Social determinants of health, diagnostic delay, and treatment abandonment in advanced lung cancer care.

Abstract

e13521 Background: Social determinants of health (SDOH) significantly influence cancer outcomes, particularly in low- and middle-income countries. Evidence on how SDOH affect diagnostic timelines and treatment adherence in advanced lung cancer remains limited. This study evaluated the association between SDOH, time to diagnosis and treatment, and treatment abandonment in patients with recurrent or metastatic lung cancer. Methods: We conducted a cross-sectional study including patients with recurrent or metastatic lung cancer treated at a Instituto Nacional de Enfermedades Neoplasicas, Lima-Peru. SDOH were assessed using the Social Determinants of Health Questionnaire (STBH-Q), generating a global continuous score (range 0–128), where lower scores indicate higher social risk. Time to diagnosis, time to molecular diagnosis, time to treatment initiation, and time to target or immunotherapy initiation were analyzed as continuous non-normally distributed variables using Spearman correlation. Treatment abandonment (yes/no) was analyzed using Mann–Whitney U test and binary logistic regression. A two-sided p-value < 0.05 was considered statistically significant. Results: A total of 54 patients were included in the analysis. Higher social risk (lower STBH-Q global score) was significantly associated with longer time to initial diagnosis (Spearman ρ = −0.276, p = 0.043). No significant correlations were observed between the global STBH-Q score and time to molecular diagnosis (Sρ = 0.119, p = 0.404), time to treatment initiation (Sρ = 0.150, p = 0.295), or time to initiation of specific therapy (Sρ = 0.061, p = 0.684). Treatment abandonment occurred in 13 patients. The global STBH-Q score differed significantly between patients who abandoned treatment and those who did not (Mann–Whitney U test, p = 0.002). In binary logistic regression, higher STBH-Q scores were independently associated with a lower probability of treatment abandonment (B = −0.049; OR 0.95; 95% CI 0.92–0.98; p = 0.004), indicating that each unit increase in the global STBH-Q score reduced the odds of abandonment by approximately 5%. Conclusions: Social determinants of health are significantly associated with diagnostic delays and higher risk of treatment abandonment in patients with advanced lung cancer. These findings highlight the need to integrate systematic SDOH assessment into oncology care pathways to identify vulnerable patients and implement targeted interventions aimed at improving timely diagnosis and treatment adherence in resource-limited settings.