Abstract PS4-09-11: Associations of patient-reported social determinants of health (SDOH) with treatment deferral and clinic no-show rates in a diverse population of patients with breast cancer

Abstract Background: SDOH are known to affect treatment and survival in breast cancer. However, most studies rely on census- or neighborhood-level data to determine SDOH risk. A gap in the research is how patient-level SDOH impact treatment. Here, we used patient-reported SDOH to describe associations with treatment delays and no-show rates in breast cancer clinics with diverse populations. Methods: We implemented a self-administered, 19 question, validated, electronic medical record (EMR)-integrated SDOH screener in North County Siteman Cancer Center breast cancer clinics after IRB approval. Evaluated SDOH risks included financial resource strain, food insecurity, housing instability, transportation availability, and depression. We assessed SDOH risk associations with infusional treatment deferrals, number of no-shows and cancellations of clinic and treatment visits, and emergency room (ER) visits within 12 months. We performed a regression adjusting for demographics to determine risk factors for infusional delays. Area deprivation index (ADI), a validated measure based on 9-digit zip code, was used to define neighborhood deprivation quartiles to compare the lowest quartile (64) and highest quartile (≥90), with higher numbers indicating increased poverty. Results: 547 patients with breast cancer had at least one response to an SDOH evaluation from July 2023 to June 2025. 267 (48.8%) self-identified as Black, 280 self-identified as White (51.2%), and 81 (14.8%) had stage IV disease. Black patients were significantly more likely than White patients to be at high risk of food insecurity (p0.001), housing instability (p0.001), transportation difficulty (p=0.008), a higher stage (p=0.001), and be insured on Medicaid (p0.001). Patients at high risk for financial resource strain, housing instability, transportation difficulty, or food insecurity had significantly more no-shows and cancelled appointments than those at low risk (p0.05). There was a significant increase in no-shows and ER visits for patients with Medicaid compared to Medicare and private insurance (p0.001). Of the 356 patients who received infusional therapy, patients with Medicaid were significantly more likely than patients on Medicare or private insurance to have a treatment deferral (p=0.02) and a higher number of deferrals (p=0.01). Patients with a high ADI had an increased number of deferrals (p=0.003) and a larger total deferral duration (p=0.005). Patients with high risk of financial resource strain, housing instability, food insecurity, or depression were significantly more likely to have a deferral in a treatment cycle (p0.05). Patients with more than one SDOH risk factor were significantly more likely to have a deferral (p=0.002). On regression analysis, patients had a higher risk of infusional therapy deferrals if they had financial resource strain (Odds ratio OR 5.51, 95% confidence interval CI 1.20-25.40, p=0.03) and housing instability (OR 4.00, 95% CI 1.09 - 14.70, p=0.04). Discussion: In this patient-level, prospective study using granular SDOH questions, we found significantly higher no-show and cancellation rates in patients with financial resource strain, housing instability, transportation difficulty, food insecurity, and Medicaid insurance. There were significantly higher infusional therapy deferral rates in patients with financial resource strain, housing instability, food insecurity, depression, Medicaid, and in higher ADI neighborhoods. Our findings show that individual screening of SDOH with real-time EMR integration in patients with breast cancer is feasible and represents an opportunity for targeted interventions to improve patient outcomes. Citation Format: E. L. Podany, B. Bowe, J. Hesse, D. Cicka, S. Addison, A. Golden, N. Katakam, F. Fa'ak, K. Weilbaecher, A. A. Davis. Associations of patient-reported social determinants of health (SDOH) with treatment deferral and clinic no-show rates in a diverse population of patients with breast cancer abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-09-11.