Ethnic disparities in unmet supportive care needs and outcomes among older ambulatory cancer patients.

Abstract

11108 Background: Older cancer patients often face unmet supportive care needs (USCNs), leading to adverse clinical outcomes. Existing research largely focuses on non-Hispanic White populations, leaving a gap in understanding the unique determinants and consequences of USCNs in underrepresented groups. This study aimed to identify factors associated with USCNs and evaluate their impact on clinical outcomes, including emergency room (ER) visits and hospitalizations, among ambulatory cancer patients aged 65 and over. Methods: A retrospective analysis was performed for older ambulatory cancer patients (aged ≥65) via My Wellness Check , an electronic health record (EHR)-based supportive care needs and patient-reported outcomes (PROs) screening and referral program. Patient demographics and clinical characteristics and outcomes were extracted from the EHR. PROs (i.e., PROMIS computerized adaptive tests for anxiety, depression, and physical function), health-related quality of life (HRQOL) using the FACT-G7, and supportive care needs (e.g., stress management, financial concerns, transportation) were also collected. Logistic regression models examined predictors of USCNs. The cumulative incidence of ER visits and hospitalization was assessed using Cox proportional hazards regression models adjusting for covariates. Results: A total of 8,996 older cancer patients were analyzed (mean age: 74±6.3 years, 44% female). Among participants, 3,297 (37%) were Hispanics, 4,901 (55%) were non-Hispanic White, and 561 (6%) were non-Hispanic Black. Most patients were partnered (64%) and insured (98%). Hispanics were more likely to experience USCNs (adjusted odds ratio [aOR]=1.79). Other factors associated with USCNs included non-White race (aOR=2.42), being unpartnered (aOR=1.24), uninsured status (aOR=1.80), shorter time since diagnosis (aOR=0.94), anxiety (aOR=1.03), depression (aOR=1.02), lower physical function (aOR=0.99), and poorer HRQOL (aOR=0.95). Hispanic ethnicity was independently associated with an increased risk of ER visits (adjusted hazard ratio [aHR]=1.76). USCNs were independently associated with an increased risk of ER visits (aHR=1.25) and hospitalizations (aHR=1.29) (all p' s<0.05). Conclusions: Older Hispanic cancer patients are disproportionately burdened by USCNs, leading to higher risk of ER visits compared to their non-Hispanic counterparts. Underrepresented groups, patients lacking social support, and those experiencing greater emotional or physical distress are more likely to report USCNs. Addressing these needs is critical, as USCNs significantly contribute to increased healthcare utilization, including ER visits and hospitalizations. Tailored interventions to meet supportive care needs in historically vulnerable populations are imperative to improving outcomes and reducing healthcare disparities among older cancer patients.