Abstract 5939: Feasibility of systemic SDOH collection and associated resource utilization at a large academic cancer center
Authors: Odai-Afotey Ashley , Haakenstad Ellana , Zhang Sunyi , Neville Bridget A. , Lipsitz Stuart , McCleary Nadine J. 
Published: June 2022

BACKGROUND: The WHO defines social determinants of health (SDoH) as “the conditions in which people are born, grow, live and age” which includes factors such as housing and food insecurity, employment, and social support and can account for 30-55% of health outcomes. Addressing unmet SDoH needs may reduce interruptions to cancer care caused by ED visits and hospitalizations (EDH). We aimed to determine feasibility of systematic patient-reported SDoH collection at a large academic cancer center and association of unmet SDoH needs with EDH.METHODS: We conducted a cross-sectional analysis of SDoH needs among new oncology patient (pt) consults from 5/15-9/21at Dana Farber Cancer Institute (DCFI). Pts completed an intake questionnaire including demographic, disease, as well as SDOH needs on a dichotomous or 5-point Likert scale, specifically health literacy (“how confident are you in filling out medical forms?”), health numeracy (“how confident are you in understanding medical statistics?”), financial distress (“how difficult is it for you, or your family, to meet monthly payments on your/your family’s bills?”) and social isolation (“do you currently live alone?”). We ran bivariate and multivariable models on the association between demographics, SDoH and EDH within 30 days of initial oncology visit using robust generalized estimating equations controlling for clustering by consult provider. RESULTS: 125,997new consults were seen from 05/15-09//21, of which 20,913 completed the intake questionnaire and were alive at 30 days of consult. Of those pts, most were female (60%), aged 40-64 (50%), White (90%), non-Hispanic (84%), primarily English-speaking (9%) and 7% had an EDH within 30 days of their 1st outpatient visit. The most reported SDOH need was limited health numeracy (26%). In bivariate analysis, factors associated with ED visits included: limited English proficiency lung or GU/GYN cancer, living &gt; 25 mi.from DFCI, and limited health literacy and numeracy (all p&lt;0.05). Demographics associated with hospitalizations included: White race and English as primary language (EPL) (both p&lt;0.05). Multivariable analysis showed female gender (OR 1.53, p &lt; 0.01), lung (OR 3.22*) and GU/GYN (OR 2.21*) (p &lt; 0.05 for both) cancer, and living &gt; 25 mi from DFCI (OR 2.50, p &lt; 0.0001) were associated with increased likelihood of ED visit while EPL (OR 1.80, p&lt;0.05) and GU/GYN (OR 1.65, p&lt;0.01*) cancer were associated with increased likelihood of hospitalization.CONCLUSIONS: It is feasible to systematically screen for unmet SDoH which are associated with increased frequency of ED visits. Differences in characteristics associated with ED vs. hospitalization could indicate possible bias or suggest SDoH needs as a reason for avoidance of costly medical care. Further study will expand both the content and site of SDoH data collection, non-English languages used for data collection, and measure impact of resource matching to reduce disruptions to cancer care.

*Compared to breast cancer

Citation Format: Ashley Odai-Afotey, Ellana Haakenstad, Sunyi Zhang, Bridget A. Neville, Stuart Lipsitz, Nadine J. McCleary. Feasibility of systemic SDOH collection and associated resource utilization at a large academic cancer center [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5939.