Social needs linked to low health-related quality of life among African American cancer survivors

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, and they were associated with lower health-related quality of life (HRQOL). The findings are published early online in Cancer, a peer-reviewed journal of the American Cancer Society (ACS).

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. Investigators looked to see if social needs may play a role in this disparity.

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. HRQOL was measured using a questionnaire called the Functional Assessment of Cancer Therapy-General (FACT-G).

Researchers found that more than one-third (36.3 percent) of survivors reported social needs, including 17.1 percent who reported two or more. Prevalence of social needs ranged from 8.9 percent for utility shut-offs to 14.8 percent 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.

Lead author Theresa Hastert, Ph.D., of the Karmanos Cancer Institute and Wayne State University School of Medicine in Detroit, noted that a link between social needs and lower HRQOL among cancer survivors is not surprising; however, 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; however, the results 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," Dr. Hastert said. "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."