Cancer remains the leading non-accidental cause of childhood death in the U.S., and novel efforts to address residual drivers of mortality in pediatric cancer are essential. One in five children with cancer lives in poverty; and poor children experience higher risks of relapse and decreased survival. Despite these disparities, poverty as a contributor to disease outcome has never been targeted in a systematic fashion in childhood cancer care. We hypothesize that interventions targeting remediable domains of poverty during cancer therapy will reduce disparities in childhood cancer relapse and survival.

Household material hardship (HMH)—a concrete measure of poverty defined as unmet basic needs including food, heat, housing or transportation—represents an ideal focus for poverty-targeted intervention. HMH is both associated with inferior child health outcomes and remediable with interventions. Prior work by our group has identified HMH in 30% of pediatric cancer families. Randomized trials in primary care have demonstrated that systematic screening for HMH and referral to existing resources (e.g. food stamps) both reduce HMH and improve health outcomes. We hypothesize that the time-sensitive and life-threatening nature of childhood cancer disparities require more immediately impactful HMH interventions that build upon systematic screening and referral.

We propose to refine and pilot the Pediatric Cancer Resource Equity (PediCARE) intervention, composed of scalable components targeting food and transportation insecurity including (1) provision of monthly grocery delivery in a dollar amount equal to the USDA thrifty-cost food plan (via AmazonFresh); (2) provision of weekly transportation from home to hospital/clinic (via Uber/Lyft). In Aim 1, we will pre-test and refine PediCARE based on qualitative family interviews. In Aim 2, we will pilot the refined intervention to assess preliminary change in family HMH. Data from this pilot will support a subsequent multi-center trial of PediCARE aimed at reducing disparities in childhood cancer relapse and survival.