Abstract
Introduction:
Individual and population-based social determinants of health (SDOH) have been shown to negatively impact outcomes for patients (pts) with acute leukemia. Studies have demonstrated that pts from lower socioeconomic neighborhoods experience worse outcomes without transplant and are less likely to receive one. Shah, et al, was the first to publish prospective data on individual SDOH in pts with acute leukemia, demonstrating that treatment complications were strongly associated with SDOH. Our goal is to better understand if SDOH barriers impact outcomes for pts within our institution. This data will attempt to identify actionable interventions.
Methods:
Pts with a new diagnosis of acute leukemia at the University of Kansas Medical Center have been prospectively enrolled and followed from diagnosis through their treatment course. Questionnaires were administered to pts during their initial hospitalization. Quantitative SDOH measures included cancer health literacy (CHLT-6), mental health (PHQ-2), and financial toxicity (COST-FACIT). Food insecurity, housing instability, and utility help needs were evaluated through the Health-Related Social Needs Screening tool (HRSN). Outcome data were collected from chart review on missed doctors' appointments, ICU admissions, ER visits, clinical trial screening and enrollment, transplant eligibility and completion, and 30-day mortality. Wilcoxon rank sum test was used for numeric variables. Pearson's chi-squared test and fisher's exact test were used for categorical variables.
Results:
A total of 61 pts were enrolled at the time of interim analysis. Enrollment began in October 2024, and our study continues to accrue. Median age of pts enrolled is 61 years. 83% of pts identified as non-Hispanic, 14% as Hispanic, 1.7% as Asian, 5.3% as black, and 1.8% as other. 98% of pts were pre-screened for clinical trial enrollment and 54% enrolled on a trial (n=33). Non-Hispanics were more likely to enroll in clinical trial than either Asians or Hispanics . Financial strain was present in more pts who did not enroll in clinical trial (41% vs 9.7%, p=0.006) as captured by the HRSN survey. Pts enrolled in a clinical trial had less food insecurity than those who did not (22% vs 3.2%, p=0.042). There was no statistically significant difference in clinical trial enrollment based on COST-FACIT score or CHLT-6 score.
21 pts were ineligible for transplant (most commonly due to ELN favorable risk disease or age/comorbidities) and 35 were eligible for transplant. 43% of pts who were ineligible reported a disability compared to 12% who were eligible (p=0.010). 14 pts had undergone transplant at the time of our analysis. There were no differences in SDOH variables between pts who had undergone transplant and those who did not.
All pts have been followed 30 days and some up to 6 months. 91% of pts did not miss any appointments. 42% had an unplanned hospitalization, and 16% of pts had an ICU . At day 30, 98% of pts enrolled were alive.
Discussion:
Our data adds to the literature demonstrating that individual and population-based SDOH may impact outcomes in pts with acute leukemia. Clinical trial enrollment was lower in pts with disabilities as well as in pts with financial toxicity, and this may be for a variety of reasons, including possible lower health literacy, although this was not reflected in our data. Further understanding of this is crucial to continue efforts towards improving outcomes for underrepresented pts in clinical trials. Importantly, transplant completion at our institution did not correlate with any SDOH variables.
Limitations include incompletion of surveys from pts, limited sample size, and many pts who were eligible for transplant may not have completed transplant due to natural timeline of transplant completion, even if no barriers were identified.
Identifying SDOH barriers early in the treatment course may help improve outcomes by allocating additional resources and support to pts. More research is needed to better understand the individual and population-based SDOH impact on outcomes for pts with acute leukemia.
