What does this research mean for the field?

Homelessness is consistently associated with lower cancer screening uptake, reduced treatment receipt, and higher mortality, while gaining stable housing acts as a protective factor that can normalize survival outcomes. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Assess the impact of housing instability on cancer screening, treatment, and survival among homeless individuals versus those who are housed.

May 29, 2026

Addressing housing instability as a quality-of-care determinant in cancer: A meta-analysis across national and Veterans Affairs cohorts.

Key Points

Assess the impact of housing instability on cancer screening, treatment, and survival among homeless individuals versus those who are housed.
Meta-analysis combining data from Veterans Health Administration, National Inpatient Sample, and community cohorts from 2011 to 2024.
Utilized random-effects models to analyze odds ratios and hazard ratios for cancer-related outcomes.
Included over 200,000 cancer cases from six cohorts to evaluate disparities in care.
Persons experiencing homelessness (PEH) had a pooled odds ratio of 0.56 for being up to date on colorectal cancer screening (95% CI 0.23–1.31).
Homelessness was associated with a pooled odds ratio of 0.42 for receiving surgery or invasive procedures (95% CI 0.26–0.66).
PEH were significantly more likely to discharge against medical advice, with a pooled odds ratio of 5.37 (95% CI 3.39–8.50).

Abstract

11045 Background: Housing instability is an under-recognized determinant of cancer outcomes that directly affects screening adherence, treatment delivery, and survival. Over 650,000 Americans experience homelessness nightly, yet its impact on oncologic quality-of-care metrics remains poorly quantified. We conducted a meta-analysis to evaluate disparities in cancer screening, treatment, and survival among persons experiencing homelessness (PEH) versus housed individuals, and to assess whether housing status functions as a system-level quality indicator. Methods: Real-world evidence from the Veterans Health Administration (VHA), National Inpatient Sample (NIS), and community cohorts (2011–2024) was pooled using random-effects DerSimonian–Laird models. Eligible studies reported odds ratios (ORs) or hazard ratios (HRs) comparing PEH with housed counterparts. Heterogeneity was summarized using I² statistics, and all analyses were performed in Stata. Results: Six cohorts contributed sixteen effect estimates encompassing >200,000 cancer cases. PEH were less likely to be up to date for colorectal cancer screening (pooled OR 0.56, 95% CI 0.23–1.31; I² = 93.9%). Homelessness was associated with markedly lower odds of surgery or other invasive procedures (pooled OR 0.42, 95% CI 0.26–0.66; I² = 98.4%) and substantially higher odds of discharge against medical advice (pooled OR 5.37, 95% CI 3.39–8.50; I² = 92.9%). In gastrointestinal cancer admissions, PEH also had longer hospital stays and higher costs. Within VHA datasets, homelessness independently predicted higher all-cause mortality after lung (HR 1.09–1.29) and colorectal cancer (HR 1.18–1.22). Veterans who gained housing after diagnosis achieved survival comparable to continuously housed peers (HR ≈ 1.0). Conclusions: Across diverse U.S. datasets, homelessness is consistently associated with lower screening uptake, reduced treatment receipt, and higher mortality—outcomes that represent measurable quality-of-care failures. Stable housing acts as a protective, modifiable factor influencing survival independent of access or insurance. Incorporating housing status screening into oncology intake workflows can close equity gaps, improve safety, and advance value-based cancer care. Housing stability should be recognized as a core quality metric in oncology. Cohorts included in the meta-analysis of homelessness and cancer outcomes. Study Cancer Type(s) Main Outcomes Effect (95% CI) Asgary 2014 Colorectal Screening OR 0.35 (0.23–0.53) VA Cohort 2011–21 CRC, Breast Screening / Colonoscopy aIRR 0.84 (0.83–0.84); 0.88 (0.84–0.92) Shah 2024 All cancers Procedure / Therapy / AMA AOR 0.53; 0.73; 4.29 Mevawalla 2019 GI Surgery / AMA OR 0.33; AOR 6.86 VA Mortality 2011–20 Lung Mortality HR 1.21 (0.93–1.57) Health Affairs 2024 Lung, CRC, Breast Mortality by housing HR 1.09–1.29 (lung); 1.22 (CRC)

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