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Novel Patient-Level Social Determinants of Health Measure Predicts Colon Cancer Outcomes within an Integrated Health Network
Journal article   Peer reviewed

Novel Patient-Level Social Determinants of Health Measure Predicts Colon Cancer Outcomes within an Integrated Health Network

Muhammad Muntazir Mehdi Khan, Artem Boyev, Edward Anthony Joseph, Dante Gilberti, Muhammad Anees, Philip E. Schumacher, Keith LeJeune, Tyson S. Barrett, David L. Bartlett and Casey J. Allen
Surgery, Forthcoming
Jun 2026
DOI: https://doi.org/10.1016/j.surg.2026.110378

Abstract

Traditional social determinants of health (SDoH) measures rely on population-level data, limiting the ability to assess individual patient-level factors. This study explores the influence of a novel, patient-level SDoH measure on oncologic outcomes in colon cancer patients. Using a program developed within our integrated health network which prospectively captures 13 specific patient-level SDoH components, we categorized patients as high-risk (HR-SDoH) if they reported significant impairments in any SDoH domain. We evaluated the independent effect of HR-SDoH on oncologic outcomes among patients with adenocarcinoma of the colon from 2020 to 2023. Among 717 patients, the mean age was 67.9±13.6 years, with 54.7% (n=392) male and 90.8% (n=651) White; 16.2% had a Charlson Comorbidity Index (CCI) >2 and 21.3% (n=128) had stage IV disease at diagnosis. Median overall survival for the cohort was 50.0 (28.0–55.0) months. Overall, 24.0% (n=172) of patients presented with HR-SDoH. Patients in the two cohorts were similar in sex, race, and CCI; p>0.050. On multivariable analysis, HR-SDoH was an independent predictor of stage IV disease at diagnosis (OR: 2.32, 95%CI: 1.45–3.73, p<0.001) and mortality among all patients (HR: 1.81, 95%CI: 1.16-2.85, p=0.010). Among early-stage patients (stage I-II), HR-SDoH was an independent predictor of mortality (HR: 4.61, 95%CI: 1.67-12.69, p=0.003). Utilizing a novel prospective measure, patient-level SDoH independently predicts metastatic disease at diagnosis as well as stage-specific survival in colon cancer. This presents an opportunity to identify specific cancer patients at high-risk for poor oncologic outcome who may benefit from directed care measures. [Display omitted]

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