Introduction
Social determinants of health (SDoH) are associated with stark
disparities in adult and pediatric cancer outcomes.1-3Adverse SDoH—including poverty, unmet material needs, and unsafe
environmental conditions—drive higher cancer incidence, limited
clinical trial access, and lower overall survival for individuals from
low socioeconomic status or historically marginalized
backgrounds.3-8 Despite robust evidence that SDoH are
independent risk factors for cancer outcomes9, US
cancer trials have historically failed to collect these data. Only 63%
of US oncology drug trials in the last decade even reported race, a
proxy for SDoH exposure due to longstanding structural
racism.10
The majority of pediatric oncology care nationwide is delivered via
multi-institutional clinical trials—thus, trial-integrated SDoH data
collection is critical to assess equitable access to cutting-edge
therapeutic options, evaluate generalizability of trial findings to a
real-world context, and identify opportunities for health-equity
interventions in the trial setting.11 We have
previously demonstrated the feasibility of systematic, parent-reported
SDoH evaluation in a clinical context in a single
center.12 However, there are no existing data on the
feasibility of this approach as a standardized component of a first-line
therapeutic clinical trial, and SDoH data collection is not routinely
conducted as a part of cooperative group trials. We report here the
feasibility of the first pediatric oncology multicenter trial-embedded
SDoH investigation.