Evaluation of social support, discrimination, and perceived health in patients with gastrointestinal tract cancers.
Authors: Butensky Samuel , Kim Jihoon , Godfrey Elizabeth , Su David G. , Kerekes Daniel , Johnson Caroline H , Ahuja Nita , Khan Sajid A. 
Published: January 2025

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Background:
Health-related social conditions affect cancer outcomes. Gastrointestinal cancers (GIC) comprise a large proportion of cancers diagnosed in the United States. We hypothesized that a diagnosis of GIC negatively impacts Social Determinants of Health (SDOH) and perceived health (PH).
Methods:
Prospectively collected data from The All of Us database was queried for GIC patients who completed SDOH and PH surveys. Healthy, non-cancer (NC) participants were matched to GIC based on age, race, sex, deprivation index, and Charlson Deyo comorbidities using Propensity Score Matching. Regression was used to analyze the relationship between cancer status and survey scores.
Results:
A total of 231,033 patients met the criteria: 14,032 GIC and 217,001 NC. The majority of patients were white (69%%), female (59.2%), and non-Hispanic (97.2%). Colorectal cancer was most represented (81%), followed by anus (12%), stomach (3%), and pancreatic (1%) cancers. The median time between cancer diagnosis and survey response was 3.4 years (IQR 1.4-6.5 years). With respect to SDOH, GIC patients perceived more social support (β 0.07 [95% CI: 0.04, 0.10]), more neighborhood positivity (β 0.07 [95% CI: 0.05, 0.10]) and less healthcare discrimination (β -0.03 [95% CI: -0.06, -0.01]) (Table, NC is reference). GIC surveyed < 1 year after their diagnosis scored higher on social support than those surveyed > 1 year (β 0.13 [95% CI: 0.05, 0.21]). For PH, GIC were 15% more likely to report better mental health and 33% more likely to report better quality of life (QOL). Those diagnosed < 1 year before their survey had no difference in perceived physical and general health compared to NC, although their QOL (OR 1.3 [95% CI: 1.2-1.4]) and mental health (OR 1.1[95% CI: 1.0-1.2]) were similar to those surveyed > 1 year after the diagnosis. Chemotherapy-treated GIC patients reported better PH in all four domains than those not treated with chemotherapy, including QOL (OR 1.3, [95% CI: 1.2-1.5]) and mental health (OR 1.2, [95% CI: 1.1-1.4]).
Conclusions:
Findings of this survey study reveal that a GI cancer diagnosis has a favorable impact on SDOH and PH - GIC feel more supported, less discriminated, and perceive better health compared to NC, and time of cancer diagnosis and chemotherapy impact outcomes. A concerted societal effort is required to improve health related social conditions for individuals with and without cancer.

Impact of cancer status on perceived health and social determinants of health.

Social Determinants of Health*
Beta (95% CI)
P Value

Social Support
0.074 (0.04, 0.10)
< 0.001

Neighborhood Positive
0.074 (0.05, 0.10)
< 0.001

Healthcare Discrimination
-0.034 (-0.06, -0.01)
< 0.001

UCLA Loneliness
-0.013 (-0.03, 0.01)
0.196

Perceived Health Domain*
Odds Ratio (95% CI)
P Value

Quality of Life
1.32 (1.27, 1.38)
< 0.001

Physical Health
1.27 (1.21, 1.32)
< 0.001

Mental Health
1.15 (1.10, 1.20)
< 0.001

General Health
1.26 (1.21, 1.32)
< 0.001

*Comparison is gastrointestinal cancer vs. non-cancer, with non-cancer as the reference group.