Impact of Social Determinants of Health on Access to and Quality of Pediatric Cancer Care in North America: A Literature Review

Abstract

Cancer is the second leading cause of death among children ages 1 to 14 in North America, with approximately 17,000 new diagnoses each year in the United States and 1,000 in Canada. Overall survival now exceeds 80% in well-resourced settings; however, not all children have equal access to the care that makes survival possible. Social determinants of health, including income, insurance status, race and ethnicity, geographic location, and language, shape every stage of a child's cancer journey. These factors account for 30 to 55% of health outcomes, surpassing the impact of direct medical care itself. This systematic review followed PRISMA-ScR guidelines and synthesized 47 review articles published between 2009 and 2024, drawn from PubMed, OVID, CINAHL, and Web of Science. Lower socioeconomic status was the most consistently documented barrier, examined in 87.2% of included reviews; it was associated with delayed diagnosis, treatment interruption, and 10 to 30% higher mortality risk. Racial disparities were documented in 80.9% of reviews: Black children faced 30 to 40% higher mortality rates for acute lymphoblastic leukemia, while Hispanic children faced a 50% increased risk of advanced-stage CNS tumors. Children in rural areas experienced longer diagnostic delays and higher treatment abandonment; some communities faced median travel times of 95 minutes to the nearest pediatric oncologist. Five-year survival rates, while exceeding 80% overall, fell to 65 to 70% for children facing multiple social disadvantages. No child's survival should depend on their postal code, race, or family income. These findings call for universal screening for social needs, culturally responsive care, and urgent intervention research targeting the most underserved children in North America.