Patterns of social determinants of health screening and health-related social needs among patients with newly diagnosed breast cancer in a safety-net system

PURPOSE: Various social determinants of health (SDOH) have been shown to negatively impact breast cancer outcomes. Though there are recommendations for comprehensive SDOH assessment, little is known about the optimal frequency of reassessments and change in health-related social needs (HRSN) over time for specific patient populations. We sought to characterize SDOH screening and HRSN patterns among patients with breast cancer in a safety-net system. METHODS: A retrospective study was conducted to evaluate SDOH survey responses in the electronic medical records and screening frequency from patients diagnosed with breast cancer between January 2021 to January 2024 at Parkland Health. RESULTS: There were 566 patients diagnosed with breast cancer with a mean age at diagnosis of 55.0 (standard deviation, SD: 11.4) years. There were 54 (9.5%) with Stage IV breast cancer. Patients were initially at risk for 1.36 (SD: 1.39) out of the 11 HRSN domains. Patients completed an average 17.3 (SD: 8.9) out of 28 questions on initial survey. The most common risk domains identified were Alcohol Use and Food Insecurity. No patients were screened for Interpersonal Violence. The median time from initial survey to first change in risk level for any domain was 8.7 months. Patients with Stage IV disease underwent fewer SDOH re-screenings compared to patients with Stage I, II, and III disease (p < 0.001). CONCLUSION: Within our system, greater attention should be placed towards fully assessing patients' HRSN and screening for interpersonal violence. SDOH screening at 6-month intervals may help to capture changes in HSRNs and assess the impact of resource interventions.