Social determinants of health explored within an electronic patient reported outcomes (ePROs) remote symptom monitoring platform for patients with acute myeloid leukemia (AML).
Authors: Jamy Omer Hassan , Wildes Tanya Marya , Coombs Nicholas C , Beamon Emily R , Kristo Fjoralba , Cherepanov Dasha , Galaznik Aaron , Rusli Emelly 
Published: October 2023

353 Background: Social determinants of health (SDoH) are non-medical factors, such as income, education, employment, and area of residence that can influence health outcomes. Research shows SDoH impact people’s health, well-being, and quality of life (QoL) and, for patients with cancer, treatment outcomes. Electronic Patient Reported Outcomes (ePROs) integration into routine oncology practice improves patient time on therapy, survival, and resource utilization. This study explores the use of an ePRO platform for routine gathering of SDoH into care for Acute Myeloid Leukemia (AML). Methods: Adult patients with AML undergoing treatment were enrolled in the Carevive remote symptom monitoring (RSM) platform between March 1, 2021 and April 20, 2023. Patients received baseline and weekly surveys to assess symptom burden, physical function, and overall health throughout treatment. Baseline characteristics included age, sex, race, frailty status (modified Geriatric Assessment, CARE survey item, and/or self-reported activity level), comorbidities, and SDoH (living-, caregiver-, marital-, employment-, education-, insurance-status, travel distance to cancer center. Symptoms (derived from the PRO-CTCAE) and QoL (EORTC QLC C30 #29 & #30) were assessed weekly, along with survey compliance. Results were stratified by SDoH status and compared by symptom burden and QoL. Results: 124 patients were included in analysis, with median follow-up time of 12 weeks. Half were male (50%); median age was 66 (range 21-88), majority were White (76%) and had at least one comorbidity (69%). Survey compliance was 69%, measured by total number of surveys completed out of total number of surveys assigned by each patient. Among the 71 (57%) who completed all SDoH responses, 38 (54%) were married, 35 (49%) had at least a bachelor’s degree, 45 (63%) were retired, 45 (63%) reported having a full- or part-time caregiver, 26 (37%) lived with at least one other adult, and 48 (68%) lived more than 20 miles from their nearest cancer center. Patients living with at least one other adult reported symptoms more often than patients living alone (1.65 vs. 1.24 total symptoms per patient-week). Symptom reporting was comparable across all other SDoH responses. Conclusions: This study illustrates feasibility of using RSM for gathering SDoH indicators in routine care. While overall survey compliance was high, 43% did not complete all SDoH items, indicating possible patient reticence to respond to some questions. Symptom reporting differences may indicate a potential need to focus on patients living alone or without a caregiver. Results support the importance and utility of SDoH indicators to identify actionable risk factors for poor health outcomes. Further exploration is needed to understand reporting of symptoms and caregiver/lifestyle arrangements.