Association of social determinant of health (SDOH) with clinical outcomes in patients with cancer: Opioid use, emergency admission, anxiety, depression, and length of hospital stays.

Abstract

e23072 Background: As cancer patients are overburdened by disease, treatment, access to care, and other demographic factors, the obstacles become increasingly significant with SDOH. Patients hospitalized in the United States in 2017 for the treatment of prostate (PC), breast (BC), and lung (LC) cancer were evaluated to characterize further and contrast variations between SDOH and clinical outcomes. Methods: We utilized the generalized linear models to assess the association between homelessness and problem-related living alone (PrbLA) and clinical outcomes–– opioid abuse/long-term use, anxiety and depression, and burden of illness (length of stay) while controlling for patients’ characteristics. Results: In the study among PC, there were 425 homeless, 355 PrbLA; BC, 320 homeless and 225 PrbLA; LC, 1345 homeless and 820 PrbLA. In the adjusted analysis, PC homelessness was significantly associated with anxiety and depression (5.15, 95%CI: 3.17-8.35); emergency admission (5.57; 95%CI: 2.63-11.82); opioid abuse (3.75,95%CI: 1.27-11.13) and longer LOS, unadjusted (2.49; 95%CI: 1.58-3.92), adjusted analysis (1.96; 95%CI: 1.03-3.74). These findings were comparable in the BC and LC cohorts. Further in the adjusted analysis, PC patients with PrbLA were associated with higher combined anxiety and depression, adjusted (2.7, 95%CI: 1.64-4.46); emergency admission, adjusted (5.86; 95%CI: 2.66-12.91); opioid long-term use, adjusted (3.74,95%CI: 1.02-6.88) and longer LOS, adjusted analysis (1.44; 95%CI: 1.11-1.88). These findings were comparable in the BC cohort. In the LC cohort, when stratified to females, the PrbLA was associated with longer LOS (1.29; 95%CI: 1.02-1.63). In all cancer cohorts, when compared to Whites, SDOH was associated with poor outcomes––Blacks had a higher burden of illness. And when compared to Whites, Hispanics, Asians, and Others were associated with lesser opioid abuse among all cancer cohorts with homelessness. Conclusions: According to this study, PC, BC, and LC patients with poor SDOH presented with the worst clinical outcomes, including higher opioid abuse, emergency admission, anxiety and depression, and longer LOS in the hospital. The findings of this study highlight a vacuum in the literature, and the recommendations stress the value of social support for cancer patients in achieving a better prognosis and quality of life.