Socioeconomic status as a possible moderator of neurocognitive outcomes in children with cancer

Survival rates for childhood cancer have improved markedly; however, there are disparities in outcomes for children from lower socioeconomic status (SES) and/or racial and ethnic minorities. Environmental factors such as reduced access to appropriate care, decreased understanding of the child's medical needs, and reduced adherence to medical regimens are thought to contribute to the association of low SES and increased mortality rates. Low SES children comparatively are also at increased risk for psychosocial morbidities following cancer, including decreased social and educational functioning and poor mental health-related quality of life (HRQOL). Differences in SES are known to influence children's neurocognitive and behavioral development in the general population, where school and home variables such as home literacy and quality of early education are some of the probable pathways but have rarely been the primary focus of investigation in children with cancer.