Screening for social determinants of health among patients with advanced and metastatic cancer undergoing comprehensive genomic profiling in underserved communities.
Authors: Nesline Mary K , Amoah Kobina , DePietro Paul , Bliss Zachery , Wallen Zachary D , Naidu Sashi , Patel Kashyap B. , Sathyan Pratheesh , Eisenberg Marcia , Caveney Brian , Severson Eric A , Robinson Sheila , Ramkissoon Shakti H 
Published: May 2024

e13545

Background: Many patients with advanced and metastatic cancer, who are potentially eligible for biomarker-directed targeted agents, do not receive them, with biomarker undertesting reported as a major factor. Little is known about non-medical factors that negatively impact treatment and outcomes, particularly in underserved communities. This study implemented screening for social determinants of health (SDOH) to identify barriers to precision medicine beyond biomarker testing for these patients. Methods: Four community oncology practice sites (GA, SC, FL), selected for their focus on underserved populations, consented patients to a prospective clinico-genomic database registry (May 2021-Dec 2023). Registry participants completed an SDOH questionnaire at the time of comprehensive genomic profile (CGP) test order. Questionnaire items were grouped by SDOH domain (economic stability, education, health care access, neighborhood/built environment, and social/community), with each potential response coded as either a positive or negative indicator for patient health. Negative indicators were summed at the item, domain, and survey levels for each patient, and aggregate frequencies tabulated. Results: Among 447 CGP-tested registry participants (24 solid tumor types, stage III/IV), 331 (74%) completed SDOH screening. Although non-White registry participants were highly represented among patients who completed SDOH screening (31.7%), unscreened patients had an even higher frequency of non-Whites (49.1%), particularly Black (14.2% v 24.8%) and American Indian/Alaska Native (10.3% v 18.1%) patients. Nearly all patients (99%) reported having health insurance, most frequently Medicare (69.2%). A small number of patients (5.4%) reported transportation issues that kept them from medical appointments. By domain, negative indicators for economic stability (46.2%), and social and community context (42.3%) were the most frequently reported, while healthcare access (14.5%), and neighborhood and built environment (9.4%) were the least common. Lack of socialization (27.5%), depression (21.5%), and very low income <$1200/month (20.8%), were the most frequently reported individual indicators. Overall, 74.5% of CGP-tested patients harboring genomic variants for oncology practice guideline-indicated therapies and/or marker-driven clinical trials reported having at least one negative indicator. Conclusions: SDOH-screening in community practice is feasible and identifies specific interventional areas among disadvantaged, vulnerable, advanced cancer patients. Increased screening among underserved, particularly for non-White patients, is needed to address their support needs beyond health insurance and biomarker testing, and improve their access to and participation in precision medicine clinical trials.