Socioeconomic disparities in the quality of life in children with cancer or brain tumors: the mediating role of family factors.
OBJECTIVE
This study aimed to determine if and to what extent (i) socioeconomic disparities exist in the health-related quality of life (QOL) of children with cancer or brain tumors and healthy children; and (ii) family functioning and burden mediate the relationship between socioeconomic status and children's QOL.


METHODS
In this cross-sectional study, parents of children ages 2-18 with (n = 71) and without (n = 135) cancer or brain tumors completed in-person interviewer-assisted surveys assessing sociodemographics (including income and parental education), child QOL (measure: PedsQL), family functioning (measure: Family Adaptability and Cohesion Evaluation Scale IV) and burden (measure: Impact on the Family Scale). For children with cancer, clinical characteristics were captured through medical record abstraction. Multiple linear regression was used to determine the relationship between income and child QOL; the interaction between group status and income was assessed. Staged multivariate regression models were used to assess the role of family factors in this relationship among children with cancer.


RESULTS
In multivariate analyses, the effect of income differed by cancer status; lower income was associated with worse QOL in children with cancer but not among healthy children. Among children with cancer, this relationship was significantly attenuated by family burden.


CONCLUSIONS
Significant socioeconomic disparities exist in the QOL of children with cancer. Family factors partially explain the relationship between low income and poor QOL outcomes among these children. Lower-income families may have fewer resources to cope with their child's cancer. Increased support, monitoring, and referrals to reduce burden for these families may lead to improved QOL in children with cancer.
Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA.
Kristin
K
Litzelman
Emily
E
Barker
Kristine
K
Catrine
Diane
D
Puccetti
Peggy
P
Possin
Whitney P
WP
Witt
D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000453:epidemiology / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005190:Family / Q000523:psychology; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology*; D010290:Parents / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D012959:Socioeconomic Factors