Moving Beyond Patient-Level Drivers of Racial/Ethnic Disparities in Childhood Cancer

Abstract

Racial/ethnic disparities in childhood cancer survival persist despite advances in cancer biology and treatment. Survival rates are consistently lower among non-Hispanic Black and Hispanic children as compared with non-Hispanic White children across a range of hematologic cancers and solid tumors. We provide a framework for considering complex systems and social determinants of health in research examining the drivers of racial/ethnic disparities in childhood cancer survival, given that pediatric patients' interactions with the healthcare system are filtered through their caregiver, family, and societal structure. Dismantling the multi-level (patient, family, healthcare system, and structural) barriers into modifiable drivers is critical to developing policies and interventions toward equitable health outcomes. This commentary highlights areas at the family, healthcare system, and society levels that merit closer examination and proposes actions and interventions to support improvements across these levels. See recently published article in the November issue of CEBP, Racial/Ethnic Disparities in Childhood Cancer Survival in the United States p. 2010.

Figure 1.

Multi-level drivers that affect the association between race/ethnicity and survival among children diagnosed with cancer. Notes: The multi-level drivers do not refer to a linear relationship, rather nesting relationships; patient-level drivers are nested within families, and patient-and family-level drivers are nested within the healthcare system, which are all nested within community and society.