O3293: Impact of Social Determinants on Pediatric Cancer Treatment Receipt: Striving for More Equitable Access to Care

Background: Despite advancements in pediatric cancer care, social determinants of health (SDOH) continue to affect multiple aspects of care such as patient compliance with treatment, including surgery, chemotherapy, and radiation. Our study aims to assess the impact of SDOH on the receipt of recommended treatment among pediatric patients across diverse cancer types.

Methods: We conducted a retrospective cohort study of children ≤18 years with malignant cancer recorded in the National Cancer Database (NCDB) between 2004-2021. Cancer types included bone and soft tissue sarcomas, central nervous system (CNS) tumors, germ cell tumors, hepatic, renal , thyroid tumors, melanoma, leukemia, lymphoma, neuroblastoma, retinoblastoma, and others. SDOH factors included race, ethnicity, parental education, median household income, insurance status, area of residence, and distance to treating facility. Patients who received all their recommended treatments were compared to those who did not receive at least one recommended treatment. Multivariable logistic regression was employed to identify factors associated with treatment non-receipt.

Results: A total of 130,392 patients were included in the study. The median age was 10 years (Interquartile range 4-15), and 60,815 (46.6%) were female. 2,271 (1.7%) patients did not receive at least one recommended treatment. Radiation therapy (2.3%) was the most commonly missed treatment, followed by hormone therapy (2.1%), immunotherapy (1.5%), and bone marrow transplant (1.1%), while chemotherapy (0.9%) and surgery of the primary tumor (0.8%) were the least frequently missed. CNS tumors (3.0%) and renal tumors (2.3%) were the most common cancers not receiving complete treatment, while retinoblastoma (1.0%) and leukemia (0.9%) were the least common. Patients who did not receive one aspect of their treatment were more likely to be Black (13.9% vs. 11.6%,p=0.009), Hispanic (20.7% vs. 17.0%, p< 0.0001), reside in areas with a high-school graduation rate of < 84.7% (lowest quartile) (26.2% vs. 22.7%,p=0.0001), come from families with a low median household income of <$46,277 (lowest quartile) (20.7% vs. 15.3%, p< 0.0001), lack insurance coverage (4.1% vs. 2.0%, p< 0.0001) and live ≥60 miles from the treating facility (21.5% vs. 18.7%, p< 0.0001). On multivariable analysis, factors associated with treatment non-receipt were Black race (adjusted odds ratio [aOR] 1.22; 95% confidence interval [CI] 1.06-1.42), Hispanic ethnicity (aOR 1.30; 95%CI 1.15-1.47), low median household income (aOR 1.48; 95%CI 1.28-1.72), lack of insurance (aOR 2.01; 95%CI 1.60-2.53), and living farther from the facility (aOR 1.24; 95%CI 1.10-1.41).

Conclusion: In conclusion, our study highlights that Black race, Hispanic ethnicity, low median household income, lack of insurance and living far from the treating facility correlate with treatment non-receipt in children with cancer. Our findings underscore the necessity for further research aimed at understanding the driving factors of these finding, in order to mitigate barriers to care and ensure equitable access to optimal cancer treatment for all pediatric patients.