Little is known about patients with cancer’s social welfare and how it affects their health outcomes. To address this, researchers at University of California (UC) San Diego School of Medicine and partnering institutions assessed the prevalence and impact of various social risk factors in patients with cancer. Their findings, published by Banegas et al in JAMA Network Open, revealed that housing instability was the social risk factor most strongly associated with an increased risk of mortality.
“We wanted to understand what social and economic issues patients were facing when they first came in with a cancer diagnosis and how those might affect their long-term health,” said corresponding author Matthew P. Banegas, PhD, MPH, an Associate Professor at UC San Diego School of Medicine and Co-Director of the Center for Health Equity Education and Research.
To evaluate patients’ baseline social risk, the researchers looked at data from 1,277 patients enrolled at Kaiser Permanente Northwest (53.5% women and 84% non-Hispanic White) who completed a social risk survey within 90 days before or after their cancer diagnosis. The survey evaluated four categories of social risk, including financial hardship, food insecurity, housing instability, and transportation difficulties. Researchers then measured how closely associated the social risk factors were with the patients’ mortality rates.
The study found that 16% of patients experienced one or more social risks, with financial hardships being the most common. A greater proportion of patients who reported social risks were women, from a racial or ethnic minority group, had Medicaid, had breast or lung cancer, or had advanced-stage tumors.
“We were surprised to find that housing instability had the biggest effect on patient outcomes, but this underscores the importance of doing this kind of research,” Dr. Banegas said. “Now we want to paint a clearer picture of the mechanism: do we get from housing instability to greater mortality, and how can this information guide the types of screenings and resources we provide?”
The authors are looking to repeat the study in other populations and health systems, and plan to evaluate a broader range of social factors, including social isolation and loneliness. In addition to collecting these baseline measurements, they also plan to track how social risks evolve as patients move through their cancer treatments.
“It’s clear that social risk factors affect health outcomes, so we should be screening for them as part of routine care,” Dr. Banegas said.
In addition to increased screening, Dr. Banegas suggested cancer centers develop programs to provide short-term housing for patients receiving cancer care.
“It’s important for health-care systems to engage with their communities and understand what social resources are already available around them,” he explained. “Forging partnerships and referral programs with local organizations will be critical to getting patients the full spectrum of care they need.”
Disclosure: This study was funded by the National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.
