Cancer Knowledge in Caregivers of Children With Cancer: Associations With Social Determinants of Health

BACKGROUND: While caregivers of children with cancer must understand their child's cancer diagnosis to navigate complex cancer care, research on caregiver cancer knowledge is scarce. METHODS: This cross-sectional study included caregivers of children with newly diagnosed cancer at Rady Children's Hospital-San Diego, a large quaternary academic center, between October 2014 and May 2020. Linear and logistic regression models were used to assess whether caregiver cancer knowledge overall and by domain (cancer stage/risk, key differences between clinical trial vs. standard of care) was associated with Social Determinants of Health (SDOH), including health literacy (HL), and socio-contextual factors. RESULTS: Of 182 caregivers who completed this study, 122 (67.0%) were female, and 86 (47.3%) were Hispanic, of whom 14 (16.3%) used Spanish for medical communication. The average caregiver baseline cancer knowledge score was 40%; IQR [21-59]. In multivariable analysis, limited HL and household income were associated with lower cancer knowledge (for HL: β = -6.60; 95% CI: -12.52, -0.69; p = 0.029; for household income < $60,000: β = -8.14; 95% CI: -13.58, -2.70; p = 0.004) and decreased odds of knowing key differences between clinical trial vs. standard of care (for HL: odds ratio (OR) = 0.27; 95% CI: 0.13, 0.54; p <0.001; for household income <$60,000, OR = 0.51; 95% CI: 0.27, 0.96; p = 0.036). Hispanic ethnicity (OR = 0.17; 95% CI: 0.04, 0.55; p = 0.005) and household income <$60,000 (OR = 0.14; 95% CI: 0.03, 0.51; p = 0.005) were associated with decreased odds of knowing the correct cancer stage/risk. CONCLUSION: Hispanic caregivers and those with limited HL tended to have lower baseline knowledge of their child's new cancer diagnosis. Our findings underscore the need for early, tailored interventions to increase cancer knowledge and facilitate healthcare navigation in underserved populations.