While survival of pediatric cancer has improved greatly over the past 40 years, demographic and socioeconomic disparities have meant that some groups have not benefitted as much from these advances. We conducted a rapid review to summarize literature on demographic and socioeconomic disparities in outcomes of childhood cancer, starting in 2000. We find that unequal outcomes have been noted for many of these groups across hematologic malignancies, central nervous system tumors, and other solid tumors, although occasional studies have noted absence of disparities for particular at-risk groups and diseases, and gaps in understanding of disparities for some cancer subtypes and groups still exist. These include disparities in duration of overall survival, risk of death, more extensive disease at presentation, and differences/delays in treatment. Black race, Hispanic ethnicity, lack of private insurance, and adolescent/young adult age are most often associated with these poorer outcomes. We then delve into documented and theorized causes of these disparities, including impaired access to care and clinical trials, differences in cancer biology, treatment non-adherence, language barriers, and implicit racial bias. Here, it is clear that socioeconomic factors account for a large proportion of disparities seen, although not all, and that the causes of disparities are complex and interconnected and still need to be better understood. Finally, in an effort to shift emphasis to addressing disparities, we review interventions against disparities that have been studied in childhood cancer patients and other populations, including improving clinical trial representation, communication, health literacy, and family navigation. We suggest ways forward in disparity mitigation toward a goal of achieving equitable cancer outcomes for all children.
Racial, ethnic, and socioeconomic disparities in pediatric cancer outcomes exist across disease types.
The causes of pediatric cancer disparities are varied, and many are reversible.
Interventions to achieve equitable outcomes include improving trial access and health literacy.
Innovations and advancements in pediatric cancer treatment have decreased the mortality rate of childhood cancer over the last 45 years. However, cancer remains the most common cause of death from disease in children . One reason for this is health disparities affecting survival outcomes. It has been shown that disparities exist in adults (18 years and older) with cancer due to race/ethnicity . Disparities based on socioeconomic status (SES) have also been demonstrated in adults with cancer . SES is a composite measure made up of several indices, including poverty, education, employment, and language barriers, which may play different roles in cancer outcomes . It is important to note that since these measures are less likely than race and ethnicity to be available on an individual level through cancer databases, many studies use census SES measures of patients’ zip code or county for these studies.
On the other hand, research into the health disparities seen in the pediatric population has been limited. This is due in part to the limited data on health disparities in childhood cancer, making it more difficult to evaluate these issues . These disparities impact specific communities challenged with different obstacles, and they result in diminished overall population health and increased health costs. In a recent study, it was estimated that health disparities in the US cause excess medical costs of $93 billion yearly, as well as an annual loss of $42 billion in productivity due to premature death ( https://altarum.org/RacialEquity2018 ). Therefore, more research into the health disparities of cancer is required, and addressing these disparities is pertinent to ensure all children receive optimal health care and the best chance of survival, as well as to continue to improve overall population health.
The objective of this rapid review is to summarize the literature on outcomes disparities in children and adolescents (0–19 years old) diagnosed with cancer in the United States based on race and ethnicity, socioeconomic measures, and age in hematologic malignancies, central nervous system tumors, and other solid tumor malignancies. Additionally, we discuss steps moving forward, including future research and potential interventions that will allow a transition to prevention and elimination of these disparities rather than solely looking to define the disparities present.