Department of Surgery, College of Medicine, University of Florida, Jacksonville, Florida, USA.
Department of Hematology, Oncology, and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California, USA.
Cancer Med. 2023 Sep;12(17):18281-18305. doi: 10.1002/cam4.6426. Epub 2023 Aug 8.
Childhood cancer survivors (CCS) experience many long-term health problems that can be mitigated with recommended survivorship care. However, many CCS do not have access to survivorship care nor receive recommended survivorship care. We reviewed the empirical evidence of disparities in survivorship care for CCS.
This systematic review searched PubMed, CINAHL, and PsycINFO for studies on survivorship care for CCS (PROSPERO: CRD42021227965) and abstracted the reported presence or absence of disparities in care. We screened 7945 citations, and of those, we reviewed 2760 publications at full text.
A total of 22 studies reported in 61 publications met inclusion criteria. Potential disparities by cancer treatment (N = 14), diagnosis (N = 13), sex (N = 13), and current age (N = 13) were frequently studied. There was high quality of evidence (QOE) of survivorship care disparities associated with non-White race, Hispanic ethnicity, and being uninsured. Moderate QOE demonstrated disparities among CCS who were unemployed and older. Lower QOE was found for disparities based on cancer diagnosis, cancer treatment, age at diagnosis, time since diagnosis, sex, insurance type, income, educational attainment, and geographic area.
We found strong empirical evidence of disparities in survivorship care for CCS associated with race, ethnicity, and insurance status. Multiple other disparate groups, such as those by employment, income, insurance type, education, cancer diagnosis, age at diagnosis, time since diagnosis, cancer treatment, geographic area, sex, and self-identified gender warrant further investigation. Prospective, multilevel research is needed to examine the role of other patient characteristics as potential disparities hindering adequate survivorship care in CCS.
儿童癌症幸存者（CCS）会经历许多长期的健康问题，这些问题可以通过推荐的生存护理来减轻。然而，许多 CCS 无法获得生存护理，也没有接受过推荐的生存护理。我们回顾了 CCS 生存护理差异的实证证据。
本系统评价在 PubMed、CINAHL 和 PsycINFO 中搜索了关于 CCS 生存护理的研究（PROSPERO：CRD42021227965），并摘录了报告的护理差异的存在或不存在。我们筛选了 7945 条引文，其中 2760 篇全文进行了审查。
共有 22 项研究报告了 61 篇出版物符合纳入标准。经常研究癌症治疗（N=14）、诊断（N=13）、性别（N=13）和当前年龄（N=13）方面的潜在差异。非白人种族、西班牙裔和没有保险与生存护理差异有高质量的证据（QOE）。就业和年龄较大的 CCS 之间存在中等 QOE 的差异。根据癌症诊断、癌症治疗、诊断时的年龄、诊断后时间、性别、保险类型、收入、教育程度和地理位置等因素，发现生存护理差异的 QOE 较低。
我们发现，与种族、族裔和保险状况相关的 CCS 生存护理差异存在强有力的实证证据。其他多个不同群体，如就业、收入、保险类型、教育程度、癌症诊断、诊断时的年龄、诊断后时间、癌症治疗、地理位置、性别和自我认同的性别等，都需要进一步调查。需要进行前瞻性、多层次的研究，以检查其他患者特征作为阻碍 CCS 获得充分生存护理的潜在差异的作用。
