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.
Highlights
The shifting racial/ethnic makeup of the population indicates that in as early as 2045 the United States (US) will become a “minority majority population” country (1)
We focused on race/ethnicity as the primary variable determining disparities in health outcomes, and viewed socioeconomic status (SES) factors as confounding or mediating variables that explain the associations between race/ethnicity and health outcomes
While there is an effect of race/ethnicity on health outcomes for childhood cancer survivors; there is not yet enough evidence to determine the true effect of SES across all outcomes given the cross-sectional design of previous studies
Summary
The shifting racial/ethnic makeup of the population indicates that in as early as 2045 the United States (US) will become a “minority majority population” country (1). Life expectancy of the US general population has steadily increased since the 1950s in the US, non-Hispanic Black individuals have a 40% higher overall mortality rates (4) and non-Hispanic Black and Hispanic populations have a higher burden of chronic health conditions (e.g., cancer, heart disease, diabetes) (5) compared to non-Hispanic White individuals. Minority populations often have lower healthcare utilization and access to quality care (6). In the context of oncology, health disparities in the US are significantly different in the rates of cancer screening, incidence, survival, treatment-related complications, and quality-of-life (7). The 5-yr relative cancer survival rates of childhood cancer have reached 94% among the child and 85% among adolescent survivors (8), there is evidence of lower patient-reported outcomes and survival rates (9–11) in minority vs non-Hispanic White survivors.
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