Impact of Socioeconomic Status on Patient-Reported Outcomes (PROs) in Non-Small Cell Lung Cancer (NSCLC)

Purpose Patient-reported outcomes (PROs) are a powerful method to assess a patient's well-being and have shown to improve patient’s quality of life and survival in lung cancer. Socioeconomic status (SES) influences patients’ ability to receive timely, high-quality care. The association between area-level SES and PROs among patients diagnosed with Non-Small Cell Lung Cancer (NSCLC) was examined. Methods We conducted a retrospective study of patients (n = 491) diagnosed with NSCLC between September 2021 and December 2023 who completed an NIH Patient-Reported Outcomes Measurement Information System (PROMIS®) questionnaire within 180 days of their initial oncology office visit. The main exposure of interest was socioeconomic disadvantage assessed via state-level Area Deprivation Index (ADI) categorized into (0 to < 5 or ≥ 5 to 10). Outcomes were four PROMIS domains - physical function, fatigue, pain interference, and depression. Four multivariable linear regression models (one for each PROMIS domain) were used to estimate associations between ADI and PROMIS T-scores adjusting for sociodemographic and clinical factors. Results Approximately 49% of patients resided in neighborhoods with ADI score ≥ 5. The mean T-score for depression was 51.5 (SD = 9.1), fatigue was 55.2 (SD = 9.5), pain interference was 56.9 (SD = 10.3), and physical function was 38.2 (SD = 9.4). Patients living in more socioeconomically disadvantaged areas (state ADI ≥ 5) were associated with significantly higher depression scores [β 2.68 (95% CI0.47, 4.89) p = 0.018] and fatigue scores [β 3.06 (95% CI0.25, 5.87) p = 0.033]. Pain interference and physical function were not statistically associated with state ADI. Conclusions Area-level socioeconomic status is independently associated with higher levels of patient-reported depression and fatigue among patients with NSCLC. These findings need further evaluation with prospective studies and underscore the importance of considering socioeconomic factors in assessing patient-reported outcomes and developing targeted interventions to address disparities in healthcare access and outcomes among lung cancer patients.