Prevalence and Trajectory of Household Material Hardship Among Children With Advanced Cancer

Families of children with advanced cancer living in poverty experience inferior outcomes including poor parent mental health and worse child quality of life. Household material hardship (HMH: food, housing, transportation, and/or utility insecurity) is a modifiable poverty exposure-and potential intervention target-that has not been systematically evaluated in pediatric advanced cancer. We aimed to determine the feasibility of systematic HMH evaluation among families of children with advanced cancer and to describe the prevalence and trajectory of HMH at baseline advanced cancer determination and at 12-week follow-up.

Parents of children < 18 years with new advanced cancer (defined as new palliative care consult, new relapse/progression, initial diagnosis of poor prognosis cancer, or early phase trial enrollment) receiving oncology care at two large pediatric cancer centers in Boston, MA, or Dallas, TX, were offered an opportunity to consent. Enrolled participants completed questionnaires at baseline and 12-week follow-up. Feasibility was defined as ≥ 75% consent rate and ≥ 75% complete baseline HMH data.

Of 90 parents approached, 80 (89%) consented to participation and 79 (99%) provided complete baseline HMH data. Nearly all participants approached for the 12-week follow-up survey completed it (n = 65/66; 98%) with 100% complete HMH data. At baseline, 42% of households reported HMH and at 12 weeks, 40% of households reported HMH.

Systematic longitudinal HMH evaluation is feasible in pediatric advanced cancer. HMH remains highly prevalent over time, with approximately 40% of families reporting HMH at baseline and 12-week follow-up. Interventions to address HMH are essential to mitigate outcome disparities.