Children with SARS-CoV-2 infection have been consistently described with milder clinical outcomes compared to adults. However, data pertaining to the clinical evolution of SARS-CoV-2 infection in children with cancer remain scarce. In this descriptive cohort study, we report the clinical characteristics and outcomes of 31 pediatric oncology patients with SARS-CoV-2 infection in the province of Quebec, Canada. Most patients were asymptomatic or had mild symptoms, with only 2 COVID-19-related hospitalizations and no COVID-19-related deaths. The favorable outcomes in our cohort may be explained by Quebec's universal access to health care and regionalization of pediatric oncology care in tertiary centers exclusively.

Black and Hispanic children with leukemia experience inferior survival compared to non-Hispanic White (NHW) children. Identifying modifiable social determinants of health can inform intervention targets to address inequities. We characterized the frequency of income poverty and household material hardship (HMH) by race/ethnicity in a clinical trial cohort with de novo acute lymphoblastic leukemia. Compared to NHW families, Black and Hispanic families reported more frequent HMH (19% vs. 47% vs. 68% respectively); low-income (27% vs. 52% vs. 74%), and combined low-income and HMH (12% vs. 37% vs. 52%) poverty exposures. Disparate poverty exposures are interventional targets to address racial/ethnic outcome inequities.

Social determinants of health (SDoH) are associated with stark disparities in cancer outcomes, but systematic SDoH data collection is currently absent from oncology clinical trials. Trial-based SDoH data are essential to ensure representation of marginalized populations, contextualize outcomes, and identify health-equity intervention opportunities. We report the feasibility of the first pediatric oncology multicenter trial-embedded SDoH investigation. Among 448 trial participants, 392 (87.5%) opted-in to the embedded SDoH study; 375 (95.7%) completed baseline surveys, with high longitudinal response rates (87.2-92.8%) over 24-months of therapy. Trial-embedded SDoH data collection is feasible and acceptable, and must be consistently included within future oncology trials.