Social Determinants of Health Impact Survival Outcomes in Patients With Hematologic Malignancies

Marisol Miranda-Galvis, DDS, MS, PhD

Although the continued development of novel treatment strategies and the emergence of new agents have improved survival outcomes for patients with hematologic malignancies, socio-economic disparities could affect survival rates for different patients in the United States, according to a systemic review evaluating social determinants of health and patient survival outcomes.

Findings from the systematic review of health outcomes collected from several observational studies featuring a total of 24,353 patients across 5 databases in the United Stateswere presented at the 2023 SOHO Annual Meeting. These findings identified 5 key variables primarily associated with worse overall survival outcomes for patients with hematologic malignancies: lack of access to health insurance, treatment at a non-academic research institution, economic instability, low education level, and marital status.

“We encourage clinicians to identify patients with hematologic malignancies who present with [socio-economic] disadvantages [associated with worse survival] and implement some socially targeted interventions,” Marisol Miranda-Galvis, DDS, MS, PhD, said. “Including the assessment of social determinants in clinical practice and implementing socially-targeted interventions could help improve the survival of those patients.”

In an interview with OncLive^®, Miranda-Galvis highlighted the importance of understanding which social determinants of health have the greatest influence on treatment-related outcomes in patients with hematologic malignancies, expanded on key variables identified in this systematic review, and emphasized the importance of continuing to implement new strategies to increase access to quality treatments, allowing for a more equitable distribution of benefit across all patient subgroups. Miranda-Galvis is a researcher at Augusta University and a research project manager at Georgia Cancer Center.

OncLive: What was the rationale for investigating the effect of social determinants of health on survival outcomes for patients with hematologic malignancies?

Miranda-Galvis: Over the last few years, we have observed an improvement in survival rates for patients with hematologic malignancies. However, when we compared those survival [rates] from specialized institutions v the overall population in the United States, we identified that this [survival] improvement has not reached every [patient] in the United States.

In this retrospective analysis, what data were analyzed?

We performed a systematic review of clinical studies conducted in the United States that evaluated any social determinants that could impact survival in patients with hematologic malignancies. With that, we performed an analysis of those social determinants that those studies evaluated. We then classified survival according to treatment-related outcomes and then identified the impact of each social determinant on the survival of those patients.

What findings from this review were presented at the 2023 SOHO Annual Meeting?

Interestingly, access to and quality of health care, [as well as] economic instability, were the most commonly studied domains in these [prior] studies. Most studies found that patients who had public insurance, such as Medicaid, Medicare, or another government insurance, had lower survival [rates] compared with patients who had private or military insurance.

Additionally, the patients who were treated at a non-academic institution [setting] presented a higher risk of mortality than those treated at academic institutions. In terms of economic stability and education levels, patients with lower median income and a lower education level presented with lower survival rates.

What strategies are currently being implemented at your institution to identify and address these variables and social determinants of health?

[At Georgia Cancer Center,] we are researching and identifying new areas that have not been explored in the past. After this review, we plan to perform some prospective and retrospective studies evaluating other domains of social determinants that have not yet been explored.

What would you like your colleagues to take away from this analysis?

Most of the time, effort, and funding that we are dedicating to research is looking [to develop] new drugs or [better techniques for] monitoring disease. We often have [effective] drugs and techniques; however, the problem is that some patients do not have access to these.

We need to guarantee that all the patients who are treated in clinical practice are looked at as a whole person, rather than only [assessing] their clinical features. [This includes] social context, economic and marital status, and other variables that we may not always pay as much attention to. These factors are important, as they impact a patient's prognosis in the same way as a patient’s disease profile.

Reference

Miranda-Galvis M, Tjioe K, Balas A, Cortes J. Cancer disparities in survival of patients with hematologic malignancies in the context of social determinants of health: a systematic review. Presented at: 2023 SOHO Annual Meeting; September 6-9, 2023; Houston, TX. Abstract MDS-044.