For oncology nurses, recognizing these differences is an important part of providing care. Patient-reported outcomes (PROs) can help identify symptoms such as fatigue, pain, and depression that may not be fully apparent during a routine clinical encounter. A recent study was conducted to examine whether neighborhood-level socioeconomic disadvantage was associated with patient-reported symptoms among patients with NSCLC.
The Role of Socioeconomic Factors in PROs
In a recent retrospective study, researchers examined whether the socioeconomic conditions of the neighborhoods where patients lived were associated with PROs and quality of life among patients with NSCLC. Researchers analyzed PROs from 491 patients who completed standardized questionnaires from the NIH’s Patient-Reported Outcomes Measurement Information System (PROMIS) within 180 days of their initial oncology visit. The study focused on four areas: depression, fatigue, pain interference, and physical function. To estimate socioeconomic disadvantage, researchers used the Area Deprivation Index (ADI), which assigns a score to a geographic area based on factors such as income, education, employment, and housing conditions. A higher score indicates greater socioeconomic disadvantage.
Nearly half of the patients lived in neighborhoods classified as having greater socioeconomic disadvantage. After adjusting for age, sex, race, marital status, cancer stage, and comorbidities, patients living in more disadvantaged areas had significantly higher scores for depression and fatigue. Specifically, a higher ADI score was associated with a 2.68-point increase in depression scores and a 3.06-point increase in fatigue scores. Socioeconomic disadvantage was not significantly associated with pain interference or physical function.
The findings highlight that social determinants of health may influence how patients experience and report cancer-related symptoms, beyond factors such as cancer stage and medical comorbidities. The authors suggest that factors more common in socioeconomically disadvantaged communities, such as financial stress, limited access to mental health and supportive care services, transportation barriers, housing challenges, and chronic psychosocial stress, may contribute to greater levels of depression and fatigue.
Nursing Considerations
For oncology nurses, this study reinforces the value of routinely assessing both PROs and social determinants of health. A patient reporting significant fatigue or symptoms of depression may also be experiencing barriers that are not immediately apparent during a clinical encounter. Pairing symptom assessment with screening for social needs could help oncology teams identify patients who may benefit from social work, financial navigation, transportation assistance, mental health services, or other supportive oncology resources earlier in their treatment course.
The study has important limitations. Its retrospective, cross-sectional design means that it cannot establish that socioeconomic disadvantage causes depression or fatigue. The study also used neighborhood-level ADI scores rather than individual socioeconomic information, was conducted at a single cancer center, and evaluated PROs relatively early in the cancer care trajectory. Future prospective studies that follow up patients over time and incorporate individual-level social determinants of health are needed.