Social needs and systemic inflammation associated with cancer survival among a historically marginalized population.

Abstract

e13797 Background: Challenges with social determinants of health (SDoH) have been shown to increase the risk of delays in cancer treatment initiation and may adversely affect therapy completion rates. In addition, exposure to chronic stress can lead to systemic immune dysregulation, which may worsen treatment response and outcomes. To elucidate these relationships, we evaluated the associations between self-reported SDoH challenges, systemic inflammation index (SII) score, and cancer survival, among historically disadvantaged patients. Objective: To study the influence of unmet social needs and elevated systemic inflammation on overall survival in cancer patients. Methods: We utilized our well-characterized retrospective cohort study of adult patients diagnosed with cancer at an urban medical center that serves an ethnically diverse population. Patients who met our inclusion criteria were diagnosed with various solid tumors and hematologic malignancies from 2018 to 2022, and filled out a self-reported, validated SDoH questionnaire that screens for 10 social needs. Univariate testing (chi-squared and t-tests, where appropriate), followed by Cox proportional hazards modeling, were used to estimate the associations between systemic inflammation index (SII) score prior to treatment, clinical and demographic data, and staging and survival outcomes. Results: Among our 1776 patients (mean age 61.3 ± 11.6), the top three cancer sites were genitourinary (n = 362, 20.4%), breast (n = 312, 17.6%), and hematologic malignancies (n = 183, 10.3%). 336 screened positive for at least one unmet social need, predominately being money for food (n = 139, 41.4%), housing situation (n = 105, 31.3%) and healthcare transportation (n = 101, 30.1%). Over half of these patients experienced >2 unmet needs (n = 188, 56.0%). Patients with unmet needs were younger (mean age 58.0 vs 61.7, p < 0.0001) and more likely to identify as Hispanic (p = 0.04) and/or African American (p = 0.03). Further, patients with unmet social needs had a significant decrease in overall survival (HR = 1.14; 95% CI: 1.02-1.27). In addition, lack of access to healthcare transportation was independently predictive of mortality (HR = 1.91; 95% CI: 1.21-3.03), when adjusting for age, stage of disease, and SII. Patients with high immune dysregulation (SII score > 913.51) also had worse overall survival in the multivariable analysis (HR = 2.27, 95% CI: 1.72-3.00). Conclusions: Cancer patients withunmet social needs may be at risk of worse outcomes. SII and SDoH were not colinear, and may independently influence survival outcomes in cancer patients. Our Bronx population is predominantly of low socio-economic status, historically marginalized patients with a high burden of unmet social needs. Should our results be confirmed, SII values and unmet social needs may be targets for interventions to mitigate cancer health disparities.