In addition to female sex, higher household incomes, in excess of USD 23000 per year, was associated with a significantly lower risk of death (HR0.071; p=0.039). We also showed a significant relationship between lower stage disease and higher SES. (p=0.03). However, early presentation alone could not account for this association.  This suggests that there are SES factors which may impact outcome during treatment. For example, access to transport may cause delays in chemotherapy or food insecurity may lead to malnutrition, negatively impacting immunity and the ability to combat infection or tolerate chemotherapy-related toxicity. Given our past of enforced racial segregation and the association between skin colour and poverty, it is critical to isolate these social determinants of health as skin colour is too easily invoked as a risk factor, when in reality these relate to privilege and access to care. In children with acute lymphoblastic leukaemia a single institutional study reported a higher risk of relapse in children from high poverty areas despite uniform treatment (30). This is relevant given our intention to embark on the implementation of a national treatment protocol for MEGCTs and will be instructive as we interrogate household income and maternal education as measures of SES. Also proving a significant relationship between SES and outcome strengthens our collective call for parity not only in service delivery and access to care but also for adequate social support for children, which is constitutionally enshrined, but not necessarily delivered in real time.