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The following is a summary of “Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma,” published in the January 2025 Journal of Pediatric Surgery by Nofi et al. 

The impact of social determinants of health (SDOH) on childhood cancer outcomes remains a complex and understudied issue. Socioeconomic status (SES) and racial disparities may contribute to variations in survival rates among pediatric patients with Wilms tumor, neuroblastoma, and hepatoblastoma. This study aimed to evaluate the influence of SES and race on survival outcomes in these malignancies. The National Cancer Database (NCDB) was queried for pediatric patients (aged 0–18 years) diagnosed with WT, NB, and HB between 2004 and 2020. A composite SES score was developed by combining quartile rankings for median household income and the percentage of individuals without a high school diploma, with higher scores indicating greater socioeconomic disadvantage. Kaplan-Meier survival analyses and Cox proportional hazards regression models were employed to identify factors associated with survival disparities. 

The study included 5,218 patients with WT, 5,851 with NB, and 1,311 with HB. The racial distribution for WT, NB, and HB was 59%, 65%, and 55% White non-Hispanic, and 18%, 11%, and 11% Black non-Hispanic, respectively. Kaplan-Meier analyses demonstrated that higher SES scores were significantly associated with poorer survival outcomes for WT (p=0.002) and NB (p=0.011). Multivariable analysis identified several independent predictors of worse survival. In WT, these included higher SES scores, older age, comorbidities, larger tumor size, bilateral disease, and metastatic disease. In NB, predictors of worse survival included higher SES score, Black non-Hispanic race/ethnicity, older age, urbanicity, larger tumor size, metastatic disease, and chemotherapy. For HB, factors associated with worse survival were older age, presence of comorbidities, and metastatic disease. After adjusting for patient and tumor characteristics, the study found significant associations between SDOH and poorer survival outcomes for WT and NB, underscoring the impact of socioeconomic disadvantage and racial disparities in pediatric cancer care. 

These findings highlight the urgent need to identify and mitigate social risk factors contributing to survival inequities in children with solid tumors. Addressing these disparities through targeted interventions, improved healthcare access, and policy-driven solutions is critical for achieving equitable cancer outcomes in pediatric oncology.

Source: jpedsurg.org/article/S0022-3468(25)00061-2/abstract