Identifying Psychosocial Needs of Patients With Cancer Undergoing Curative Radiation Therapy in an Inner-City Academic Center to Address Racial Disparities

Abstract

Purpose: There are little data quantifying the psychosocial needs of patients with cancer undergoing definitive radiation therapy. These needs significantly affect patients' access to care and treatment outcomes. Thus, our study aimed to characterize the socioeconomic needs of patients with cancer treated at an academic institution in urban and suburban radiation clinics.

Methods and materials: A prospective, cross-sectional analysis was performed of patients undergoing curative radiation therapy for head and neck, lung/thoracic, gynecologic, or gastrointestinal malignancies using a questionnaire consolidated from prevalidated surveys. Main outcomes were differences in psychosocial needs stratified by race (Black vs non-Black) and time point (pretreatment, 1 month, 6 months, and 1 year after completion of radiation treatment). χ² and Mann-Whitney U testing determined statistical differences between selected variables. Binary logistic regression analysis identified predictors of certain socioeconomic needs.

Results: Two hundred twenty-one of 266 patients completed the survey, giving a compliance rate of 83%. Black patients were more likely to be single (79% vs 37%; P < .001), reside in zip codes with a lower median income (74% vs 42%; P < .001), and be seen at our inner-city photon location (60% vs 25%; P < .001) compared with non-Black patients. Significantly higher proportions of Black compared with non-Black patients had unmet needs regarding pain (67% vs 39%; P = .005), stress management (64.7% vs 43.3%; P = .009), transportation (64% vs 19%; P < .001), and smoking cessation (35% vs 8.7%; P < .001) when all time points were considered. On multivariate analysis, Black patients were 2.6, 2.2, 7.2, and 3.4 times more likely than non-Black patients to request assistance with pain, stress, transportation, and financial aid, respectively.

Conclusions: We identified disparate psychosocial needs of our cancer population, where Black patients had greater unmet needs than non-Black patients. By doing so, we plan to develop pragmatic, targeted interventions that, when combined with guideline-concordant cancer care, can lead to improvements in cancer outcomes and quality of life before, during, and after radiation therapy.