Childhood Cancer Survival Climbs to 90%, but Black Patients Lag
Five-year survival for US children and adolescents with cancer rose from 60% in 1975 to 90% in 2017, a registry analysis found. Non-Hispanic Black patients had the lowest survival across multiple cancers, even after adjusting for age and diagnosis decade.
Childhood cancer survival climbs in the United States, but not equally for everyone. Five-year overall survival for children and adolescents diagnosed with cancer rose from 60% in 1975 to 90% in 2017, according to a registry analysis published in the Journal of the National Cancer Institute.
Non-Hispanic Black patients had the lowest five-year survival across multiple cancers. The gap held after adjustment for age and decade of diagnosis.
"Understanding drivers of disparities is essential to achieve equitable outcomes for all young cancer patients," the investigators wrote.
How the study worked
The team used two registries run by the National Cancer Institute, known as SEER 8 and SEER 17. SEER stands for Surveillance, Epidemiology, and End Results. The registries captured patients diagnosed with cancer at ages 0 to 19 from 1975 to 2022.
The SEER 8 group included 52,165 patients. The SEER 17 group included 100,110.
Survival was broken down by race and ethnicity, diagnosis and population density. Investigators tracked trends over time with the NCI Joinpoint Regression Program and compared subgroups using Kaplan-Meier curves. They also ran models that adjusted for age, decade of diagnosis, and race and ethnicity.
Where survival improved most
Survival rose from 60% (95% confidence interval, 56%-64%) in 1975 to 90% (95% CI, 88%-91%) in 2017. The biggest gains came in acute lymphoblastic leukemia. Improvements in solid tumors were more modest.
Some patients still faced elevated risk of death long after diagnosis. Mortality beyond 20 years persisted for certain cancers, including Hodgkin lymphoma.
Differences by race and ethnicity
Survival differed statistically by race and ethnicity (P < .001). Non-Hispanic Black patients fared worst across several cancers.
Earlier data on specific diseases point the same way. In a Children's Oncology Group analysis of high-risk neuroblastoma trials, five-year survival in induction and consolidation trials was 47.2% for Hispanic patients and 61.3% for White patients. In postconsolidation trials, it was 67.7% for Black patients, 62.2% for Hispanic patients and 75.7% for White patients. Those gaps appeared even though all patients received standardized, protocol-driven therapy.
Money may add to the problem. In phase 3 trial data (NCT03020030) presented at the 2025 American Society of Hematology Annual Meeting, 30.0% of families of children with acute lymphoblastic leukemia had experienced household material hardship by 24 months of chemotherapy. Non-Hispanic Black children had a relative risk of 3.5 for developing new hardship.
Limits of the analysis
The study relied on population-based registry data. The year 2017 is the latest diagnosis year with a reported five-year estimate, because that much follow-up is needed to measure it.
The investigators called for research into what drives the disparities, to guide future efforts.
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