Collecting Social Determinants of Health in a Children’s Oncology Group Trial for High-Risk Neuroblastoma

Jones E, Naranjo A, Winestone LE, Umaretiya PJ, Aziz-Bose R, Kelly CA, Newman H, Zheng DJ, Greengard E, Bagatell R, DuBois SG, Bona K. Collecting Social Determinants of Health in a Children’s Oncology Group Trial for High-Risk Neuroblastoma. JAMA Netw Open. 2026 Mar 2;9(3):e260419. doi: 10.1001/jamanetworkopen.2026.0419. PMID: 41770565; PMCID: PMC12954535.

Children with cancer exposed to adverse social determinants of health (SDOH), including poverty, experience outcome disparities. Medicaid insurance, a proxy for low-income, is independently associated with inferior event-free and overall survival—despite receipt of uniform planned treatment on National Clinical Trials Network (NCTN) Children’s Oncology Group (COG) trials.1,2 Sociodemographic data collected in NCTN trials—race, ethnicity, and insurance—serve as proxies for exposure to adverse SDOH but are prone to misclassification, and can neither identify mechanisms underlying disparities nor provide modifiable intervention targets. Household material hardship (HMH)—unmet basic needs including food, housing, utility, or transportation insecurity—is a parent-reported SDOH exposure associated with inferior general pediatric health outcomes3 and modifiable with intervention at the policy, system, and household levels.4 We evaluated the feasibility and acceptability of parent-reported SDOH data collection in an international COG NCTN trial.