Social determinants of health in a prospective study of whole-exome sequencing in advanced cancer patients from underserved communities.
Authors: Patel Kashyap B. , Jun Tomi , Chhadwa Shilpa , Zabala Valerie , Gill Sonia , Branchcomb Randall , Naidu Sashi , Nathwani Niyati A. , Hansen Gabriel , Hubbert Adara , Mukhi Hirangi , Mehta Dhwani , Nixon Sandra , Kodali Ashima , Zimmerman Michelle , Hantash Feras , Oh William K. 
Published: June 2022

e18539

Background: Social determinants of health (SDOH) influence outcomes of oncologic care and more data are needed to understand these factors in underserved communities. At the same time, disparities in access to genomic tests and genomic databases that overrepresent European ancestry may contribute to disparities in precision oncology. We established a prospective study incorporating SDOH assessments and whole exome sequencing for advanced cancer patients in underserved communities. Methods: In this ongoing multi-center, prospective, observational study involving community oncology practices in underserved communities, patients with advanced cancers received whole exome/whole transcriptome sequencing and hereditary cancer testing (Sema4, Stamford, CT). Patients also completed an enrollment questionnaire focused on SDOH. The study began enrollment in July 2021 at a community practice in South Carolina and has expanded to a second practice in North Carolina as of February 2022. This report describes demographic and SDOH characteristics of patients enrolled at the first site between 7/2021-2/2022. Results: A total of 161 enrolled patients have completed baseline demographics. SDOH data are available for 148 (91.9%) patients. The cohort was predominantly female (N = 99, 61.5%), with 34 (21.1%) patients reporting Black race, and a mean age of 65.5 years (s.d. 14.2). Three patients (0.02%) reported Hispanic ethnicity. The most common cancer types in the cohort were breast (N = 37, 23.0%), chronic lymphocytic leukemia (N = 18, 11.2%), colorectal (N = 13, 8.1%), myelodysplastic syndrome (N = 12, 7.5%), and non-small cell lung cancer (N = 11, 6.8%). In terms of SDOH factors, 64 (43.2%) patients reported household incomes < $25,000 and the majority reported household incomes < $50,000 (N = 93, 57.8%). A minority of patients had 4-year college degrees or higher (N = 36, 24.3%); the highest educational attainment was high school graduate for most (N = 70, 47.3%). Household income < $50,000 was associated with financial and food insecurity: patients from lower-income households were more likely to report being worried about being able to pay bills often/always (19.4% vs. 0%, Fisher’s exact p = 0.03) and were more likely to have either worried about running out of food (18.3% vs. 0%, Fisher’s exact p = 0.02) or to have run of out of food (15.1% vs. 0%, Fisher’s exact p = 0.02) in the past 12 months. Conclusions: Among advanced cancer patients in an underserved community, lower household income was associated with both financial and food insecurity. This ongoing observational study will integrate SDOH, genomic characteristics, and clinical outcomes from a diverse cohort of patients seen in community oncology practices.