Social Determinants of Health and Patient-Reported Outcome Measures Among Head and Neck Cancer Survivors

Tuesday, October 1, 2024

9:48 AM – 9:54 AM EDT

Location: MBCC, 208

Disclosure(s):

Fendi Obuekwe, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Christopher T. Wilke, MD/PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jonas T. Johnson, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The influence of social determinants of health (SDoH), particularly neighborhood-level factors, on patient-reported outcome measures (PROMs) in head and neck cancer (HNC) is underreported. The purpose of this analysis is to examine the association between SDoH and PROMs post-radiation.

Methods: This is a secondary analysis of a symptom monitoring intervention in HNC patients receiving radiation at an academic cancer center from 2020 to 2024. SDoH [education, employment, health literacy, insurance, and national area deprivation index (ADI)] were used to create a composite score (higher score indicated greater adverse factors). PROMs [University of Washington Quality of Life (QOL), Neck Disability Index (NDI), Eating Assessment Tool-10, Insomnia Severity Index, Patient Health Questionnaire-8 (PHQ-8) and Generalized Anxiety Disorder-7 (GAD-7) scores] were obtained pre-and 1-year post-radiation. Analysis was conducted using linear regression models controlling for pre-radiation PROMs.

Results: In total, 69 patients were included (mean (SD) age, 62.41 (11.21) years; 47 [68.1%] male; 61 [88.4%] white). Majority had HNC of oropharynx (34 [49.3%]) and oral cavity (20 [29%]), with tumor stage I/II (39 [56.5%]) and nodal stage 0/1 (44 [63.8%]). The 1-point higher SDoH was significantly associated with 2.67 points lower social-emotional QOL score (95% CI [-4.99, -0.35], p=0.025) post-radiation. ADI > 58 (median) was significantly associated with 7.87 points lower social-emotional QOL (95% CI [-13.43, -2.31], p = 0.006) and 2.95 points higher NDI (95% CI [0.66, 5.24], p = 0.013) scores. Medicaid/no insurance was significantly associated with 15.21 points lower social-emotional QOL (95% CI [-24.91, -5.51], p = 0.003), 2.45 points higher GAD-7 (95% CI [0.25, 4.65], p = 0.029) and 3.74 points higher PHQ-8 (95% CI [1.07, 6.40], p = 0.007) scores.

Conclusions: Adverse individual and neighborhood-level SDoH were associated with lower QOL and higher symptoms burden. Future research should focus on developing targeted interventions that address SDoH in HNC survivors to improve outcomes and advance equitable care.

Presenting Author(s)

Fendi Obuekwe, BS

Medical Student
University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Department of Otolaryngology
Pittsburgh, Pennsylvania, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

JL

Jinhong Li, MS

Graduate Student Researcher
University of Pittsburgh, School of Public Health, Department of Biostatistics
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.
MR

Margaret Q. Rosenzweig, PhD

Distinguished Service Professor
University of Pittsburgh School of Nursing
PITTSBURGH, Pennsylvania, United States

Disclosure information not submitted.
DZ

Dan P. Zandberg, MD

Associate Professor of Medicine, Director, Head and Neck and Thyroid Cancer Disease Sections
Division of Hematology/Oncology, University of Pittsburgh Medical Center, United States

Disclosure information not submitted.
Christopher T. Wilke, MD, PhD

Clinical Assistant Professor
UPMC
Pittsburgh, Pennsylvania, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Jonas T. Johnson, MD

EmeritProfessor, Department of Otolaryngology; Professor, Department of Radiation Oncology Professor
Department of Otolaryngology – Head and Neck Surgery, University of Pittsburgh, Medical Center
Pittsburgh, PA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Marci L. Nilsen, PhD

Assistant Professor
University of Pittsburgh, School of Nursing, Department of Acute and Tertiary Care
Pittsburgh, Pennsylvania, United States

Disclosure information not submitted.