3348 - Social Determinants of Health and Psychological Distress in Prostate Cancer Patients Undergoing Radiation Therapy: A Prospective Cohort Study

Purpose/Objective(s):

Social determinants of health (SDOH) including housing insecurity, food insecurity, and transportation barriers may exacerbate psychological distress in cancer patients. However, the relationship between SDOH burden and psychological distress in prostate cancer patients undergoing radiation therapy (RT) remains poorly characterized, particularly in racially diverse populations.

Materials/Methods: Prospective cohort study of prostate cancer patients initiating external beam RT at a safety-net hospital and an urban academic cancer center. Participants completed validated measures at baseline (pre-RT) and post-RT completion. Psychological distress was assessed using the PHQ-4 (range 0-12; =3 indicates elevated symptoms). SDOH were assessed via three binary indicators: housing insecurity, food insecurity, and transportation worry. SDOH burden count (0-3) was computed. Associations were evaluated using Spearman correlation, ANOVA, and multivariable linear and logistic regression adjusting for age, marital status, and race.

Results: 84 patients enrolled (mean age 70.3±8.0 years; 64% Black/African American/Caribbean, 23% White; 52% married). SDOH were prevalent: housing insecurity 48%, food insecurity 42%, transportation worry 27%. At baseline, mean PHQ-4 was 2.12±3.22 with 29% having elevated scores (=3). A strong dose-response relationship was observed between SDOH burden and PHQ-4 scores: 0 concerns (n=35): 0.51±1.15; 1 concern (n=13): 1.77±3.00; 2 concerns (n=23): 2.70±3.31; 3 concerns (n=13): 5.77±4.04 (Spearman ?=0.503, p<0.001; ANOVA F=12.3, p<0.001). Each individual SDOH indicator was significantly associated with higher PHQ-4 (all p<0.001). In multivariable logistic regression, each additional SDOH concern increased odds of elevated PHQ-4 by 4.79-fold (95% CI: 2.23-10.32, p<0.001). Married status was associated with lower distress (PHQ-4: 1.45 vs 2.85, p=0.047). Among 67 patients completing both assessments, PHQ-4 scores remained stable from baseline to post-RT (1.93±3.06 vs 2.00±3.17, p=0.79).

Conclusion: In this racially diverse cohort, SDOH burden demonstrated a strong, graded association with psychological distress. Nearly half of patients reported housing or food insecurity, highlighting the substantial social vulnerability in this population. Each additional SDOH concern nearly quintupled the odds of clinically elevated distress. These findings underscore the need for systematic SDOH screening and integrated support services in radiation oncology settings to address modifiable social risk factors that compound cancer-related distress.