Race, Ethnicity and Poverty Associated With Lower Overall Survival in Children With High-Risk Neuroblastoma

For immediate release
May 26, 2022


Rachel Cagan

ASCO Perspective:
“These findings in high-risk neuroblastoma point out that while there is an urgent need for all patients to have equal access to the latest cancer treatments, with the goal of improving treatment outcomes in pediatric clinical trials, there remains an effect of poverty on treatment outcomes that persists even when patients are enrolled in a trial and treatment is standardized,” said ASCO President Everett E. Vokes, MD, FASCO. 

ALEXANDRIA, Va. — Children with high-risk neuroblastoma from historically marginalized racial and ethnic groups had a higher probability of dying than other children despite equal planned treatment on pediatric clinical trials, according to research that will be presented at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting.

Study at a Glance


Association of race, ethnicity and poverty on overall survival (OS) for children with high-risk neuroblastoma.


696 children enrolled in Children’s Oncology Group (COG) clinical trials.


  • The five-year OS rate varied by race/ethnicity (47% for Hispanic children; 50% for other non-Hispanic children; 61% for white non-Hispanic children; and 63% for Black non-Hispanic children).
  • Five-year OS was lower among children with public insurance only (as a proxy for household poverty) compared to others (53% vs. 63%). Five-year OS was also lower among children living in neighborhood level poverty compared to others (54% vs. 62%).
  •  There was no difference in OS by rural status as children who live in rural areas typically receive care at urban cancer centers.


This study suggests that simply having access to clinical trials does not ensure equitable outcomes by race and ethnicity. These results will allow researchers to develop and focus on new ways to provide care in clinical trials to improve equity.


Key Findings

In this study, the five-year OS rate for high-risk neuroblastoma varied by race/ethnicity: 47% for Hispanic children; 50% for the category of other non-Hispanic children; 61% for white non-Hispanic children; and 63% for Black non-Hispanic children.

When looking at poverty levels, five-year OS was lower among children with public insurance only (such as Medicaid and the Children’s Health Insurance Program) compared to other children (53% vs. 63%). Five-year OS was also lower for children living in neighborhood level poverty compared to other children (54% vs. 62%). Neighborhood poverty was defined as ZIP codes where 20% or more of the population lives below the Federal Poverty Linei. Tumor stage and biology did not differ by race/ethnicity or poverty measures in the three Children’s Oncology Group trials analyzed in this study.

“Many previous studies have shown racial, ethnic and socioeconomic disparities across different pediatric cancers, but we haven’t been able to comprehensively look at whether these disparities persist when you take into account the type of cancer treatment that children receive,” said lead author Puja J. Umaretiya, MD, a Clinical Fellow in Pediatric Hematology/Oncology at Dana-Farber Cancer Institute and Boston Children's Hospital. “To address this gap, we decided to look at whether outcomes were the same for children across racial and ethnic groups when they received treatment on the same clinical trials for high-risk neuroblastoma.”

One other way that the study authors looked at poverty was by examining where children lived (rural vs. urban areas) and they found no difference in OS. The authors believe that this outcome may be because, regardless of where children lived at diagnosis, in this study all children who participated in these trials had already accessed care at a pediatric cancer center. These results suggest that even when children are treated on the same clinical trials, there are differences in survival by race and ethnicity.

About the Study

Data on treatment outcomes were assessed in three different trials conducted by the Children's Oncology Group, a clinical trials group supported by the National Cancer Institute. The study group included children who were Black non-Hispanic (16%), Hispanic (11%), other non-Hispanic (4%) and white non-Hispanic (69%). One-third had public insurance only (a proxy for household poverty), 26% lived in high poverty ZIP code locations and 15% lived in rural communities. OS and event-free survival (EFS) from time of trial enrollment were assessed.

Racial and socioeconomic disparities have not been comprehensively investigated in high-risk neuroblastoma. Prior Children’s Oncology Group studies have shown population-based disparities in late relapse rates among Black patients with neuroblastoma. Research has also found clinical trial-based disparities in relapse and survival among children with high-risk neuroblastoma living in poverty who received immunotherapy after their initial therapy. Studies have also demonstrated differences in disease incidence for Black children – they are more likely to be diagnosed with high-risk neuroblastoma.

Next Steps

To better understand what drives disparities in survival outcomes, the investigators will next look at how therapy was delivered in this same group of children, including whether there are delays during treatment, whether trials are discontinued disproportionately and whether children who relapse have the same access to early-phase trials by race, ethnicity and poverty measures. The investigators will also examine what role poverty plays in the associations between race/ethnicity and survival.

This study did not receive any funding.

View the full abstract

View the author disclosures: https://coi.asco.org/Report/ViewAbstractCOI?id=362224

View the disclosures for ASCO’s Cancer Communications Committee: https://www.asco.org/sites/new-www.asco.org/files/content-files/about-asco/pdf/2022-asco-ccc-disclosures.pdf

View the disclosures for Dr. Vokes: https://coi.asco.org/share/4SR-2FFX/Everett%20Vokes

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