China has made significant progress in childhood and adolescent cancer survival in 2018–2024. Differences in survival and access to health care persist between regions and depending on the level of socio-economic development. Inequalities are greater among adolescents than among children. Interprovincial healthcare seeking is generally associated with higher survival. Differences in survival outcomes persist according to the socio-economic development of the patients' residence and the places of treatment. The study is a prospective nationwide cohort study. In China's health care system, multi-level resource allocation for pediatric oncology care at the provincial and regional levels is recommended to achieve health equity.