Prioritizing Social Determinants of Health (SDOH)
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 SDOH on pediatric oncology patients is well established in the literature.38–40
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.41–44 Biology, tumor genetics, and response to initial therapy aside, pre-existing social and psychological factors, including SDOH, play a significant role in patient outcomes.45,46
Financial toxicity has been categorized as direct expenditures associated with treatment and access, and the indirect costs families sustain throughout the treatment trajectory related to loss of income and educational opportunities. Further, financial toxicity is detrimental to parental mental health and family functioning.47–49
Despite awareness of the multifaceted disparities and inequities in pediatric cancer, the systematic collection of information on SDOH and socioeconomic status has not been included in clinical trials.50Collaborative, multidisciplinary research studies within COG are beginning to embed these measures within clinical trials to better understand these factors and design interventions to ensure equitable access to, and benefit from, treatment.51,52