Social determinants of health and pediatric cancer survival: A systematic review

Abstract

Despite treatment advancements and improved survival, approximately 1800 children in the United States will die of cancer annually. Survival may depend on nonclinical factors, such as economic stability, neighborhood and built environment, health and health care, social and community context, and education, otherwise known as social determinants of health (SDoH). Extant literature reviews have linked socioeconomic status (SES) and race to disparate outcomes; however, these are not inclusive of all SDoH.Thus, we conducted a systematic review on associations between SDoH and survival in pediatric cancer patients. Of the 854 identified studies, 25 were included in this review. In addition to SES, poverty and insurance coverage were associated with survival. More studies that include other SDoH, such as social and community factors, utilize prospective designs, and conduct analyses with more precise SDoH measures are needed. K E Y W O R D Sadolescents, cancer health disparities, childhood cancer, pediatrics, social determinants of health, survival INTRODUCTIONIn the United States, approximately 16,000 cases of cancer are diagnosed in individuals ages 0-19 years, and an estimated 1800 children and adolescents will die of cancer each year. 1,2 Malignant neoplasms are the third leading cause of deaths among children and adolescents

Children's Oncology Group's 2023 blueprint for research: Behavioral science

“…In particular, the impact of household material hardship and adverse social determinants of health (SDOH) on pediatric oncology patients is well established in the literature. [38][39][40] Although the gains achieved in cure rates in pediatric oncology may be attributed in large part to clinical trial organizations, children living in poverty and those identified as being from marginalized racial, ethnic, and minority groups are more likely to relapse and die at rates different from their non-Hispanic White counterparts. [41][42][43][44] Biology, tumor genetics, and response to initial therapy aside, pre-existing social and psychological factors, including SDOH, play a significant role in patient outcomes.…”

“…The BSC strongly supports ongoing work to identify and address health disparities in pediatric and AYA cancer care. In particular, the impact of household material hardship and adverse social determinants of health (SDOH) on pediatric oncology patients is well established in the literature 38–40 …”

Race, Neighborhood Opportunity, and Life-Threatening Complications in Children With Cancer

“…Racial disparities have been found across the entire trajectory of childhood cancer from the point of access into the healthcare system to mortality risk and quality of life in long-term survivors. 8,9,26 Structural racism in the form of economic, social, and cultural forces likely contributes to a complex causality for these racial disparities. Structural racism perpetuates the association between race and socioeconomic and power gradients in society via legislation, policy, and societal norms that systematize neighborhood segregation.…”

“…[3][4][5][6][7] Based on their systematic review of the extant literature, Beltrami et al 8 concluded that social and cultural forces likely contribute to a complex causality for these racial disparities beyond biological differences alone. In a second review of the current literature published between 2009 and 2021, Tran et al 9 identified gaps in our understanding of the mechanisms underlying these persistent disparities, citing the absence of social and cultural factors at both the individual and community levels in the research of childhood cancer survivorship.…”

Impact of social disparities on 10 year survival rates in paediatric cancers: a cohort study

“… 12 , 13 , 14 , 15 In a systematic review by Tran et al., in 2022, inconsistent findings have been found on the association of SDoH and paediatric cancer. 16 In a prospective study on the topic, Bona et al. found that 20% of the 99 families with children receiving chemotherapy for a primary cancer had income ≤200% the federal poverty line and at least one episode of a food, energy, or housing insecurity.…”