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Access to Pediatric Cancer Care by Age, Race, and Diagnosis, and Outcomes of Cancer Treatment in Pediatric and Adolescent Patients in the State of Georgia

Della L. Howell, Kevin C. Ward, Harland D. Austin, John L. Young, William G. Woods

From the Departments of Pediatrics, Rollins School of Public Health; Department of Epidemiology, Emory University; Children's Healthcare of Atlanta; Aflac Cancer Center and Blood Disorders Service; and the Georgia Center for Cancer Statistics, Atlanta, GA

Address reprint requests to Della L. Howell, MD, 2200 Bergquist Dr, Suite 1A, MMNP, Pediatric Hematology/Oncology, San Antonio, TX 78236; e-mail: Della.Howell{at}lackland.af.mil

Purpose: There have been concerns among pediatric oncologists that adolescent and minority patients are not getting adequate access to care. This study examines access to cancer care and survival outcomes based on age, race, and type of cancer in patients in Georgia.

Patients and Methods: We performed a retrospective review of 1,751 cancer patients aged 0 to 19 years, diagnosed between 1998 and 2002, in the Georgia Comprehensive Cancer Registry, which identified patients who were treated at one of five Georgia pediatric cancer centers (Children's Oncology Group [COG] members) at any point in their treatment. Data were further analyzed for age at diagnosis, race, county of residence, and 5-year survival.

Results: Eighty-seven percent of patients aged 0 to 14 years and 36% of those aged 15 to 19 years were treated at a COG institution. Twenty-five percent of all patients were of African descent, with 75.4% of black versus 70.3% of white patients (age 0 to 19 years) treated at a COG institution (P < .01); 97.1% of other minorities were treated at a COG institution (P < .05). The 5-year actuarial survival rates for more pediatric-specific cancers were significantly lower in all leukemias (75.1% v 46.4%; P = .0015), and acute lymphoblastic leukemia specifically (86.3% v 53.3%; P < .05) for patients not treated at a COG institution. Actuarial survival rates were much lower for blacks than whites in all cancers as a whole (70% v 82%; P < .001) and for many specific subtypes.

Conclusion: Adolescent-aged patients are less likely to be referred to a COG institution, potentially exposing them to worse outcomes in some cancer subtypes. Reassuringly, minority populations are receiving adequate access to pediatric cancer care; unfortunately their survival rates are lower.

Supported by the Aflac Cancer Center and Blood Disorders Service.

Presented in poster format at the 18th Annual Meeting of the American Society of Pediatric Hematology/Oncology (ASPHO), May 13 to 16, 2005, Washington, DC.

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

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