Social determinants of health explored within an electronic patient reported outcomes (ePROS) remote symptom monitoring platform for patients with multiple myeloma (MM).
Authors: Wildes Tanya Marya , Coombs Nicholas C , Beamon Emily R , Kristo Fjoralba , Cherepanov Dasha , Galaznik Aaron , Rusli Emelly 
Published: October 2023

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Background: Social determinants of health (SDoH) are non-medical factors, such as income, education, employment, and area of residence, that can influence health outcomes. Research shows SDoH impact people’s health, well-being, and quality of life (QoL) and, for patients with cancer, treatment outcomes. Electronic Patient Reported Outcomes (ePROs) integration into routine oncology practice improves patient time on therapy, survival, and resource utilization. This study explores the use of an ePRO platform for routine gathering of SDoH incorporated into care for Multiple Myeloma (MM). Methods: Adult patients with MM undergoing treatment were enrolled in the Carevive remote symptom monitoring (RSM) platform between March 1, 2021 and April 20, 2023. Patients received baseline and weekly surveys to assess patient-reported symptom burden, physical function, overall health, and survey compliance. Baseline characteristics included age, sex, race, frailty status (modified Geriatric Assessment, CARE survey item, and/or self-reported activity level), comorbidities, and SDoH (living-, caregiver-, marital-, employment-, education-, insurance-status, travel distance to cancer center). Symptoms (derived from the PRO-CTCAE) and QoL (EORTC QLQ-C30 items #29 & #30) were assessed weekly. Results were stratified by SDoH status and compared by symptom burden and QoL. Results: A total of 151 patients were included in analysis, with median follow-up time of 12 weeks: majority were male (56%) and white (75%); median age was 66 years old (range 20-87), and 70% had at least one comorbidity. Survey compliance was 71%, measured by the total number of surveys completed out of the total number of surveys assigned by each patient. Among 84 (56)% patients with SDoH responses, 67 (80%) were married, 45 (54%) had at least a bachelor’s degree, 49 (58%) were retired, 21 (25%) reported having a full- or part-time caregiver, 73 (87%) lived with at least one other adult, and 39 (46%) lived more than 20 miles from their nearest cancer center. Symptoms were reported more often by patients with a caregiver compared to patients without a caregiver (1.67 vs. 1.12 total symptoms per patient-week) and by patients living with at least one other adult compared to patients living alone (1.53 vs. 1.21 symptoms per patient-week). Conclusions: This study illustrates the feasibility of using RSM for gathering SDoH and patience experience indicators in routine clinical care. While overall survey compliance was high, 44% did not complete all SDoH items, indicating possible patient reticence to respond to some questions. Differences in symptom reporting rates indicate a potential need to focus on patients living alone, or without a caregiver. This further supports the importance and utility of SDoH indicators to identify actionable risk factors for poor health outcomes.