Survival After Childhood Cancer–Social Inequalities in High-Income Countries

Abstract

Despite substantial improvements in survival from childhood cancer during the last decades, there are indications that survival rates for several cancer types are no longer improving. Moreover, evidence accumulates suggesting that socioeconomic and sociodemographic factors may have an impact on survival also in high-income countries. The aim of this review is to summarize the findings from studies on social factors and survival in childhood cancer. Several types of cancer and social factors are included in order to shed light on potential mechanisms and identify particularly affected groups. A literature search conducted in PubMed identified 333 articles published from December 2012 until June 2018, of which 24 fulfilled the inclusion criteria. The findings are diverse; some studies found no associations but several indicated a social gradient with higher mortality among children from families of lower socioeconomic status (SES). There were no clear suggestions of particularly vulnerable subgroups, but hematological malignancies were most commonly investigated. A wide range of social factors have been examined and seem to be of different importance and varying between studies. However, potential underlying mechanisms linking a specific social factor to childhood cancer survival was seldom described. This review provides some support for a relationship between lower parental SES and worse survival after childhood cancer, which is a finding that needs further attention. Studies investigating predefined hypotheses involving specific social factors within homogenous cancer types are lacking and would increase the understanding of mechanisms involved, and allow targeted interventions to reduce health inequalities.

Area deprivation is associated with poorer overall survival in children with acute lymphoblastic leukemia

“…A study of children diagnosed with ALL in Texas and Florida found that residence in census tracts with 5‐20% or >20% of residents below the poverty line, relative to tracts with <5% below the poverty line, was associated with poorer OS (HR 1.29, 95% CI 1.03‐1.61 and HR 1.80, 95% CI 1.41‐2.30, respectively) 21 . Additional studies in diverse populations, 26,29‐35 summarized in two reviews, 36,37 indicate that household SES is associated with survival for children with ALL. We observed stronger associations between neighborhood socioeconomic disadvantage and survival than have been reported previously, except for the study performed in Texas and Florida, which may reflect differences in study population.…”

Risk stratification of young adult survivors of cancer to estimate hospital morbidity burden: applicability of a pediatric therapy-based approach

“…Through utilization of hospital activity as a surrogate for morbidity burden, the study adds novel insights to the existing evidence base supporting the NCSI risk stratification model by demonstrating the effectiveness of its applicability to cancer survivors diagnosed in young adult life, aged 18-29 years inclusive. Despite previous evidence supporting racial/ethnic disparities in mortality, with a disproportionate number of cancer deaths occurring among ethnic minorities, particularly African Americans [29] and previous work in long-term survivors of childhood cancer which found the morbidity associated with survival following cancer treatment to be greatest for the most socioeconomically deprived [30][31][32]; the study did not provide any strong consistent evidence to suggest that socioeconomic deprivation nor ethnicity independently impacted upon hospital activity, time to first admission, number of admissions, or length of hospital stay (Tables 2 and 4). Moreover, measures of deprivation did not contribute any significant variation in hospital activity within NCSI levels.…”

Particular Qualities of Organizing Teaching Parents to Care a Child With Oncological and Oncomematological Pathology: Recommendations for Oncologists and Family Physicians

“…Протягом останніх десятиріч діагностики та лікувальний алгоритм онкологічних та онкогематологічних хвороб у дітей значно поліпшилася завдяки багатьом медичним дослідженням та отриманим досягненням в сфері онкології, гематології та імунології. Як наслідок -прогноз у разі наявності онкологічної патології поліпшився і наразі близько 60 -80 % дітей з онкологічним діагнозом досягають зрілого віку [1,2]. Діти з онкологічними та онко-гематологічними захворюваннями отримують лікування в спеціалізованих стаціонарах, а відсутність адекватного навчання членів родини пацієнта або самого пацієнта відносно навичок догляду та контролю за ними мо-же негативно вплинути на перебіг захворювання та результати лікування.…”