Racial and Ethnic Disparities in Health Outcomes Among Long-Term Survivors of Childhood Cancer: A Scoping Review

Abstract

The five-year survival rate of childhood cancer has increased substantially over the past 50 yr; however, racial/ethnic disparities in health outcomes of survival have not been systematically reviewed. This scoping review summarized health disparities between racial/ethnic minorities (specifically non-Hispanic Black and Hispanic) and non-Hispanic White childhood cancer survivors, and elucidated factors that may explain disparities in health outcomes. We used the terms “race”, “ethnicity”, “childhood cancer”, “pediatric cancer”, and “survivor” to search the title and abstract for the articles published in PubMed and Scopus from inception to February 2021. After removing duplicates, 189 articles were screened, and 23 empirical articles were included in this review study. All study populations were from North America, and the mean distribution of race/ethnicity was 6.9% for non-Hispanic Black and 4.5% for Hispanic. Health outcomes were categorized as healthcare utilization, patient-reported outcomes, chronic health conditions, and survival status. We found robust evidence of racial/ethnic disparities over four domains of health outcomes. However, health disparities were explained by clinical factors (e.g., diagnosis, treatment), demographic (e.g., age, sex), individual-level socioeconomic status (SES; e.g., educational attainment, personal income, health insurance coverage), family-level SES (e.g., family income, parent educational attainment), neighborhood-level SES (e.g., geographic location), and lifestyle health risk (e.g., cardiovascular risk) in some but not all articles. We discuss the importance of collecting comprehensive social determinants of racial/ethnic disparities inclusive of individual-level, family-level, and neighborhood-level SES. We suggest integrating these variables into healthcare systems (e.g., electronic health records), and utilizing information technology and analytics to better understand the disparity gap for racial/ethnic minorities of childhood cancer survivors. Furthermore, we suggest national and local efforts to close the gap through improving health insurance access, education and transportation aid, racial-culture-specific social learning interventions, and diversity informed training.

Barriers and facilitators of Hispanic/Latino parents caregiving for a childhood cancer survivor: a qualitative study

“…Patient and caregiver needs are not adequately addressed during the transition from therapy to survivorship care, particularly in patients from culturally and medically underserved backgrounds [7][8][9]. Hispanic/Latino parents and CCS are more likely to report health disparities due to social and structural determinants of health (SDOH) such as individual and family level socioeconomic status, underinsurance, immigration status, and perceived ethnic/ racial discrimination [10,11]. Additionally, in the broader survivorship research, Hispanics/Latinos have a greater prevalence of unmet supportive care needs and limited access to information [12,13].…”

Langerhans Cell Histiocytosis: A Population-based Study of Anatomical Distribution and Treatment Patterns

“…In addition, our study identified a racial disparity in surgery utilization in pediatric patients with bone LCH: the non-white patients were less likely to be treated with surgery than the whites. In the United States, the racial disparity, whether or not mediated by patient’s socioeconomic status, is an important factor influencing the care and outcome of various childhood neoplasms [22] , [23] , [24] . Our work suggests that equitable care should be stressed in pediatric patients with osseous LCH as well.…”

Race, ethnicity, and experienced racism are associated with adverse physical and mental health outcomes among cancer survivors

“…14 Racial and ethnic disparities experienced by cancer survivors are multifactorial and mediated by inequitably distributed social determinants of health such as access to health care, clinical trial enrollment, health literacy, and socioeconomic position. [15][16][17] These factors are downstream manifestations of systemic racism, or the interconnected, cross-institutional systems and structures by which persons belonging to historically marginalized racial and ethnic groups are disadvantaged. 18 Racism is widely recognized as an independent social determinant of health and root cause of racial and ethnic disparities.…”