Abstract B108: Social determinants of health factors impact the psychological distress of lung cancer surgery patients and their family caregivers
Authors: Teteh Dede K. , Zou Xiaoke , Ferrell Betty , Erhunmwunsee Loretta , Raz Dan , Kittles Rick , Montgomery Susanne , Kim Jae , Sun Virginia 
Published: January 2023

Social determinants of health (SDH) are understudied in oncology yet significantly impact the quality of life of lung cancer patients and family caregivers (FCGs). Preoperative psychological distress is common for lung cancer patients and their FCGs. The purpose of this study was to determine how SDH factors influence prolonged social and environmental stressors for lung cancer surgery patients and their FCGs. Methods: This cross-sectional study evaluated the impact of SDH on psychological distress of lung cancer surgery patients and their FCGs at a comprehensive cancer center in Southern California. The 21-item Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) survey was used to measure SDH factors related to social and community context, education access and quality, healthcare access and quality, economic stability, and neighborhood and built environment. The Distress Thermometer was used to evaluate the psychological distress of participants prior to surgery (0, no distress to 10, extremely distressed). The established cut-off of 3/10 indicated a need for intervention. A two-sided Fisher's exact test, Wilcoxon rank sum test or Pearson's Chi-squared test was used based on SDH questions and p-value &lt; 0.05 was defined as statistically significant. Results: Overall, 57% of participants (N = 152) reported psychological distress, including 55% of patients (n = 76) and 59% of caregivers (n = 76). Eighty-eight percent of participants were comfortable speaking English, 30% were from racially minoritized groups, 49% reported an annual family income between $50-$124K, and 44% interacted with their social network 5 or more times a week. Overall, 47% of participants reported experiencing some stress prior to surgery, 38% of patients and 55% of FCGs. Participants who were more likely to experience significant psychological distress prior to surgery included individuals who were more stressed (p=0.012), did not speak English (p=0.05), had a lower annual family income (p=0.032), and less interactions with their social network (p=0.028). For patients, the stress of surgery (p=0.033) and decreased communication with their social network (p=0.016) was associated with psychological distress. FCGs who spoke other languages (p=0.022), including Chinese were more likely to experience psychological distress compared to English speakers. Discussion: Lung cancer surgery patients and their FCGs experienced significant psychological distress prior to surgery due to unmet social needs. SDH may impact psychological distress differently for patients and FCGs as the impact of SDH related to social and community context (stress and social network), education access and quality (preferred language) and economic stability (annual family income) differed by group. Preoperative assessment of SDH and psychological distress should be conducted to identify dyads with unmet social needs and inform the provision of personalized interventions to improve dyadic outcomes.

Citation Format: Dede K. Teteh, Xiaoke Zou, Betty Ferrell, Loretta Erhunmwunsee, Dan Raz, Rick Kittles, Susanne Montgomery, Jae Kim, Virginia Sun. Social determinants of health factors impact the psychological distress of lung cancer surgery patients and their family caregivers [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B108.