BACKGROUND: The impact of social determinants of health (SDoH) on survival outcomes is unclear in the universal Canadian health care system. We investigated the impact of distance to treatment center and income quintile on survival outcomes in pediatric extracranial solid tumors in Canada.
METHODS: Children < 15 years old diagnosed with 7 common solid extracranial tumors from 2001 to 2020 were included using the Cancer in Young People in Canada (CYP-C) data tool. We used logistic regression to examine the association of income quintile and distance on cancer outcomes. We used Cox proportional hazard models to examine associations with time-to-event outcomes (OS) and Fine-Gray competing risk regression (recurrence) adjusting for metastasis, age, region, and tumor location.
RESULTS: The cohort included 3969 patients. Median age was 3.6 years (IQR: 1.3-8.9); 48.7% were female. Tumor diagnosis: 34% neuroblastoma, 21% Wilms tumor, 13% rhabdomyosarcoma, 11% osteosarcoma, 8% Ewing sarcoma, 7% hepatoblastoma, and 6% germ cell tumors. On multivariable analysis, income quintile and distance did not significantly or consistently impact survival across all tumors. In rhabdomyosarcoma, the second lowest income quintile had inferior survival compared to the highest income quintile (p = 0.0264, HR 1.91, 95% CI 1.08, 3.37). In neuroblastoma, the lowest income quintile had inferior survival compared to the highest (p = 0.0052, HR 1.82, 95% CI 1.20, 2.77). Patients diagnosed with hepatoblastoma living > 500 km from a pediatric treatment facility had inferior OS compared to those within 50 km (p = 0.0065, HR 3.29, 95% CI 1.40, 7.79).
CONCLUSION: Overall, distance and income did not show a consistent significant impact on survival outcomes for children with extracranial solid tumors.