Baseline Household Material Hardship in Pediatric and AYA HSCT Recipients

Social drivers of health are associated with inferior outcomes in patients undergoing hematopoietic stem cell transplantation (HSCT). Household material hardship (HMH) is a concrete measure of financial burden that includes food, housing, and energy insecurity. HMH has not been studied in the context of HSCT, which can often present additional financial barriers for patients. To identify the presence of baseline household material hardship in pediatric and adolescent and young adult (AYA) patients undergoing HSCT. Pediatric (<18y) and AYA (18-39y) patients undergoing evaluation for HSCT for malignant or nonmalignant conditions were enrolled and completed baseline surveys prior to HSCT. Survey items queried demographics, measures of socioeconomic status, and presence of HMH. Eighty-three (21 pediatric, 62 AYA) participants completed baseline surveys. Median age at time of transplant was 6 years and 30.5 years, respectively. Among pediatric and AYA participants, 24% and 26% respectively were Hispanic, 38% and 60% Non-Hispanic White, 29% and 11% Asian, 10% and 6% Black or African American, 5% and 3% Native Hawaiian/Pacific Islander, and 0% and 3% American Indian/Alaskan Native. Thirteen percent of all respondents utilized a language other than English as their primary language of care; 49% had public insurance alone. Approximately 1 in 5 (19%) pediatric and 1 in 3 (34%) AYA families endorsed baseline HMH prior to transplant, with food insecurity being the most commonly identified hardship (19% in pediatric, 24% in AYAs). The majority (86% pediatric and 52% AYA) of participants identified receiving support from resources such as Medicaid, food stamps, free school lunch, food pantries , energy assistance, disability benefits, or low-income housing. Despite lower rates of baseline HMH within pediatric participants, nearly half (48%) of pediatric families identified that their savings would not last longer than 2 months if they were to lose their current sources of income, compared to a third (32%) of AYA families. Household material hardship prior to transplant is prevalent in 1 in 5 pediatric families and 1 in 3 AYA families. Notably, there were lower rates of HMH within pediatric HSCT patients than what has been previously demonstrated in pediatric oncology patients. Even without baseline HMH, HSCT recipients may have lower financial reserve and may be especially vulnerable to loss of income that can occur during the HCST process. Importantly, this cohort is being prospectively followed in order to explore the impact of HMH on HSCT outcomes. HSCT patients and families may benefit from early identification of the presence of HMH and provision of additional resources.