and better preventive practices. Hispanic survivors had equitable access to cancer related care.

Supported by Grant No. U024-CA-55727-05 from the Department of Health and Human Services and funding to the University of Minnesota from the Children's Cancer Research Fund, and the University of California, Los Angeles, Jonsson Comprehensive Cancer Seed Grant Fund.

S.M.C. and J.C. contributed equally to the preparation of this manuscript.

Presented as abstracts/poster at the Pediatric Academic Societies Meeting, San Francisco, CA, May 1, 2004, and the Eighth International Conference on Long-Term Complications of Treatment of Children and Adolescents for Cancer, Niagra-on-the-Lake, Ontario, Canada, June 25, 2004.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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