Impact of Race and Socioeconomic Status on Psychologic Outcomes in Childhood Cancer Patients and Caregivers

Abstract

Complex relationships between race and socioeconomic status have a poorly understood influence on psychologic outcomes in pediatric oncology. The Family Symptom Inventory was used to assess symptoms of depression and anxiety in pediatric patients with cancer and their caregivers. Separate hierarchical linear regression models examined the relationship between demographic variables, cancer characteristics, socioeconomic status, and access to care and patient or caregiver depression/anxiety. Participants included 196 pediatric patients with cancer (mean age, 11.21 y; 49% African American) and their caregivers. On average, caregivers reported low levels of depression/anxiety. Symptoms of depression and anxiety in patients were correlated with poorer mental health in caregivers (r=0.62; P<0.01). Self-reported financial difficulty (β=0.49; P<0.001) and brain cancer diagnosis for their child (β=0.42; P=0.008) were significantly associated with depression and anxiety in caregivers. Analysis did not reveal significant associations between race, household income, or access to care and patient or caregiver depression/anxiety. Perception of financial hardship can adversely impact mental health in caregivers of children with cancer. Psychosocial assessment and interventions may be especially important for caregivers of patients with brain tumors and caregivers who report feeling financial difficulty.

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

“…7,9 Consistent with our findings in survivors, a recent study in pediatric patients with cancer found no difference in reported symptoms of depression or anxiety in black patients or their caregivers compared with white patients. 32 In the overall US population, both Hispanics and NHBs reported higher rates of depressive symptoms than NHWs; however, after accounting for poverty, population rates of depression did not differ significantly by race or ethnicity. 33 Fortunately, there were no overall disparities in neurocognitive outcomes among minority survivors compared with NHW survivors; however, the magnitude of reported survivor-sibling differences in task efficiency for NHBs compared with NHWs was significant.…”

Systematic review of financial burden assessment in cancer: Evaluation of measures and utility among adolescents and young adults and caregivers

“…The Financial Well‐Being subscale of the Singapore Caregiver Quality of Life Scale 46 was the only measure that provided sufficiently strong support for this psychometric category. Very few of the measures were tested among sizeable subgroups of racial or ethnic minority participants, rural patients, or even AYAs, who may be more likely to be uninsured or underinsured and thus at greater risk of financial burden 12‐14,42,55‐59 . Second, too few studies leveraged longitudinal designs to inform assessments of responsiveness and criterion validity.…”

“…No caregiver studies were specifically focused on AYAs, although a small number of studies focused on caregivers of pediatric patients with cancer 24,59,62‐64 . These were rarely older adolescents (aged 15‐17 years) or emerging adults (aged 18‐25 years).…”

“…Very few of the measures were tested among sizeable subgroups of racial or ethnic minority participants, rural patients, or even AYAs, who may be more likely to be uninsured or underinsured and thus at greater risk of financial burden. [12][13][14]42,[55][56][57][58][59] Second, too few studies leveraged longitudinal designs to inform assessments of responsiveness and criterion validity. Because financial burden may fluctuate over time and across the cancer care continuum, 60 longitudinal designs are needed to address the lack of responsiveness data.…”

“…No caregiver studies were specifically focused on AYAs, although a small number of studies focused on caregivers of pediatric patients with cancer. 24,59,[62][63][64] These were rarely older adolescents (aged 15-17 years) or emerging adults (aged 18-25 years). Assessing the financial experience of these AYA and caregiver subgroups is critical because they face unique financial needs and challenges.…”