Patient-reported socioeconomic vulnerability and treatment delivery in patients receiving oral anticancer drugs within the Oncoral outpatient care program.

Abstract

e23272 Background: Socioeconomic vulnerability has been identified as a major determinant of cancer outcomes and treatment adherence, supporting the need for personalised follow-up strategies. While several studies suggest that social deprivation adversely affects treatment delivery, the extent to which structured multidisciplinary outpatient care can mitigate these inequalities remains unclear. We aimed to assess the association between socioeconomic vulnerability and treatment delivery in patients treated with oral anticancer drugs (OADs) within the multidisciplinary ONCORAL care plan, based on personalised community and hospital follow-up by oncologists, pharmacists and nurses. Methods: We conducted an observational real-life study of patients initiating the ONCORAL pathway between October 2021 and April 2024. Socioeconomic vulnerability was assessed using the simplified EPICES score, a validated composite index capturing self-reported social and material deprivation, including financial issues, access to leisure activities and social support. Associations between EPICES score and patient characteristics, cancer type, metastatic status, treatment characteristics, relative dose-intensity (RDI: the ratio of prescribed to the theoretically approved dose), early treatment termination and overall survival were analysed using non-parametric tests. Results: Two hundred and seventy patients were included: M/F sex ratio 0.8; median [range] age, 71 [31-93] years; with solid tumour (62.6%) or haematological malignancy (37.4%). Baseline EPICES scores ranged from 0 to 10 (median = 3), with 32.6% of patients presenting a score ≥ 4, the threshold defining social vulnerability. EPICES score correlated weakly with age (p = 0.002) and was higher in patients with metastatic disease (p = 0.039). EPICES distributions differed between cancer types (p = 0.013). However, mean RDI was 85.2 ± 21.4% at 6 months, and remained above the recommended 80%-85% target range for OAD efficacy throughout follow-up, including in patients aged ≥ 75 years. RDI did not correlate with EPICES score at any time point. Socioeconomic vulnerability was not associated with treatment characteristics, adherence, early treatment termination or overall survival. Conclusions: In this real-life cohort, socioeconomic vulnerability was associated with age, metastatic status and cancer type but not with treatment intensity, treatment delivery or survival. Despite heterogeneity in patients’ social vulnerability and cancers, treatment delivery and intensity were comparable across all patients within the personalised ONCORAL outpatient care pathway, suggesting that multidisciplinary community-hospital follow-up may attenuate the impact of socioeconomic inequalities in treatment delivery.