Social determinants and health‐related quality of life in a sample of diverse, low socioeconomic status cancer patients

Lui, Florence; Finik, Jackie; Leng, Jennifer; Gany, Francesca

doi:10.1002/pon.6006

Cited by 7 publications

(4 citation statements)

References 57 publications

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“…Existing literature assessing the association between cumulative social disadvantage and HRQoL have two shortfalls the present study addresses. First, indices used to evaluate the association of cumulative disadvantage with health status have mostly been limited to a few SDoH items and domains [17,29,30]. Here, we utilized a more nuanced construct of cumulative social disadvantage encompassing objective and perceived measures of economic stability, language and literacy, housing, community and social environment, and the healthcare system access and experience.…”

Section: Discussionmentioning

confidence: 99%

Cumulative social disadvantage and health-related quality of life: national health interview survey 2013–2017

Hagan,

Javed,

Cainzos-Achirica

et al. 2023

BMC Public Health

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Background Evidence for the association between social determinants of health (SDoH) and health-related quality of life (HRQoL) is largely based on single SDoH measures, with limited evaluation of cumulative social disadvantage. We examined the association between cumulative social disadvantage and the Health and Activity Limitation Index (HALex). Methods Using adult data from the National Health Interview Survey (2013–2017), we created a cumulative disadvantage index by aggregating 47 deprivations across 6 SDoH domains. Respondents were ranked using cumulative SDoH index quartiles (SDoH-Q1 to Q4), with higher quartile groups being more disadvantaged. We used two-part models for continuous HALex scores and logistic regression for poor HALex (< 20th percentile score) to examine HALex differences associated with cumulative disadvantage. Lower HALex scores implied poorer HRQoL performance. Results The study sample included 156,182 respondents, representing 232.8 million adults in the United States (mean age 46 years; 51.7% women). The mean HALex score was 0.85 and 17.7% had poor HALex. Higher SDoH quartile groups had poorer HALex performance (lower scores and increased prevalence of poor HALex). A unit increase in SDoH index was associated with − 0.010 (95% CI [-0.011, -0.010]) difference in HALex score and 20% higher odds of poor HALex (odds ratio, OR = 1.20; 95% CI [1.19, 1.21]). Relative to SDoH-Q1, SDoH-Q4 was associated with HALex score difference of -0.086 (95% CI [-0.089, -0.083]) and OR = 5.32 (95% CI [4.97, 5.70]) for poor HALex. Despite a higher burden of cumulative social disadvantage, Hispanics had a weaker SDoH-HALex association than their non-Hispanic White counterparts. Conclusions Cumulative social disadvantage was associated with poorer HALex performance in an incremental fashion. Innovations to incorporate SDoH-screening tools into clinical decision systems must continue in order to accurately identify socially vulnerable groups in need of both clinical risk mitigation and social support. To maximize health returns, policies can be tailored through community partnerships to address systemic barriers that exist within distinct sociodemographic groups, as well as demographic differences in health perception and healthcare experience.

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Section: Discussionmentioning

confidence: 99%

Cumulative social disadvantage and health-related quality of life: national health interview survey 2013–2017

Hagan,

Javed,

Cainzos-Achirica

et al. 2023

BMC Public Health

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“…A variety of social determinants impact health outcomes for immigrant and LEP individuals 3,4 . Immigrant and LEP patients are less likely to utilize preventive medical care, including cancer screenings and regular medical visits 5,6 .…”

Section: Introductionmentioning

confidence: 99%

“…A variety of social determinants impact health outcomes for immigrant and LEP individuals. 3,4 Immigrant and LEP patients are less likely to utilize preventive medical care, including cancer screenings and regular medical visits. 5,6 This may be due to limited knowledge about navigating the healthcare system in a foreign setting; social isolation; and financial, cultural, and linguistic barriers to healthcare access.…”

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confidence: 99%

“…11 Given these disparities in cancer outcomes and care, immigrants and LEP individuals may be especially vulnerable to poor psychosocial outcomes in survivorship. Studies suggest that foreign-born, ethnoracial minority, LEP, and lower-income cancer patients are more likely to be distressed 12,13 and to report poor quality of life 4,14 than native born, non-Hispanic White (NHW), English proficient, and higher-income patients.…”

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confidence: 99%

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A systematic review and meta‐analysis of psychosocial interventions for immigrant and limited English proficient cancer patients

et al. 2023

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Objective Immigrants, particularly those who are less acculturated and limited English proficient (LEP), often lack access to culturally and linguistically appropriate psychosocial care in cancer survivorship. We sought to determine what psychosocial interventions are available for immigrant and/or LEP cancer patients and to assess treatment and patient factors that may correlate with better psychosocial outcomes for this population. Methods We conducted a systematic review and meta‐analysis of studies published through August 2022 of interventions conducted with immigrant and/or LEP cancer patients aimed at improving psychosocial outcomes (i.e., quality of life, depression, cancer‐related distress, and anxiety). Using Covidence, a software program for systematic review management, four independent raters screened 16,123 records with a systematic process for reconciling disagreement, yielding 48 articles (45 studies) for systematic review and 21 studies for meta‐analysis. Results Most studies were conducted with Spanish‐speaking patients with breast cancer. Study participants (N = 5400) were primarily middle‐aged (mean = 53 years old), female (90.0%), and Hispanic (67.0%). The weighted average effect size (g) across studies was 0.14 (95% CI 0.03–0.26) for quality of life (18 studies), 0.04 (95% CI −0.08 to 0.17) for depression (8 studies), 0.14 (95% CI −0.03 to 0.31) for cancer‐related distress (6 studies), and 0.03 (95% CI −0.11 to 0.16) for anxiety (5 studies). Conclusion The interventions under review had small but beneficial effects on psychosocial outcomes for immigrant and LEP cancer patients. Notably, effect sizes were smaller than those found in previous meta‐analyses of psychosocial interventions conducted in majority U.S.‐born, non‐Hispanic White, English‐speaking cancer patient samples. More research is needed to identify key components and adaptations of interventions that benefit immigrant and LEP cancer patients to strengthen their effects for this growing yet underserved population.

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Risk of significant functional impairment across cancer diagnosis and care continuum

Flores,

Shah,

Bedjeti

et al. 2024

Cancer

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BackgroundThe authors examined baseline physical functional (PF) impairment among cancer outpatients in the National Cancer Institute Cancer Moonshot study Northwestern University Improving the Management of Symptoms During and Following Cancer Treatment (NU IMPACT). They hypothesized that PF impairment, measured with the Patient Reported Outcome Measurement Information System–Physical Function (PROMIS‐PF) survey, would (1) be common and more prevalent for patients receiving treatment compared with no treatment and (2) differ across tumor types, independent of cancer continuum phase.MethodsAdults who were diagnosed with cancer in NU IMPACT (n = 2273) were sampled, and their PROMIS‐PF scores were compared across tumor types and cancer continuum (curative, noncurative, or no treatment), with scores ≤40 indicating moderate–severe impairment. Multivariable logistic regression models were used to evaluate the relation among patient and cancer factors and PF scores using a 95% confidence interval.ResultsForty percent of the surveyed patients reported moderate–severe PF impairment. Patients with melanoma reported the least impairment, and those with lung cancer were 6.5 times more likely to have moderate–severe impairment (95% confidence interval, 2.393–17.769). The noncurative group was 1.5 times more likely to have moderate–severe impairment (95% confidence interval, 1.045–2.145; mean score, 43; p < .001) than the curative (mean score, 6) and no treatment (mean score, 48) groups. One‐third of those who reported PF impairment also had significant pain and/or fatigue.ConclusionsA sizeable minority experienced PF impairment across tumor types for which pain and/or fatigue co‐occurred, particularly in the noncurative group. The PROMIS‐PF survey effectively identified variations in physical function. Future studies will explore how screening for PF impairment can be used to refer patients for appropriate cancer rehabilitation services.

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Social determinants and health‐related quality of life in a sample of diverse, low socioeconomic status cancer patients

Cited by 7 publications

References 57 publications

Cumulative social disadvantage and health-related quality of life: national health interview survey 2013–2017

Cumulative social disadvantage and health-related quality of life: national health interview survey 2013–2017

A systematic review and meta‐analysis of psychosocial interventions for immigrant and limited English proficient cancer patients

Risk of significant functional impairment across cancer diagnosis and care continuum

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