Social Inequalities in Treatment Receipt for Childhood Cancers in Ireland: A Population-Based Analysis

Abstract

Treatment advances over the past five decades have resulted in significant improvements in survival from childhood cancer. Although survival rates are relatively high, social disparities in outcomes have been sometimes observed. In a population-based study, we investigated social inequalities by sex and deprivation in treatment receipt in childhood cancer in Ireland. Cancer incident in people aged 0-19 during 1994-2012 and treatments received were abstracted from the National Cancer Registry Ireland. Multivariable modified Poisson regression with robust error variance (adjusting for age, and year) was used to assess associations between sex and deprivation category of area of residence at diagnosis and receipt of cancer-directed surgery, chemotherapy or radiotherapy. 3,704 childhood cancers were included.

Girls were significantly less likely than boys to receive radiotherapy for leukemia overall (relative risk (RR)=0.70; 95% CI: 0.50-0.98), and ALL specifically (RR=0.54; 95% CI: 0.36-0.79), and surgery for CNS overall (RR=0.83; 95% CI: 0.74-0.93) and other CNS (RR=0.76; 95% CI: 0.60-0.96). Girls were slightly less likely to receive chemotherapy for NHL and surgery for Hodgkin lymphoma, but these results were not statistically significant. Children residing in more deprived areas were significantly less likely to receive chemotherapy for AML or surgery for lymphoma overall and Hodgkin lymphoma, but more likely to receive chemotherapy for medulloblastoma. These results may suggest social inequalities in treatment receipt for childhood cancers. Further research is warranted to explore whether similar patterns are evident in other childhood cancer populations and to better understand the reasons for the findings.