Pediatric cancer survival in the United States from 2001 to 2021

BACKGROUND: Approximately 15,000 United States (US) children and adolescents, 0-14 and 15-19 years old, respectively, are diagnosed with cancer annually. Although overall survival now exceeds 80%, cancer remains the second leading cause of death in this population, and improvements have not been uniform across subgroups. METHODS: Five- and 10-year relative survival (RS) for cancer cases diagnosed during 2001-2021 among individuals <20 years old at diagnosis were calculated using the National Program of Cancer Registries database, covering 87.4% of the US population. Results were stratified by age, sex, race and ethnicity, US Census region, economic status, cancer type, stage, and diagnosis year. All-cause survival was calculated using the Kaplan-Meier method with log-rank testing. RESULTS: Among 272,279 pediatric cancers diagnosed from 2001 to 2021, 5-year RS was 84.7%, and 10-year RS was 82.3%. Five-year RS increased from 83.0% in 2001-2011 to 86.8% in 2012-2021. Ten-year RS was higher for females than males. By age, adolescents 15-19 years old had the highest RS, whereas infants had the lowest. Non-Hispanic Black patients had the lowest 5- and 10-year RS (79.2% and 76.3%, respectively) compared with non-Hispanic White patients (86.3% and 84.0%). RS was highest for patients in the top 25% of counties by economic status and in the Northeastern US Census region. Overall, all-cause 10-year survival was 81.7% and differed by sex, age, race and ethnicity, stage, and cancer subtypes. CONCLUSIONS: Pediatric cancer survival has continued to improve. However, differences persist by age, sex, race and ethnicity, economic status, geography, and cancer type.