Loss to follow-up of minorities, adolescents, and young adults on clinical trials : A report from the Children's Oncology Group
© 2023 American Cancer Society..
BACKGROUND: The increasing number of childhood cancer survivors necessitates continued follow-up to monitor for long-term complications. Inequities in loss to follow-up for patients enrolled on pediatric clinical trials have not been well studied.
METHODS: This was a retrospective study of 21,084 patients residing in the United States enrolled on phase 2/3 and phase 3 Children's Oncology Group (COG) trials between January 1, 2000 and March 31, 2021. Rates of loss to follow-up to COG were evaluated using log-rank tests and multivariable Cox proportional hazards regression models with adjusted hazard ratios (HRs). Demographic characteristics included age at enrollment, race, ethnicity, and zip code level socioeconomic data.
RESULTS: Adolescent and young adult (AYA) patients 15-39 years old at diagnosis had an increased hazard of loss to follow-up compared to patients 0-14 years old (HR, 1.89; 95% confidence interval (CI), 1.76-2.02). In the overall cohort, non-Hispanic Blacks were found to have an increased hazard of loss to follow-up compared to non-Hispanic Whites (HR, 1.56; 95% CI, 1.43-1.70). Among AYAs, the highest loss to follow-up rates were among non-Hispanic Blacks (69.8% ± 3.1%), patients on germ cell tumor trials (78.2% ± 9.2%), and patients living in zip codes with a median household income ≤150% of the federal poverty line at diagnosis (66.7% ± 2.4%).
CONCLUSIONS: AYAs, racial and ethnic minority patients, and those living in lower socioeconomic status areas had the highest rates of loss to follow-up among clinical trial participants. Targeted interventions are warranted to ensure equitable follow-up and improved assessment of long-term outcomes.
PLAIN LANGUAGE SUMMARY: Little is known about disparities in loss to follow-up for pediatric cancer clinical trial participants. In this study, we found that participants who were adolescents and young adults when treated, those who identified as a racial and/or ethnic minority, or those residing in areas with lower socioeconomic status at diagnosis were associated with higher rates of loss to follow-up. As a result, the ability to assess their long-term survival, treatment-related health conditions, and quality of life is hindered. These findings suggest the need for targeted interventions to improve long-term follow-up among disadvantaged pediatric clinical trial participants.
| Errataetall: |
CommentIn: Cancer. 2023 May 15;129(10):1476-1478. - PMID 36813752 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:129 |
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| Enthalten in: |
Cancer - 129(2023), 10 vom: 15. Mai, Seite 1547-1556 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Puthenpura, Vidya [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 25.04.2023 Date Revised 10.03.2024 published: Print-Electronic CommentIn: Cancer. 2023 May 15;129(10):1476-1478. - PMID 36813752 Citation Status MEDLINE |
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| doi: |
10.1002/cncr.34701 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Loss to follow-up of minorities, adolescents, and young adults on clinical trials |b A report from the Children's Oncology Group |
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| 500 | |a Date Completed 25.04.2023 | ||
| 500 | |a Date Revised 10.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Cancer. 2023 May 15;129(10):1476-1478. - PMID 36813752 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 American Cancer Society. | ||
| 520 | |a BACKGROUND: The increasing number of childhood cancer survivors necessitates continued follow-up to monitor for long-term complications. Inequities in loss to follow-up for patients enrolled on pediatric clinical trials have not been well studied | ||
| 520 | |a METHODS: This was a retrospective study of 21,084 patients residing in the United States enrolled on phase 2/3 and phase 3 Children's Oncology Group (COG) trials between January 1, 2000 and March 31, 2021. Rates of loss to follow-up to COG were evaluated using log-rank tests and multivariable Cox proportional hazards regression models with adjusted hazard ratios (HRs). Demographic characteristics included age at enrollment, race, ethnicity, and zip code level socioeconomic data | ||
| 520 | |a RESULTS: Adolescent and young adult (AYA) patients 15-39 years old at diagnosis had an increased hazard of loss to follow-up compared to patients 0-14 years old (HR, 1.89; 95% confidence interval (CI), 1.76-2.02). In the overall cohort, non-Hispanic Blacks were found to have an increased hazard of loss to follow-up compared to non-Hispanic Whites (HR, 1.56; 95% CI, 1.43-1.70). Among AYAs, the highest loss to follow-up rates were among non-Hispanic Blacks (69.8% ± 3.1%), patients on germ cell tumor trials (78.2% ± 9.2%), and patients living in zip codes with a median household income ≤150% of the federal poverty line at diagnosis (66.7% ± 2.4%) | ||
| 520 | |a CONCLUSIONS: AYAs, racial and ethnic minority patients, and those living in lower socioeconomic status areas had the highest rates of loss to follow-up among clinical trial participants. Targeted interventions are warranted to ensure equitable follow-up and improved assessment of long-term outcomes | ||
| 520 | |a PLAIN LANGUAGE SUMMARY: Little is known about disparities in loss to follow-up for pediatric cancer clinical trial participants. In this study, we found that participants who were adolescents and young adults when treated, those who identified as a racial and/or ethnic minority, or those residing in areas with lower socioeconomic status at diagnosis were associated with higher rates of loss to follow-up. As a result, the ability to assess their long-term survival, treatment-related health conditions, and quality of life is hindered. These findings suggest the need for targeted interventions to improve long-term follow-up among disadvantaged pediatric clinical trial participants | ||
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| 650 | 4 | |a adolescent and young adults | |
| 650 | 4 | |a clinical trials | |
| 650 | 4 | |a long-term follow-up | |
| 650 | 4 | |a loss to follow-up | |
| 650 | 4 | |a pediatrics | |
| 650 | 4 | |a racial and ethnic disparities | |
| 650 | 4 | |a socioeconomic disparities | |
| 700 | 1 | |a Ji, Lingyun |e verfasserin |4 aut | |
| 700 | 1 | |a Xu, Xinxin |e verfasserin |4 aut | |
| 700 | 1 | |a Roth, Michael E |e verfasserin |4 aut | |
| 700 | 1 | |a Freyer, David R |e verfasserin |4 aut | |
| 700 | 1 | |a Frazier, A Lindsay |e verfasserin |4 aut | |
| 700 | 1 | |a Marks, Asher M |e verfasserin |4 aut | |
| 700 | 1 | |a Pashankar, Farzana D |e verfasserin |4 aut | |
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