Assessing social determinants of health and optimizing resource support for patients with metastatic breast cancer: Results from the LIFT-UP study.
Authors: Fadelu Temidayo , Hughes Melissa E. , Skeffington Molly , Martin Alyssa R. , Fullem Renee , Perilla Glen Adriana , Brown Sandra , Kusmick Ross J , Moore Abigail , Buck Simone , Sendrick Kerry , Caporale Caitlin , Sammons Sarah L , Tolaney Sara M. , Lin Nancy U. , Freedman Rachel A. 
Published: May 2024

e13719

Background: Although the impacts of social determinants of health (SDOH) on outcomes of patients with breast cancer are well-recognized, few cancer care programs systematically assess and address SDOH. We examined the feasibility of systematic assessment of SDOH within a clinical metastatic breast cancer (MBC) program, and subsequent linkage to support services. Methods: Embedded within the Ending Metastatic Breast Cancer for Everyone (EMBRACE) program at a single center, we approached consecutive patients from March to September 2023, who were within 6 months of institutional presentation. Recruited patients participated in a multidimensional baseline survey of SDOH including domains such as language barriers, transportation burden, financial and housing concerns, depression, and anxiety. Based on pre-determined thresholds on a Likert scale for each potential SDOH need, referrals were made to connect patients to specific support services; a follow-up survey was conducted at 3-6 months. Outcomes included feasibility of SDOH documentation (% who completed survey); prevalence of needs; use of support services; and satisfaction with services. Results: Among eligible patients from two clinic sites, 112 were approached for participation and 98 (87%) enrolled. Most participants (n=73, 74%) completed the baseline SDOH survey. Median age was 58 (range 29-84). Most participants identified as White (82%) and non-Hispanic (89%); two patients were non-English speaking. Median travel time to clinic was 80 mins. Overall, 63% reported 1+ need; 25% had 3+ needs. Reported concerns included the following: 33% were somewhat/very worried about transportation costs, 21% worried about medical costs (e.g., copays), 15% worried about medication payments, 19% worried about utility bills; 14% and 7% had some degree of housing or food insecurity, respectively. Moreover, many patients experienced some personal (49%) or spousal (19%) loss of income since their cancer diagnosis. Using the Hospital Anxiety and Depression Scale, 37% and 27% met thresholds for social work referral. Overall, referrals to resource services were placed for >95% of those with SDOH needs, but the data are not yet mature to assess utilization of services. Preliminary results from a follow-up survey at 3-6 months indicate that among those who accessed resources, transportation concerns (50%), food insecurity (66%) and medication payment challenges (50%) persisted. Conclusions: Our findings highlight the feasibility and importance of systematically assessing SDOH in a routine clinical setting, with a high degree of unmet needs reported among MBC patients. As a result of these assessments, >95% were referred for relevant resources. Future studies will determine successful implementation strategies to optimize access to support and resource services.