Race Associated with Treatment Interruptions and Higher Prevalence and Urgency of Social Needs Among Gynecologic Cancer Patients

*** EMBARGOED UNTIL 12.30 PM MST,  March 21, 2022 ***

Newswise — PHOENIX (March 21, 2022) – Racial disparities have profound effects on gynecologic cancer patients and their cancer outcomes in terms of both race-based stress that contributes to interruptions in care and social needs that are more prevalent and urgent among non-White patients. Integrating screening for those needs into routine clinical care could help address the racial disparities in gynecologic care and outcomes, according to two new studies. The findings were presented today in three scientific plenaries at the hybrid Society of Gynecologic Oncology 2022 Annual Meeting on Women’s Cancer, the premier scientific conference focused on the delivery of high-quality gynecologic cancer care.

The first study examined associations between race-based stress and interruptions in cancer care treatment among 72 patients with gynecologic cancers, 49 of whom identified as Black, 21 as White, and 2 as Hispanic. The participants completed a brief health history and the Index of Race-Related Stress-Brief Questionnaire (IRRS-B), for which a higher score indicates a higher levels of stress.

IRRS-B scores were higher overall for Black patients than for White patients, and higher for Black patients who experienced treatment interruptions. The study also found correlations between IRRS-B scores and the length of treatment interruption and the length of time to treatment initiation.

“Our study demonstrates the toll of racism experienced by Black women with gynecologic cancer affects their standard cancer care,” said senior author Ebony R. Hoskins, MD, Gynecologic Oncologist at MedStar Washington Hospital Center and Assistant Professor of Clinical Obstetrics and Gynecology at Georgetown University Medical Center. “Expanded studies are needed to examine race-related stress and its possible contribution to worse clinical outcomes in these Black patients. With further understanding, we can work toward solutions for more equitable cancer care.”

The second study reported on the integration of social needs screening into routine outpatient clinic workflow for gynecologic cancer patients. A total of 373 patients were screened in the first 3 months of implementation by completing the EMR-based assessment, either through an online patient portal ahead of their appointment, or in-person with the medical assistant at the time of the appointment. For those with needs who desired assistance, a referral to resources was placed. The team examined the collected data in two ways:

• The prevalence, types and urgency of needs identified for all patients and by patients’ race/ethnicity
• The implementation success of the assessment, measured as the percentage of patients completing it, the percentage of those with needs who sought a resource referral, and the percentage of those without needs who opted out of future screenings

For the first part of the data analysis, participants were divided into two groups: 58% who identified as non-Hispanic White (NHW); and 42% who identified as patients of color (POC), including non-Hispanic Black, Asian, Hispanic, American Indian/Alaska Native, and multiple/other race.

POCs more often reported having at least one need compared with NHWs and were more likely to report a financial need, needing help in reading hospital materials, food insecurity, housing insecurity, transportation need, and needing household items. POCs also more frequently reported urgency in housing, utilities and transportation needs than NHW.

“Our findings demonstrate that social needs are prevalent, and screening for them should be a routine part of the standard of care for cancer patients,” said co-Principal Investigator Anna Beavis, MD, MPH, John Hopkins School of Medicine. “Social needs are also actionable for us as physicians, because we can address tangible, individual-level needs, such as food insecurity and transportation, through the provision of resources. These needs stand in contrast to the social determinants of health, which are community-level and require changes on a much larger scale through policy decisions.”

In the second part of the analysis, the Johns Hopkins team found that the completion rate for the EMR assessment (373 of 405 eligible patients, or 92%) was significantly higher than the rate of 54% reported for a previous paper-based screening method. They also found that:

• Of the 74 patients with needs, 57% desired a referral to a partner organization for resource assistance, and that desire was associated with being of Hispanic ethnicity or having two or more needs. 
• Of the 299 patients who did not have needs, 192 (64%) opted out of future screening, and opting out was not associated with race/ethnicity.

“Developing ways to identify social needs in the course of routine clinical care is a first and concrete step in addressing  factors that contribute to racial, ethnic and socioeconomic disparities in gynecologic cancer care and outcomes,” said co-Investigator Stephanie Wethington, MD, Johns Hopkins School of Medicine. “Our EMR-based assessment is one step towards a patient-centric model of treating all of a patient’s needs, not just their need for cancer treatment.”

“Our long-term evaluation will focus on the EMR-based program’s impact on adherence to follow-up care and treatment, said co-Principal Investigator Anne Rositch, PhD, MSPH, Johns Hopkins Bloomberg School of Public Health. “We aim to develop a scalable and sustainable social needs screening workflow that could be adapted to other disciplines and institutions, maximizing its reach and acceptability across a diverse population of gynecologic cancer patients.”

The Johns Hopkins team’s work was funded by a grant from the American Cancer Society and Pfizer Global Medical Grants under the Addressing Racial Disparities in Cancer Care Competitive Grant Program.

About SGO

The Society of Gynecologic Oncology (SGO) is the premier medical specialty society for health care professionals trained in the comprehensive management of gynecologic cancers. As a 501(c)(6) organization, SGO contributes to the advancement of gyn cancer care by encouraging research, providing education, raising standards of practice, advocating for patients and members and collaborating with other domestic and international organizations. Learn more at www.sgo.org.