Health-related social needs and mortality risk among United States Veterans with non-small cell lung cancer.

Abstract

e13750 Background: Multiple expert bodies recognize screening and referrals for health-related social needs (HRSNs) as vital components of comprehensive and equitable cancer care. However, systematic HRSNs screening in oncology settings remains limited, with little data available regarding the clinical adoption or reach of screening interventions. We evaluated HRSNs screening rates among Veterans newly diagnosed with non-small cell lung cancer (NSCLC) and assessed the impact of HRSNs on stage at diagnosis and overall survival (OS). Methods: We conducted a retrospective cohort study of patients diagnosed with NSCLC at the Veterans Health Administration (VHA) across all 18 Veterans Integrated Service Networks from 01/01/2013-12/31/2021. Data on HRSNs screenings completed within 3 months after NSCLC diagnosis were extracted from structured data fields in clinical social work assessment notes and VHA clinical screeners for food insecurity, housing instability, and intimate partner violence. We used multivariable logistic regression and Cox proportional hazards models to evaluate the association of HRSNs with stage at diagnosis and 5-year OS, respectively, adjusting for age, sex, race, clinical stage, histologic type, Charlson-Deyo comorbidity index (CCI) score, area deprivation index (ADI), and year of diagnosis. Results: A total of 62,902 Veterans (mean age: 70.7 years; median follow-up: 6.6 years) met inclusion criteria. The distribution of NSCLC stages is shown in Table 1. Only 13,145 (20.9%) Veterans had ≥1 documented screens for HRSNs in the first 3 months following receipt of their NSCLC diagnosis. Among these, 5,515 (42.0%) screened positive for ≥1 HRSNs on their index screen. Compared to Veterans who screened negative, those with a positive index screen were significantly more likely to be Black (19.5% vs. 17.4%, p = 0.012), have multiple comorbidities (mean CCI score: 2.7 vs. 2.4, p < 0.001), and reside in higher ADI areas (mean ADI: 60.4 vs. 59.1, p < 0.001). In multivariable analyses, Veterans with a positive index screen had significantly elevated odds of diagnosis with late-stage NSCLC (III/V vs. I/II: adjusted odds ratio 1.812, 1.681-1.949) and reduced adjusted 5-year OS across all disease stages (I: 48.8% vs. 54.7%; II: 32.1% vs. 38.5%; III: 16.7% vs. 22.4%; IV: 1.8% vs. 3.1%, p < 0.001), compared to those who screened negative. Conclusions: HRSNsscreening is infrequently performed among Veterans newly diagnosed with NSCLC. Veterans with HRSNs are more likely to be diagnosed with late-stage NSCLC and experience reduced OS. There is a critical need to enhance systematic screening for HRSNs and processes to address identified HRSNs among Veterans with NSCLC. NSCLC stage distribution. Clinical Stage Total Patients, N=62,902 (%) Patients Screened, N=13,145 (%) I 23,834 (37.9) 4,478 (34.1) II 6,942 (11.0) 1,419 (10.8) III 13,435 (21.4) 2,975 (22.6) IV 18,691 (29.7) 4,273 (32.5)