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DALLAS – April 29, 2025 – Black and Hispanic children with high-risk neuroblastoma experience worse survival outcomes than their white peers, even when treated in frontline clinical trials, according to a study led by a UT Southwestern Medical Center researcher. Published in , the study is believed to be the first to comprehensively evaluate survival by race and ethnicity in a national cohort of children with high-risk neuroblastoma enrolled in clinical trials. 

Neuroblastoma is a type of cancer that involves immature nerve cells and is the most common extracranial solid tumor in children.

“The findings show that access to clinical trials alone is insufficient to overcome the inferior survival outcomes experienced by Black and Hispanic children with cancer,” said lead author , Assistant Professor of  in the  and a member of the  at UT Southwestern.

Although racial and ethnic differences in childhood cancer survival have been previously documented, those datasets often lack important clinical treatment details to help understand why they occur. By using data from the Children’s Oncology Group, the research team was able to move beyond access and examine whether there are variations in survival even after accounting for access to highly specialized care as part of a clinical trial. The team also leveraged clinical trial data to examine potential mechanisms contributing to these differences in outcomes. 

The study analyzed data from two cohorts of children with high-risk neuroblastoma, including 696 children on chemotherapy induction/consolidation studies and 935 children on post-consolidation studies through the Children’s Oncology Group. The study found that Hispanic children had a nearly 80% higher hazard of death after treatment on induction trials compared to white patients after adjusting for tumor characteristics. In post-consolidation trials, both Black and Hispanic children had significantly lower survival rates than white children, even after researchers accounted for disease biology and response to early treatment.

The team found no significant racial or ethnic differences in care, including a lack of any delays during chemotherapy.

Dr. Umaretiya noted that her earlier research has shown children from racially and ethnically marginalized groups participate in frontline neuroblastoma trials at rates similar to white children. Despite this comparable access, racial and ethnic survival differences persist.

“These data identify the need for studies focused in two areas,” she said. “First, we need to be thoughtful about the data we collect on clinical trials to understand why marginalized groups do not experience the same outcomes. Collecting more specific data, such as social determinants of health, may provide insight into the underlying causes. Simultaneously, we need to embed supportive care interventions for groups at risk for worse outcomes despite standardized therapies.”

Previous work from Dr. Umaretiya’s team found that nearly three-quarters of Black and Hispanic families of children with cancer face at least one unmet health-related social need — such as food, housing, or transportation insecurity — which may affect outcomes.

“While further work is needed to understand disparate survival outcomes, any efforts to improve outcomes for children with cancer will likely need to focus on health-related social needs, which are highly prevalent and may contribute to worse outcomes in Black and Hispanic children,” Dr. Umaretiya said.

Sandi L. Pruitt, Ph.D., M.P.H., Professor in the  and Associate Director of Community Outreach and Engagement in the Simmons Cancer Center, also contributed to this study. Dr. Pruitt holds the Barrett Family Professorship in Cancer Research. 

The study was funded by the American Society of Clinical Oncology Young Investigator Award, a Children’s Oncology Group National Clinical Trials Network Statistics and Data Center grant (U10CA180899) and an Operations Center grant (U10CA180886), St. Baldrick’s Foundation, and the National Cancer Institute (NCI) Cancer Center Support Grant (P30CA142543).

About UT Southwestern Medical Center   

UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 25 members of the National Academy of Sciences, 23 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,200 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 140,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5.1 million outpatient visits a year.