Abstract

Background: Although advancements in pediatric oncology have transformed the field, comprehensive, long-term, population-based assessments remain scarce, necessitating continuous tracking of incidence and survival trends. Aims: To evaluate long-term trends in pediatric cancer incidence and survival in the US, emphasizing temporal patterns, demographic disparities, and changes specific to cancer types using SEER data from 2000 to 2021. Study design: Retrospective cohort study. Methods: This study examined primary cancer incidence rates and survival trends in individuals aged 0-19, employing age-standardized incidence rates, survival trends, Joinpoint regression, Kaplan-Meier curves, and Cox proportional hazards models, with significance set at p < 0.05. Trends were evaluated by joinpoint regression to get the annual percent changes (APC). Results: The age-adjusted incidence rate of all Pediatric cancers has risen during the study period (APC = 0.7%; 95% CI: 0.4–1.0%), with a joinpoint observed around 2010 for both incidence and survival trends. The 5-year overall survival for pediatric cancers increased from 79.8% to 87.9% between 2000 and 2021. Black children at 42% (HR: 1.42, 95% CI: 1.25-1.62) and Hispanic children at 15% (HR: 1.15, 95% CI: 1.01-1.32) experienced poorer survival compared to Whites, as well as those from lower socioeconomic statuses. Rural residence is associated with a 23% higher risk of death compared to urban counterparts. Males had an 18% higher risk of mortality compared to females. Early-stage diagnosis was associated with higher survival rates, with 5-year survival rates ranging from 91% (localized) to 44% (distant). The distant stage at diagnosis contributed to an exceptionally high hazard of death, more than threefold compared to local stages at diagnosis (HR: 3.60, 95% CI: 3.20–6.10). Conclusions: This research revealed pediatric cancer survival has improved over the past two decades, but within-group disparities are associated with sex, race, SES, geography, and stage at diagnosis. Future research should focus on utilizing large, multi-country cohorts, enhancing data integration and longitudinal tracking, as well as the application of machine learning.

Keywords

pediatric cancer, SEER, incidence trends, survival analysis, racial disparities, temporal trends