Table 1.

Call for actions in key areas across multi-level drivers of disparate childhood cancer survival.

Level	Proposed action or intervention
Family:
Caregiver capacity Caregiver health literacy	Standardize measures of household material hardshipa Standardize measures of key social determinants of health Develop community programs to address patient/family social and material hardship Increase psychosocial resources (social workers, financial navigators) for caregivers Provide educational and culturally tailored interventions to improve caregiver health literacy Increase access to care after hours and on weekends
Healthcare system:
Delivery of quality care	Improve DEI in childhood cancer clinical trials: Align family trust with provider cultural competence to engage patients/families Address regulatory and language barriers Include bilingual and culturally competent study team members to enhance engagement with minoritized patients/families Invest in language translation and use simplified, accessible language in consents Implement institutional approaches and metrics to overcome mistrust rooted in the history of unethical research including minoritized patients Capture reasons for refusal and ineligibility in trials Incorporate patients’/families’ social circumstances when tailoring and delivering patient-centered care Collect institutional data beyond 5-year survival: disease-specific survival; postrelapse survival; early and late noncancer mortality Invest in transition to postcancer care
Community and society:
Structural racism	Utilize available data on geographic concentration of deprivation in medical and health services research Call for RFAs to study and inform policies to eliminate modifiable and unjust drivers of structural racism
Public policy	Evaluate the impact of the ACA provisions and insurance products on childhood cancer survival Enhance research to inform evidence-based policies toward universal and seamless insurance coverage

Abbreviations: DEI, Diversity, Equity, and Inclusion; RFA, Research Funding Announcement.

^aEvaluate at cancer diagnosis and through cancer survivorship.