An examination of the association between social determinants of health and psychosocial concerns among post-treatment breast cancer survivors
Open Access DepositedPsychological-interpersonal and financial concerns were observed well into the post-treatment phase of survivorship and were significantly influenced by SDOH. Cancer stage did not moderate these associations, suggesting that the relationship between SDOH and the outcome variables was similar across cancer stages. The relationship between younger age and greater concerns reinforces the need for age-tailored survivorship research and care, especially as breast cancer and particularly advanced stage disease is rising more rapidly in women under 40 compared to older women. Greater financial concerns among survivors with diabetes underscores the need for targeted support for these survivors. The findings highlight the importance of routine screening for collective SDOH and psychological-interpersonal and financial concerns across the cancer continuum, including the often-neglected post-treatment phase. The development of standardized yet flexible survivorship care models and policy reforms that promote equitable, comprehensive, and high-quality care are strongly needed.
Using cross-sectional data from the 2021 and 2022 National Coalition for Cancer Survivorship (NCCS) State of Survivorship Surveys, a series of confirmatory factor analyses were conducted to evaluate the fit of a hypothesized latent structure underlying the outcome variables (psychological-interpersonal and financial concerns) and the predictor, SDOH. Structural equation modeling was then used to examine the associations between SDOH and the outcomes. Cancer stage was tested as a potential moderator of these associations, and age and comorbid conditions were included as covariates. Results
The sample (N=400) had a mean age of 63.03 years (SE = .558) and was primarily White (81.2%), urban/suburban (73%), college-educated (84.7%), and insured (97.8%). Most had early-stage breast cancer (81.8%) and were more than five years post-treatment (52.5%). Less favorable SDOH were significantly associated with greater psychological-interpersonal (b = 0.185, p = .001) and financial concerns (b = 0.287, p < .001). Cancer stage did not moderate these relationships. Younger age was associated with greater psychological-interpersonal (b = -0.329, p < .001) and financial concerns (b = -0.311, p < .001). Comorbid diabetes was also associated with greater financial concerns (b = 0.174, p < .001). Conclusions
Significance
Advancements in cancer care have improved survival rates, yet post-treatment needs remain poorly understood. The purpose of this study was to examine the association between social determinants of health (SDOH) and psychosocial concerns (conceptualized as psychological-interpersonal and financial concerns) among post-treatment breast cancer survivors. The role of cancer stage was also assessed in these relationships. Methods
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