The Impact of Social Determinants of Health on Cancer Care Delivery & Outcomes for Metastatic Breast Cancer Patients

This is a single arm study that seeks to identify disparities in delivery of care and treatment outcomes for metastatic breast cancer patients of color and to identify socioeconomic variables that may be related to the inequity. The study will enroll female patients, ages >18 years initially diagnosed with metastatic disease within 60 months of study enrollment and continue to receive treatment for their metastatic disease at SKCC-Jefferson.

Patients will have an in person or telehealth encounter with an oncology social worker at baseline, and when feasible, one additional encounter at 3-6 months from baseline. At each encounter a comprehensive screening tool will be completed by the oncology social work that includes 3 instruments: SDOH wheel, CMS' Innovation's Accountable Health Communities Health-Related Social Needs Screening Tool (16) and Oncology Support tab. All three instruments will be administered by a social worker at the patient's first encounter following consent to participate in the study and when feasible re-administered at the next visit. An acuity risk score will be calculated within the EMR for each of the encounters based on data input into the SDOH section.

The social worker will also record information about financial toxicity, social needs, barriers to medical care and recommended intervention. We will supplement the data extracted from our EMR with data extracted or calculated from county- or state-level data files, to add to our ability to predict SDOH variables that are most associated with cancer care delivery or health outcomes. This includes calculating an Area Deprivation Index for each patient, which is a reflection of the level of neighborhood deprivation where a patient lives (15). We will also calculate the distance to travel to the cancer center for each patient based on their current address. County-level breast cancer incidence and mortality will be added for each patient based on their current county of residence, as these rates are proxies for access to cancer care among residents of a particular county. Lastly, we will add county-level rates of employment, home ownership, and educational attainment as measurements of SDOH that may influence outcomes among metastatic breast cancer patients.

We will complete a retrospective chart review to identify patients who had delays in starting their recommended first line systemic treatment of greater than 21 days from their initial metastatic breast cancer diagnosis and collect information on the reason for the treatment delay when available. We will also measure the number of treatment interruptions of greater than 7 days during the course of a patient's first 3 lines of systemic treatment and categorize these interruptions as due to side effects vs. reasons other than side effects. We will also measure any interruption in their palliative radiation therapy and categorize these interruptions as due to side effect vs other reasons. We plan to evaluate the number of referrals that are placed by the social worker or the provider at time of the comprehensive screening assessment and tracking if the patient had an appointment with Palliative Care, genetic counseling, and Psychiatry Oncology within 3 months of the referral placed by a cancer care providers or oncology social worker. We will also evaluate the effect of the mentioned SES and SDOH measures on clinical trial participation of metastatic breast cancer.

The study will last approximately 12 months.