Findings from a study published early online in CANCER, a peer-reviewed journal of the American Cancer Society (ACS), demonstrate that social needs—such as food and economic insecurity, poor housing and neighborhood conditions, and lack of access to transportation—were common in a group of African American cancer survivors in Detroit, Michigan, and they were associated with lower health-related quality of life (hrQoL).[1]

Among cancer survivors, hrQoL—or individuals’ perceived well-being regarding their mental, physical, and social health status—tends to be significantly lower among African Americans compared with other groups.

The study’s investigators looked to see if social needs may play a role in this disparity.

Substantial economic burdens
“Many cancer survivors and their families face substantial economic burdens related to cancer treatment, including out-of-pocket costs, non-medical expenses, and changes to employment status,” said Theresa Hastert, Ph.D., assistant professor population science at the Karmanos Cancer Institute and Wayne State University School of Medicine in Detroit, Michigan, and the study’s lead author.

“These burdens are associated with poor quality of life in survivors and may impact treatment decisions,” she added.

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“With our study, we focus on these economic burdens,” Hastert said, “We don’t really know what the most important components of economic burden are for cancer survivors. And many measures being developed are based on information from mostly white survivors. These may not represent the experiences of all survivors and could underestimate the economic burdens experienced by other groups,” she said.

The analysis included 1,754 participants in the Detroit Research on Cancer Survivors (ROCS) cohort, a population-based study of African American survivors of breast, colorectal, lung, and prostate cancer. Social needs related to food insecurity, utility shut-offs, housing instability, not getting health care due to cost or lack of transportation, and negative perceptions of neighborhood safety.

The investigators measured hrQoL using a questionnaire called the Functional Assessment of Cancer Therapy–General (FACT-G), a 27-item questionnaire designed to measure four physical, social, emotional, and functional well-being of cancer patients.*

Researchers found that more than one-third (36.3%) of cancer survivors reported social needs. This included 17.1% who reported two or more specific needs.

The prevalence of social needs ranged from 8.9% for utility shut-offs to 14.8% for food insecurity. Social needs that were linked with a low hrQoL score in the FACT-G questionnaire included not getting care due to lack of transportation, housing instability, food insecurity, feeling unsafe in the neighborhood, utility shut-offs, and not getting care due to cost.

A link between social needs and lower hrQoL among cancer survivors is not surprising. “However,” Hastert added, “the association had not been quantified before.”

Additionally, the study was conducted in a population of African American cancer survivors, a population that is often underrepresented in cancer research. The prevalence of social needs in this population may be higher than in cancer survivors more broadly. The results of the study will likely apply to other populations as well.

“My hope is that these findings raise awareness among cancer care providers and cancer researchers that many patients face substantial social and financial difficulties and that these have real impacts on patients’ health-related quality of life on top of cancer and cancer treatment,” Hastert noted.

“Cancer care and survivorship settings may represent an opportunity to screen for social needs, to connect patients and survivors with programs and services to address those needs, and to implement innovative interventions to reduce health disparities by addressing social needs among Black cancer survivors. These findings also highlight the need for and importance of having a social safety net in advancing population health and health equity,” she concluded.

* The FACT-G ability to discriminate patients on the basis of stage of disease, performance status rating (PSR), and hospitalization status supports its sensitivity. It has also demonstrated sensitivity to change over time.

[1] Hastert TA, McDougall JA, Strayhorn SM, Nair M, Beebe-Dimmer JL, Schwartz AG. Social needs and health-related quality of life among African American cancer survivors: results from the Detroit Research on Cancer Survivors (ROCS) study. . CANCER; Published Online: November 23, 2020 (DOI: 10.1002/cncr.33286).URL Upon Publication:

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