Improving Social Needs For Women With Gynecological Cancer Could Improve Outcomes and Lessen Healthcare Disparities

Women with gynecologic cancer who experience an improvement of social needs such as companionship and food insecurity could experience improved outcomes.

The identification of social needs and accompanying solutions could result in more actionable health care disparities and impact outcomes for women with gynecologic cancer, according to a study published in CANCER.1

According to findings from the study, 65.2% of women with a gynecologic malignancy had at least 1 unmet social need, with 37.8% of patients screening positive for psychological distress. One unmet social need identified by patients (30.4%) was needing help with reading hospital materials. In response to this, the expertise of a cancer care navigator was utilized who consulted with women and offering support and education, resulting in open communication and adherence to care recommendations.

"While it is not within the power of individual healthcare systems or providers to modify social determinants of health, these data offer hope that we can implement programs to reduce healthcare disparities by addressing unmet social needs," senior author Abdulrahman K. Sinno, MD, of the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine said in a press release.

The study included 135 women and was conducted at Olive View-University of California Los Angeles Medical Center, with 84 women in the surveillance group and 51 women in the treatment group. Many women were living below the poverty line and were immigrants. The patient population consisted of 60.7% Hispanic women, 53.2% of whom were Spanish speaking and 82.2% (n = 111) were foreign born.2

Investigators used the National Comprehensive Cancer Network distress thermometer (NCCN DT) and the emotions thermometer tool (ETT) to assess patient’s mental health, which helped patients to report feelings of anxiety, anger, and depression.

Other unmet social needs that were reported included the need for someone to talk to (20%; n = 27), the need for companionship (14.8%; n = 20), housing instability (13.3%; n = 18), financial strain limiting medical care (13.3%; n = 18), food insecurity (12.6%; n = 17), and transportation difficulties (8.9%; n = 12). Additionally, 39.3% of patients felt like they needed assistance with social needs and 5.2% said their needs were urgent.

Patients who reported feeling depressed had a higher range of social needs (P< .05), with a range of 0 to 7 at a mean 1.38 per patients. Social needs associated with distress, including a lack of companionship and social isolation (OR, 3.70; 95% CI, 1.7-10.1; P=.01), as well as a lack of safety at home (OR, 1.09; 95% CI, 1.00-1.18; P=.02) were associated with positive distress scores.

There was no significant difference in patients between the surveillance and treatment groups who reported unmet social needs (61.9% vs. 70.5%, respectively; P = .35), or in the number of patients who screened positive on the ETT scale.

Investigators also assessed emergency room (ER) visits among this patient population and found that 39.3% (n = 53) of patients went to the ER at least once. Additionally, a lack of transportation (P = .002) and housing instability (P = .04), having 1 social need or more (P = .046), and an NCCN DT score 4 or greater (P= .027) was associated with ER visits. On a multivariate basis, a lack of transportation was associated with ER visits (OR, 6.60; 95% CI, 1.3-33.6; P=.02). Additionally, 38.8% of patients required at least 1 inpatient admission.

Of the patients included in this study, 26 had interruptions in their care plan, 8.9% of whom (n = 12) had comorbidities and 10.4% (n = 14) had interruptions due to of nonadherence. Nonadherence was described as missed appointments, loss to follow up, incorrect use of medications, and delay of treatment. Patients who had an NCCN DT score 4 or greater (P = .005) and an ETT anxiety score of 4 or greater (P = .013). Moreover, a lack of transportation (P = .001) and lack of childcare (P = .005) were associated with treatment interruptions.

"In the future, we plan to demonstrate the utility and cost effectiveness of identified social need intervention algorithms not only for improving quality of life and health outcomes, but also for reducing healthcare disparities," said Dr. Sinno.

References

  1. Addressing social needs may help mitigate distress and improve the health of women with cancer. News Release. Wiley. July 12, 2021. Accessed July 28, 2021. https://bit.ly/3itpuWd
  2. Nyakudarika NC, Holschneider CH, Sinno AK. Universal social needs assessment in gynecologic oncology: An important step toward more informed and targeted care in the public safety net. Cancer. Published online ahead of print, July 12, 2021. doi:10.1002/cncr.33761