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