(454) Social Determinants of Health and Treatment Delays in Pediatric DTC

Introduction: Social determinants of health (SDoH) are environmental conditions that influence health outcomes. As treatment delays have been found to affect outcomes in cancer care, we seek to assess the effects of specific SDoH on delays in the treatment of pediatric differentiated thyroid cancer (DTC).

Methods: The National Cancer Database (NCDB) was queried from 2004-2018 to identify patients ≤ 18-years-old who underwent treatment for follicular of papillary thyroid cancer. Specific SDoH assessed included socioeconomic status (SES), education status, and racial/ethnic identity. Multivariable regressions were performed to examine associations between specific SDoH and extant of disease at presentation, as well as delays from diagnosis to treatment, definitive surgery, and radioiodine initiation.

Results: Of the 5,839 patients who underwent treatment for thyroid cancer, 4,714 (81%) were female, 4,150 (71%) identified as Caucasian, and 5,335 (91%) has papillary histology. Hispanic individuals (OR: 1.57, CI: 1.13-2.16), uninsured individuals (OR: 3.44, CI:2.26-5.12), and individuals from areas with lower educational attainment (OR: 1.43, CI:1.06-1.93) presented at a more advanced stage after adjusting for covariates. In linear regression analysis, African Americans patients (β=5.7; p=0.037), Asian/Pacific Islander patients (β=7.4; p=0.006), and Hispanic patients (β=9.5; p< 0.001) all had greater time from diagnosis to definitive surgery than Caucasian patients. Those with government provided insurance had longer duration from diagnosis to radioactive iodine therapy than those with private insurance (β=9.7; p< 0.001).

Conclusions: Disparities exist in the time from diagnosis to treatment between individuals of different SES and race presenting with pediatric thyroid cancer.