The impact of self-reported social determinants of health (SDOH) on patient engagement and symptom burden across a remote patient monitoring (RPM) pathway in 42 European hospitals.
Authors: Franzoi Maria Alice B , Di Palma Mario , Ribeiro Joana M. , Grellety Thomas , Ithurbide-Dachary Eliane , Artignan Xavier , Blanchard Elsa , Thirot-Bidault Anne , Lacombe Pénélope , Rodriguez Joseph , Lemaire Antoine , Polastro Laura , Caravella Laurence , Grosjean Jessica , Ferreira Arlindo R. , Diab Amine , Basch Ethan , Scotte Florian , Vaz-Luis Ines 
Published: June 2024

1506

Background: SDOH are a significant driver of cancer care disparities impacting access to care, adherence to treatment plans, treatment-related toxicities and quality of life (QoL) across the cancer care continuum. RPM based on electronic patient-reported outcomes (ePROs) is a powerful tool to facilitate communication between pts and providers, thereby improving symptom management, QoL and disease outcomes. Equitable participation in RPM pathways must be ensured to avoid increase existing disparities. In this study we report the prevalence of unfavorable SDOH and their impact on engagement with RPM and symptom burden in an RPM pathway deployed in routine care across 42 hospitals in FR and BE. Methods: Patient-level SDOH data provided by consented pts enrolled in the RPM pathway between 08-2023 and 12-2023 was used. Single-item questions were dichotomized from validated ePROs covering educational level, health literacy (3 subdomains health status, treatment and disease understanding), digital literacy, employment status, financial and food security, caregiver support, and access to care. SDOH profiles were defined as unfavorable (impairment at moderate/elevated level) vs. favorable (absence or impairment at a low level). RPM engagement and symptom burden were defined respectively as weekly ePRO reporting and number of alerts due to severe or worsening symptoms. Multivariable backward stepwise regression models (including age, gender, stage, health behaviors) assessed associations between SDOH profile and RPM engagement and symptom burden. Results: 896 (40%) pts provided SDOH data, of which 622 (69%) females with median age of 60 (P25-75 50-70). Most common primary tumor were breast (436, 49%) and gastrointestinal (171, 19%), 488 (55%) were non-metastatic. 653 (73%) pts reported at least 1 unfavorable SDOH, specifically: 199 (22.2%) on educational level, 134 (15.0%) on health status understanding, 27 (3.0%) on treatment understanding, 84 (9.4%) on disease understanding, 218 (24.3%) on digital literacy, 63 (7.0%) on employment status, 104 (11.6%) on financial security, 89 (9.9%) on food security, 348 (38.8%) on caregiver support and 56 (6.3%) on access to care. Lower RPM engagement was associated with unfavorable digital literacy (β -0.05, p<0.001) and treatment understanding (β -0.1, p=0.004). Higher symptom burden was associated with unfavorable financial security (β 0.066, p=0.020) and disease understanding (β -0.1077, p=0.001), but favorable employment status (β 0.0497, p=0.025). Conclusions: RPM with ePROs offers an opportunity to screen for SDOH in routine care. The vast majority of pts enrolled had at least 1 unfavorable SDOH. Specific actionable unfavorable SDOH were associated with lower engagement and higher symptom burden. Personalizing RPM pathways according to SDOH may foster equitable care.