Five-year overall survival for children and adolescents diagnosed with cancer in the United States improved from 60% in 1975 to 90% in 2017, but those gains have been uneven across cancer types and racial and ethnic groups, according to a registry analysis published in the Journal of the National Cancer Institute.¹ Non-Hispanic Black patients had the lowest 5-year overall survival across multiple cancers, a gap that 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.¹

How was the study designed?

Investigators drew on the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 8 and SEER 17 registries, which captured patients diagnosed with cancer at ages 0 to 19 years from 1975 to 2022. The SEER 8 cohort included 52,165 patients, and the SEER 17 cohort included 100,110.¹

Overall survival was stratified by race and ethnicity, diagnosis, and population density. Temporal trends in 5-year overall survival were evaluated with the NCI Joinpoint Regression Program. Kaplan-Meier curves with log-rank tests compared survival across subgroups, and multivariable Cox proportional hazards models adjusted for age, decade of diagnosis, and race and ethnicity.¹

Which childhood cancers saw the largest survival gains?

Across all cancers, results included the following¹:

• Five-year overall survival rose from 60% (95% CI, 56%-64%) in 1975 to 90% (95% CI, 88%-91%) in 2017.
• The greatest survival gains occurred in acute lymphoblastic leukemia (ALL).
• Improvements in solid tumors were more modest.
• Mortality beyond 20 years after diagnosis persisted for some cancers, including Hodgkin lymphoma.

How did survival differ by race and ethnicity?

Survival differed statistically by race and ethnicity (P < .001). Non-Hispanic Black patients experienced the lowest 5-year overall survival across multiple cancers, even after adjusting for age and decade of diagnosis.¹

The pattern mirrors disease-specific data Oncology Nursing News has previously reported. In a Children's Oncology Group analysis of high-risk neuroblastoma trials, 5-year overall survival in induction/consolidation trials was 47.2% for Hispanic patients vs 61.3% for White patients. In postconsolidation trials, 5-year overall survival was 67.7% for Black patients, 62.2% for Hispanic patients, and 75.7% for White patients. These differences emerged even though patients received standardized, protocol-driven therapy.²

Financial strain may compound these gaps. In data from the phase 3 DFCI 16-001 trial (NCT03020030) presented at the 2025 American Society of Hematology Annual Meeting and covered by Oncology Nursing News, 30.0% of families of children with ALL 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.³

What are the limitations of the analysis?

The analysis relied on population-based registry data. In addition, 2017 is the most recent diagnosis year with a reported 5-year estimate, reflecting the follow-up needed to measure it. The investigators called for research into the drivers of these disparities to guide future efforts.¹

What are the key takeaways for oncology nurses?

• Frame prognosis by diagnosis. Overall survival now approaches 90%, but gains in solid tumors have been more modest than in ALL, so families benefit from diagnosis-specific education.¹
• Plan for lifelong follow-up. Mortality beyond 20 years for cancers such as Hodgkin lymphoma reinforces the need for survivorship care plans and a structured transition to adult providers.¹
• Screen for social needs early. Material hardship affected nearly 1 in 3 families of children with ALL during treatment, with higher risk among non-Hispanic Black families.³
• Watch for equity gaps in practice. Disparities in survival persisted after adjustment in the SEER analysis and among children treated on standardized trials, which suggests access to treatment alone may not close them.^1,2
• Support data collection. Documenting social determinants of health and supporting enrollment in research can help identify the drivers the investigators highlighted.

References

1. Schwartz LF, Wesevich A, Englum BR, et al. Advances and disparities in survival of childhood and adolescent cancers. J Natl Cancer Inst. 2026;118(10):1919-1932. doi:10.1093/jnci/djag155
2. Conroy R. Racial, ethnic disparities present in pediatric neuroblastoma survival. Oncology Nursing News. May 8, 2025. Accessed November 12, 2026. https://www.oncnursingnews.com/view/racial-ethnic-disparities-present-in-pediatric-brain-cancer-survival
3. Biese A. Families of children with ALL face extreme financial toxicity. Oncology Nursing News. December 6, 2025. Accessed November 12, 2026. https://www.oncnursingnews.com/view/families-of-children-with-all-face-extreme-financial-toxicity