Data_Sheet_1_Survival After Childhood Cancer–Social Inequalities in High-Income Countries.PDF

Despite substantial improvements in survival from childhood cancer during the last decades, there are indications that survival rates for several cancer types are no longer improving. Moreover, evidence accumulates suggesting that socioeconomic and sociodemographic factors may have an impact on survival also in high-income countries. The aim of this review is to summarize the findings from studies on social factors and survival in childhood cancer. Several types of cancer and social factors are included in order to shed light on potential mechanisms and identify particularly affected groups. A literature search conducted in PubMed identified 333 articles published from December 2012 until June 2018, of which 24 fulfilled the inclusion criteria. The findings are diverse; some studies found no associations but several indicated a social gradient with higher mortality among children from families of lower socioeconomic status (SES). There were no clear suggestions of particularly vulnerable subgroups, but hematological malignancies were most commonly investigated. A wide range of social factors have been examined and seem to be of different importance and varying between studies. However, potential underlying mechanisms linking a specific social factor to childhood cancer survival was seldom described. This review provides some support for a relationship between lower parental SES and worse survival after childhood cancer, which is a finding that needs further attention. Studies investigating predefined hypotheses involving specific social factors within homogenous cancer types are lacking and would increase the understanding of mechanisms involved, and allow targeted interventions to reduce health inequalities.

尽管近数十年来儿童癌症患者的生存率已有显著改善，但多项迹象表明，多种儿童癌症类型的生存率已陷入停滞，未能实现进一步提升。此外，越来越多的证据显示，即便在高收入国家，社会经济与社会人口学因素也可能对癌症生存率产生影响。本综述旨在梳理儿童癌症社会影响因素与生存率相关性研究的相关发现。本次研究纳入了多种癌症类型与社会影响因素的相关文献，以期阐明潜在作用机制，并识别出受影响最为显著的患儿群体。本次通过PubMed开展的文献检索共筛选出2012年12月至2018年6月期间发表的333篇相关文章，其中仅24篇符合纳入标准。相关研究结果呈现出多样性：部分研究未发现二者存在关联，但另有多项研究显示存在社会梯度效应——即来自社会经济地位(SES)较低家庭的患儿死亡率更高。尽管尚未明确识别出某一特定的弱势亚群，但血液系统恶性肿瘤是此类研究中最常被关注的癌症类型。现有研究已考察了多种社会影响因素，且不同因素的重要性存在差异，相关结论在各研究间也不尽一致。然而，鲜有研究阐明将特定社会因素与儿童癌症生存率关联起来的潜在内在机制。本综述为“父母社会经济地位较低与儿童癌症患者术后生存率更差”这一关联提供了一定支撑，该结论有待学界进一步关注。目前仍缺乏针对同质癌症类型内特定社会因素开展的预设假说研究，此类研究将有助于深化我们对相关作用机制的理解，并助力制定针对性干预措施以缩小健康不平等。