Social Needs May Be Linked to Low Health-Related Quality of Life Among Black Cancer Survivors

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Social needs—such as food and economic insecurity, poor housing and neighborhood conditions, and lack of access to transportation—were common in a group of Black cancer survivors in Detroit. These factors were associated with lower health-related quality of life, according to findings published by Hastert et al in the journal Cancer.

Among cancer survivors, health-related quality of life—or individuals’ perceived well-being regarding their mental, physical, and social health status—tends to be significantly lower among Black patients compared with other groups. Investigators looked to see if social needs may play a role in this disparity.

Study Details and Analysis Findings

The analysis included 1,754 participants in the Detroit Research on Cancer Survivors (ROCS) cohort, a population-based study of Black survivors of breast, colorectal, lung, and prostate cancers. Social needs related to food insecurity, utility shutoffs, housing instability, avoidance of health care due to cost or lack of transportation, and negative perceptions of neighborhood safety. Health-related quality of life was measured using the Functional Assessment of Cancer Therapy–General (FACT-G) questionnaire.

Researchers found that more than one-third (36.3%) of survivors reported social needs, including 17.1% who reported two or more. Prevalence of social needs ranged from 8.9% for utility shutoffs to 14.8% for food insecurity.

FACT‐G score differences associated with social needs were:

  • –12.2 (95% confidence interval [CI] = –15.2 to –9.3) for not getting care because of a lack of transportation
  • –11.3 (95% CI = –14.2 to –8.4) for housing instability
  • –10.1 (95% CI = –12.7 to –7.4) for food insecurity
  • –9.8 (95% CI = –12.7 to –6.9) for feeling unsafe in the neighborhood
  • –8.6 (95% CI = –11.7 to –5.4) for utility shutoffs
  • –6.7 (95% CI = –9.2 to –4.1) for not getting care because of cost.

First study author Theresa A. Hastert, PhD, of Wayne State University School of Medicine and the Barbara Ann Karmanos Cancer Institute, noted that a link between social needs and lower health-related quality of life among cancer survivors is not surprising. However, the association had not been quantified before.

Additionally, the study was conducted in a population of Black cancer survivors, a population that is often underrepresented in cancer research. The prevalence of social needs in this population may be higher than in cancer survivors more broadly, but the results likely apply to other populations as well.

Theresa A. Hastert, PhD

Theresa A. Hastert, PhD

“My hope is that these findings raise awareness among cancer care providers and cancer researchers by showing that many patients face substantial social and financial difficulties and that these have real impacts on patients' health-related quality of life on top of cancer and cancer treatment,” said Dr. Hastert. “Cancer care and survivorship settings may represent an opportunity to screen for social needs, to connect patients and survivors with programs and services to address those needs, and to implement innovative interventions to reduce health disparities by addressing social needs among Black cancer survivors. These findings also highlight the need for and importance of having a social safety net in advancing population health and health equity.”

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.