Health related social needs in an urban academic breast cancer survivorship program.

Abstract

1636 Background: Health-related social needs (HRSN) impact cancer care and are associated with late stage at diagnosis (dx), prolonged time to therapy initiation, and poor outcomes. Little data exists regarding long-term impact of cancer dx and therapy on HRSN in late survivorship. We evaluated associations of cancer therapies with HRSN in a diverse cohort of breast cancer (BC) survivors seen in an urban academic medical center. Methods: HRSN screening was completed by BC survivors seen in the cancer center survivorship program in 2023. Survivors were 4 or more years (yrs) from dx of Stage 0 to III BC, with all therapy complete (including endocrine therapy) and no evidence of metastasis. HRSN screens were compared with those completed by newly diagnosed (dxed) BC patients (pts) and adult general medical pts. Charts of survivors were reviewed for details of BC dx and treatment [stage, hormone receptor (HR) and HER2 status, type of surgery, and use of chemotherapy, radiation, and endocrine therapy]; as well as demographic data (age, race, ethnicity, insurance status, ZIP code). Neighborhood distress was categorized using Distressed Communities Index (DCI). Associations of clinical and demographic factors with HRSN in BC survivors were evaluated by Chi-Square and ANOVA tests. Results: 465 BC survivors [177 (38%) Black, 228 (49%) Hispanic] completed HRSN screening. Median age at assessment was 68 (range 43-98) and at dx was 57 (range 27-89); median time from dx was 11.25 yrs (range 4-35). 63.5% resided in distressed ZIP codes; 26.4% in at-risk ZIP codes. Most common HRSN in survivors completing their first HRSN screen (n = 395) were housing quality (5.3%) and food insecurity (4.8%). BC survivors were less likely to endorse HRSN than newly dxed BC pts (16.7% vs 24.0%, p = 0.03), but had similar HSRN as general medical pts (16.7% vs 14.6%, NS). Among survivors, younger age at BC dx (p = 0.006) and at HRSN screen (p = 0.004) was associated with greater risk of HRSN, with pts dxed prior to 57 almost twice as likely to endorse HRSN as those dxed after 57 (22.7% v 12.6%, p = 0.004). Younger survivors with HRSN were more likely to reside in distressed ZIP codes (p = 0.03). Hispanics seen in new survivorship visits were more likely to endorse HRSN than Hispanics seen in follow-up and than non-Hispanics seen in new or follow-up visits (p = 0.03). Race, insurance status, time from BC dx, stage, HR and HER2 status, extent of surgery, and use of chemotherapy, radiation, or endocrine therapy were not significantly associated with HRSN in survivors. Conclusions: In this diverse cohort, late BC survivors had similar HRSN prevalence as general medical pts. Younger age was associated with greater HRSN in survivors, while BC stage, receptor status, and extent of treatment were not. Hispanics presenting for first survivorship visit endorsed greatest HRSN. These findings have implications for interventions targeted to young survivors and for culturally sensitive survivorship care.