Abstract 4838: Impact of social determinants of health (SDH) on systemic therapy and survival in young women with breast cancer
Authors: Reed Natalie J. , Ahmed Ferdous , Schepel Courtney , Hadzikadic-Gusic Lejla , Fisher Julie , Tan Antoinette R. , Heeke Arielle L. 
Published: March 2024

Abstract
Introduction: Health disparities are often influenced by SDH. Breast cancer patients (pts) with negative SDH may experience less access to treatment, which can impact outcomes. This study evaluated the association between SDH, utilization of medical therapy, and outcomes in young pts with early breast cancer.
Methods: We performed a retrospective review of female pts 18-40 years old in the Young Women’s Breast Cancer Database at a single institution with non-metastatic breast cancer diagnosed from 2011-2020. Predefined SDH were recorded along with clinical characteristics at diagnosis. Descriptive statistics and logistic regression analyses were performed. Survival analyses were conducted using Kaplan-Meier and Cox Proportional Hazard model.
Results: 1,061 pts were eligible for analysis; 67% were White, 27% Black, 4% Asian, and 3% Other. Additional demographic and clinical characteristics are shown in Table 1. Pts with Medicaid received chemotherapy (chemo) more often than pts with private insurance (OR 2.04, p=0.003), as did self-pay/uninsured pts (OR 1.74, p=0.003). Divorced/separated/widowed pts were more likely to receive chemo than married pts (OR 1.85, p=0.049). Pts living in 1st quartile of area deprivation index (ADI) received chemo less than those in the 4th ADI quartile (OR 0.45, p=0.003). Divorced/separated/widowed pts with HR+ disease were less likely to receive endocrine treatment than married pts (OR 0.48, p=0.039). Worse overall survival (OS) was seen for Black vs White pts (HR 1.72, p&lt;.001); pts with Medicaid or self-pay/uninsured vs privately insured (HR 1.67, HR 1.92; p=0.025); and unemployed vs employed pts (HR 2.49, p&lt;.001) adjusted for chemo use and clinical stage.
Conclusions: Young pts experiencing negative SDH were more likely to receive chemo, less likely to take endocrine therapy if indicated, and suffered from worse OS. These findings may highlight the influence of a pt’s social network on access to care and treatment completion.
Table 1. Demographics & clinical characteristics in young women with early-stage breast cancer Demographic Characteristics Overall, N=1061 Race Asian: 40 (3.9 %) Black or African American: 270 (26.6 %) Other: 29 (2.9 %) White or Caucasian: 677 (66.6 %) Ethnicity Hispanic or Latino: 86 (8.4 %) Non-Hispanic or Non-Latino: 939 (91.6%) Insurance Type Private: 824 (77.7 %) Medicare: 16 (1.5 %) Medicaid: 145 (13.7 %) Self-pay/Uninsured: 75 (7.1 %) Area Deprivation Index (ADI) Quartile* Q1= 1-25: 215 (20.3 %) Q2= 26-50: 375 (35.4 %) Q3= 51-75: 315 (29.7 %) Q4= 76-100: 155 (14.6 %) Median Household Income &lt;45000: 44 (4.1 %) 45000-79,999: 600 (56.6 %) 80000-119,999: 304 (28.7 %) ≥120,000: 112 (10.6 %) Employment status Unemployed: 224 (21.1 %) Employed: 657 (61.9 %) Unknown: 180 (17.0 %) Marital Status Married: 631 (59.8 %) Single: 355 (33.6 %) Separated/Divorced/Widowed: 70 (6.6 %) Clinical Characteristics Clinical AJCC Stage Stage 0: 149 (14.3 %) Stage I: 335 (32.1 %) Stage II: 430 (41.2 %) Stage III: 129 (12.4 %) Receptor Status HR+/HER2+: 174 (19.9 %) HR+/HER2-: 519 (59.3 %) HR-/HER2-: 182 (20.8 %) Utilization of Chemotherapy Yes: 702 (67.1 %) No: 344 (32.9 %) Utilization of Endocrine Therapy Yes: 451 (43.3 %) No: 590 (56.7 %) Recurrence Status Yes: 111 (10.5 %) No: 942 (89.5 %) Survival Status Alive: 868 (81.8 %) Dead: 101 (9.5 %) Lost to follow-up: 92 (8.7 %) *Higher score correlates with greater disadvantage
Citation Format: Natalie J. Reed, Ferdous Ahmed, Courtney Schepel, Lejla Hadzikadic-Gusic, Julie Fisher, Antoinette R. Tan, Arielle L. Heeke. Impact of social determinants of health (SDH) on systemic therapy and survival in young women with breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4838.