Abstract A013: Intersecting inequities: Neighborhood deprivation, psychological distress, and financial burden among pediatric and AYA patients with a solid tumor diagnosis and their caregivers

Abstract Background: A cancer diagnosis places substantial stress on both patients and caregivers. While caregiver burden in pediatric leukemia is well-documented, less is known about families facing pediatric and adolescent/young adult (AYA) solid tumors, which often require intensive, multidisciplinary care. This longitudinal study aims to further characterize the associations between area deprivation, perceived financial burden, and psychological distress in a diverse cohort of newly diagnosed pediatric and AYA solid tumor patients and their caregivers. Methods: A cross-sectional analysis was performed using baseline data from 7 pediatric/AYA patients and 8 caregivers enrolled in a prospective longitudinal study (target N=40, including 20 dyads and 20 additional individuals). Psychological distress was assessed via the Distress Thermometer and Problem List (DT&PL), with clinically significant distress defined as a score ≥4. Financial burden was measured using the ENRICh Financial Toxicity instrument, with higher scores indicating greater burden. Neighborhood-level socioeconomic deprivation was quantified using the Area Deprivation Index (ADI), which ranks census block groups on a 1–10 scale (1 = least disadvantaged, 10 = most disadvantaged). Results: Majority of our patients were diagnosed with a sarcoma, with a median age =16.5 years [IQR: 13.5–19.25] and 66.7% required multimodal therapy (radiation, surgery and chemotherapy). Caregiver median age was 44.5 years [IQR: 40.00-46.00]; 66.7% female; 66.7% Hispanic/Latino. Median ADI among the group was 5 [range: 3-8]. Caregivers reported high levels of distress (median=8[IQR: 6.00-9.00]) and stress (median=10 [IQR: 8.5-10.00]), characterized by sleep difficulties (83.3%); persistent anxiety (83.3%); sadness/depression (66.7%); and financial burden (median=6 [IQR: 2.00-7.00]). Patients reported a median distress score of 4 [IQR: 0–5], indicating moderate to severe distress. Common physical concerns included sleep, pain, and fatigue (40%). When reporting emotional concerns changes in appearance and worry/anxiety were highly reported (80%, 60% respectively). Social concerns were prevalent with all participants being concerned with how the cancer diagnosis may impact peer relationships and 66.7% expressing concern about future fertility. Financial concerns were reported by 40%, while 60% had concerns regarding their ability to care for themselves and 30% concerned with continuing school. Conclusions: Early findings reveal high psychological and financial distress among pediatric/AYA solid tumor patients and their caregivers, particularly in socioeconomically disadvantaged families. Caregivers reported high levels of distress, largely driven by emotional, financial, and caregiving-related stressors, while patients expressed concerns spanning physical symptoms, emotional well-being, and social functioning. These results highlight the need for early, targeted psychosocial and financial support. Ongoing data collection will clarify how these burdens change over time. Citation Format: Katherine Rodriguez, Ariana Hardy, Erika Acosta, Erin Crumpler, Michelle Greene, Sonia Morales. Intersecting inequities: Neighborhood deprivation, psychological distress, and financial burden among pediatric and AYA patients with a solid tumor diagnosis and their caregivers [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A013.