SDOH Drive Disparities in Access to Cancer Care Among Undeserved Populations

Social determinants of health (SODH) often drive inequities in healthcare access, according to the results of a cross-sectional survey of underserved patients in rural Tennessee. These findings were presented at the ASH Annual Meeting 2023.

Delays in treatment have been linked to worse outcomes for patients with aggressive lymphomas and leukemias, making timely access to healthcare critical for both timely diagnosis and optimal outcomes, said presenter and researcher Laura Quillen, BS. 

Disparities in outcomes based on age, race, and socioeconomic status exist among patients with hematologic malignancies. Therefore, a research team based in Memphis, Tennessee, conducted a pilot cross-sectional study to gain a better understanding of potential barriers to access to hematologic care for an underserved population in their community. 

Forty-six patients with hematologic malignancies were recruited at the local safety net hospital, of whom 41 completed the survey study for a response rate of 89.1%. Participants were median age 56.3 years, 53.7% were male, and 46.3% were Black or African American. B-cell non-Hodgkin’s lymphoma was the most common diagnosis. Almost half (45%) had a history of smoking, and 11 (28.2%) had a history of psychiatric diagnosis, such as depression or anxiety. Approximately one-third of patients (32.5%) were uninsured at the time of diagnosis, and 20 (57.1%) reported an annual household income of less than $25,000.

The researchers asked the patients to complete a 56-item survey designed to assess 10 components of social determinants of health: structural, behavioral, psychosocial, chronic stress, environmental, cultural, clinical, economic, health literacy, and healthcare perception. Most of the items were presented as closed-ended statements on a 4-point Likert scale, and then collapsed into 2 levels of “agreement” and “concern” for analyses.

Approximately 60% of the patient cohort reported being asymptomatic or symptomatic for less than 1 month before seeking medical care, noted Ms Quillen. Approximately 80% of the cohort had “reliable social support” at the time of their cancer diagnosis, most often in the form of a family member, spouse or partner, or friend. 

Some stressors included financial pressures, family dysfunction, and work-related stress. More than one-third reported having financial concerns about paying for routine medical care, she noted. 

“Approximately 44% of respondents self-reported that they believe medical attention to their cancer symptoms was delayed prior to their cancer diagnosis by a doctor,” said Ms Quillen. Within this subset of patients, the percentage of participants who endorsed any degree of concern about at least 1 item within each SODH category were calculated.

Structural barriers played an important role in the delay of their care, with 61% of patients reporting concern about finding a doctor who would correctly diagnose their symptoms. 

Economic concerns were in regard to medication costs (78%) and hospital costs (83%). 

Health literacy also played a role in delay of care, as 89% of patients cited not knowing their symptoms were a sign of cancer. 

Emotional and psychosocial factors were the most important self-reported contributors to the delay in accessing care, whereas culture and clinical factors were the least important. 

The study was limited by a small sample size and a skewed patient selection that did not include the sickest patients in the relevant patient population. Additionally, the definition of delay was patient-reported. 

“Importantly, this pilot study establishes the feasibility of approaching an extremely underserved population about sharing their experiences accessing medical care around the time of their cancer diagnosis as well as participating in research,” said Ms Quillen, noting that the etiology delays in seeking care are multifactorial.

Reference

Quillen L, Elsedawy N, Jones T, Randolph B, Hamid MS, Thora S. Comprehensive analysis of structural and social determinants of health leading to delays in seeking hematologic care: survey of an underserved population with hematologic malignancies. Presented at ASH 2023. December 9-12, 2023. San Diego, CA. Abstract 910.