Health Services Research

SS 11 - HSR 1

79 - Structural Vulnerability Associated with Radiation Treatment Gaps in Head and Neck Cancer Patients

Monday, October 22
8:05 AM - 8:15 AM
Location: Room 007 A/B

Structural Vulnerability Associated with Radiation Treatment Gaps in Head and Neck Cancer Patients
L. Boreta1, A. Lazar1, S. Y. Wu1, J. Chan2, S. Choi1, Y. Yu1, J. Szilagyi1, T. S. Sherertz1, S. Holmes3, and S. S. Yom1; 1University of California, San Francisco, San Francisco, CA, 2University of California San Francisco, Department of Radiation Oncology, San Francisco, CA, 3University of California, Berkeley, Department of Anthropology, Berkeley, CA

Purpose/Objective(s): Social determinants of health influence access to cancer screening, treatment and outcomes. Structural vulnerability (SV) is defined as an individual’s risk for negative health outcomes due to socioeconomic, cultural, and institutional factors as related to ability to access care and adhere to recommended treatment. In head and neck cancer (HNC) patients, missed radiation therapy (RT) leads to worse survival. We hypothesized that increased SV correlated with impaired RT adherence.

Materials/Methods: This was a prospective IRB-approved survey offered to all HNC patients scheduled for at least 5 continuous weeks of RT. The survey assessed 8 domains of SV: financial security, food access, social support, legal status, physical security, access to shelter, functional health literacy, and perceived discrimination. Clinical data were extracted from the chart. Logistic regression analysis was used to identify factors associated with SV, adjusted for resources provided to patients (i.e. transport, housing, food).

Results: 62 patients consented; 2 declined. The median age was 62 (range 53-83). 35% of patients identified as non-white, and 20% spoke a non-English primary language. Patients received RT for cancers of the oropharynx, oral cavity, larynx, nasopharynx, skin, salivary gland and thyroid. 23 (37%) reported financial insecurity and 9 (15%) reported discrimination. 3 (5%) did not have a place to sleep, 6 (10%) felt unsafe in their home/neighborhood, 5 (8%) did not have adequate food, 8 (13%) were without social support, 4 (6%) had legal concerns, and 12 (19%) had difficulty with medical documents. SV in any domain (p=0.006, OR 8.2, 95% CI 1.8-37.0) and the factor of financial insecurity (p=0.02, OR 5.2, CI 1.3-21.0) were significantly associated with ≥2 missed RT fractions. SV was associated with primary language other than English (p=0.007, OR 14.5, 95% CI 2.1-102). Patients with SV were 3.4 times more likely to miss fractions than those without SV, after adjusting for resources utilized (p=0.024, adjusted OR 3.4, 95% CI 1.2-9.9).

Conclusion: This assessment reveals the multifaceted needs of our patients, beyond the purely financial, that threaten health outcomes. There are complex interplays of social hierarchy, power dynamics, and institutional policies that directly impact the health of our patients. Further study is needed to understand the impact of resources or services in mitigating these factors.

Author Disclosure: L. Boreta: None. A. Lazar: None. S.Y. Wu: None. Y. Yu: None. J. Szilagyi: None. T.S. Sherertz: None. S.S. Yom: Research Grant; Bristol-Myers Squibb, Merck, Genentech. Honoraria; ASTRO. Chair; Am Radium Society-Am College of Radiology. Treasurer; American Radium Society.

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