The Impact of Social Determinants on Healthcare Transition Readiness Among Adolescent and Young Adult Childhood Cancer Survivors: A Mixed Methods Systematic Review.
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PURPOSE: Healthcare transition readiness is crucial for adolescent and young adult childhood cancer survivors (AYA CCS) to ensure continuity of care as they move from pediatric to adult healthcare services. A systematic review of the evidence linking social determinants of health (SDoH) and healthcare transition readiness is needed to provide valuable insights into the impact of disparities on transition. METHODS: A mixed-methods systematic review (MMSR) was conducted on studies published through November 2025. Quantitative data were extracted to assess measurable outcomes related to healthcare transition readiness and SDoH, while qualitative studies exploring the perceptions and experiences of AYA CCS, their families, and healthcare providers on transition readiness were analyzed using thematic synthesis. The final synthesis followed a convergent integrated approach, guided by the Healthy People 2030 SDoH framework. RESULTS: Seventeen studies (five quantitative and twelve qualitative) were included. Healthcare access and quality emerged as the most influential SDoH, with consistent evidence showing that relationships with knowledgeable healthcare providers, and access to health insurance and healthcare services were associated with healthcare transition readiness. Social and community context - including parental and peer support - also contributed to readiness. Evidence for economic stability was mixed, while education access and quality and neighborhood factors were the least examined and remain inconclusive. Integrated analysis indicated that structural (e.g., insurance, provider access) and relational SDoH (e.g., communication quality, family and peer support) influence healthcare transition readiness among AYA CCS. CONCLUSIONS AND IMPLICATIONS: This MMSR provides a comprehensive understanding of how SDoH impact healthcare transition readiness among AYA CCS. The findings underscore the need for future research to address gaps in the current literature and to improve transition outcomes and reduce disparities during the transition process in this population.