Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Health disparities persist in the United States healthcare system, notably affecting head and neck cancer (HNC) patients. Social determinants of health (SDoH) contribute significantly to these disparities but are understudied in HNC. This study is one of the first to evaluate prevalence of specific social vulnerabilities in HNC patients and their associations with HNC treatment.
Methods: A retrospective chart review was performed at a tertiary care academic medical center of adult patients presenting to a head and neck cancer clinic from April to June 2024 after obtaining institutional review board approval. Patient demographics, treatment information, and social vulnerability factors were collected. Patients completed a social determinants of health screening prior to their first clinic appointment and were considered “screened positive” (SP) if they answered “yes” in any of the categories of housing stability, food insecurity, or transportation, and “screened negative” (SN) if they did not answer “yes” to any of these categories. SP patients underwent an extended 18 question SDoH screening. Statistical analysis was performed.
Results: Of 106 patients identified, 22.6% (n=24) were SP, while 77.4% (n=82) were SN. The most common social vulnerabilities identified were tobacco use (83%), transportation (62.5%), social connections (62.5%), food insecurity (62.5%), and financial resource strain (58%). Average age of SN and SP patients was 63.38 and 54.75 years, respectively (p=0.006). White patients in reference to Black patients had decreased odds of positive screen test (OR=0.129, p<0.001, CI[0.046,0.362]). Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) were not significantly different between SP and SN patients. SN patients were more likely to have private insurance than SP patients (31% vs. 4.2%, p <0.001), while SP patients were more likely to have Medicaid (33.3% vs. 2.4%, p < .001). SP patients were more likely to be smoking at time of diagnosis (p=0.002) and were more likely to die during treatment compared to SN patients (16.7% vs. 0%, p<.001). A higher proportion of SN patients completed recommended treatment (86.1% vs. 72.2%) however this was not statistically significant (p=0.157). Patients living in areas with higher area deprivation were more likely to have financial resource strain (p=0.002). Medicare patients had lower odds of screening positive for housing instability (p<0.001).
Conclusions: This study is the first of its kind to evaluate the prevalence of specific social vulnerabilities among a cohort of HNC patients. SP patients were more likely to be Black, have Medicaid, and to die during treatment. ADI and SVI did not significantly differ between groups, highlighting the importance of SDoH in healthcare outcomes beyond neighborhood factors. Further research is needed to understand the full impact of SDoH on HNC patient outcomes. Prospective trials should explore how SDoH-targeted interventions can enhance HNC treatment and disease prognosis.