儿童癌症幸存者神经认知、情绪和生活质量结局的种族和民族差异：来自儿童癌症幸存者研究的报告。
Racial and ethnic disparities in neurocognitive, emotional, and quality-of-life outcomes in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.
机构信息
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
出版信息
Cancer. 2019 Oct 15;125(20):3666-3677. doi: 10.1002/cncr.32370. Epub 2019 Jul 10.
BACKGROUND
Survivors of childhood cancer are at risk of neurocognitive impairment, emotional distress, and poor health-related quality of life (HRQOL); however, the effect of race/ethnicity is understudied. The objective of this study was to identify race/ethnicity-based disparities in neurocognitive, emotional, and HRQOL outcomes among survivors of childhood cancer.
METHODS
Self-reported measures of neurocognitive function, emotional distress (the Brief Symptom Inventory-18), and HRQOL (the Medical Outcomes Study Short Form-36 health survey) were compared between minority (Hispanic, n = 821; non-Hispanic black [NHB], n = 600) and non-Hispanic white (NHW) (n = 12,287) survivors from the Childhood Cancer Survivor Study (median age, 30.9 years; range, 16.0-54.1 years). By using a sample of 3055 siblings, the magnitude of same-race/same-ethnicity survivor-sibling differences was compared between racial/ethnic groups, adjusting for demographic and treatment characteristics and current socioeconomic status (SES).
RESULTS
No clear pattern of disparity in neurocognitive outcomes by race/ethnicity was observed. The magnitude of the survivor-sibling difference in the mean score for depression was greater in Hispanics than in NHWs (3.59 vs 1.09; P = .004). NHBs and Hispanics had greater survivor-sibling differences in HRQOL than NHWs for mental health (NHBs: -5.78 vs -0.69; P = .001; Hispanics: -3.87 vs -0.69; P = .03), and social function (NHBs: -7.11 vs -1.47; P < .001; Hispanics: -5.33 vs -1.47; P = .001). NHBs had greater survivor-sibling differences in physical subscale scores for HRQOL than NHWs. In general, the findings were not attenuated by current SES.
CONCLUSIONS
Although no pattern of disparity in neurocognitive outcomes was observed, differences across many HRQOL outcomes among minorities compared with NHWs, not attenuated by current SES, were identified. This suggests that further research into environmental and sociocultural factors during and immediately after treatment is needed.
背景
儿童癌症幸存者存在神经认知障碍、情绪困扰和较差的健康相关生活质量（HRQOL）的风险；然而，种族/民族的影响研究不足。本研究的目的是确定儿童癌症幸存者神经认知、情绪和 HRQOL 结果的种族/民族差异。
方法
通过比较少数族裔（西班牙裔，n=821；非西班牙裔黑人 [NHB]，n=600）和非西班牙裔白人（NHW）（n=12287）幸存者的自我报告的神经认知功能、情绪困扰（简明症状量表-18）和 HRQOL（医疗结果研究 36 项简短健康调查），来识别儿童癌症幸存者研究（中位数年龄 30.9 岁；范围 16.0-54.1 岁）中是否存在种族/民族差异。通过对 3055 名兄弟姐妹的样本进行分析，调整人口统计学和治疗特征以及当前社会经济地位（SES）后，比较了不同种族/民族群体中同种族/同民族幸存者与兄弟姐妹之间差异的幅度。
结果
没有观察到神经认知结果的明显种族/民族差异模式。与 NHW 相比，西班牙裔的幸存者与兄弟姐妹之间在抑郁平均得分上的差异更大（3.59 对 1.09；P=0.004）。与 NHW 相比，NHB 和西班牙裔在心理健康（NHB：-5.78 对-0.69；P=0.001；西班牙裔：-3.87 对-0.69；P=0.03）和社会功能（NHB：-7.11 对-1.47；P<0.001；西班牙裔：-5.33 对-1.47；P=0.001）方面的 HRQOL 幸存者与兄弟姐妹之间的差异更大。一般来说，目前的 SES 并没有减弱这些发现。
结论
尽管没有观察到神经认知结果的差异模式，但与 NHW 相比，少数族裔在许多 HRQOL 结果方面存在差异，而且目前的 SES 并不能减弱这种差异。这表明需要进一步研究治疗期间和治疗后立即的环境和社会文化因素。
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