Patterns of social determinants of health screening and health-related social needs among patients with newly diagnosed breast cancer in a safety-net system.

476 Background: Various social determinants of health (SDOH) have been shown to negatively impact breast cancer survival rates. Though there are recommendations advocating for comprehensive SDOH assessment, little is known about the optimal frequency of reassessments and change in health-related social needs (HRSN) over time for specific patient populations. We sought to characterize SDOH screening and HRSN patterns among patients with breast cancer in a safety-net system. Methods: A retrospective study was conducted to evaluate EPIC SDOH survey responses from female patients who were diagnosed with breast cancer between January 2021 to January 2024 at Parkland Health and Hospital System (PHHS). We analyzed patient survey including 50 questions that calculate the 11 HRSN risk domains. We utilized a linear mixed model with random intercepts and slopes to characterize the rate of decreasing unanswered questions overtime. Results: We identified 566 patients diagnosed with breast cancer with HRSN survey responses available from PHHS. The mean (SD) age of diagnosis of 54.9 (11.4) years. In our cohort, there were 42 (7.4%) White, 342 (60.4%) Hispanic, and 153 (27.0%) Black patients. The median (IQR) follow-up time was 1.57 (0.9-2.17) years. On average (SD), patients were initially at risk for 1.36 (1.39) out of the 11 HRSN domains. Alcohol use and food insecurity were the most common risk factors in 314 (55.5%) and 280 (49.5%) patients, respectively. In our cohort, no patients were screened for interpersonal violence. The median (IQR) time from initial survey to first change in risk level for any domain was 8.7 (3.5-18.0) months. There were no documented changes in Alcohol Use risk level over time for any patient. The number of answered questions increased by an estimated (95% confidence interval) 8.9 (7.52, 8.57; p<0.001) questions every year from initial survey. Patients with Stage I and II disease had significantly more HRSN identified in their lifetime compared to those with Stage III and IV disease (p=0.02). However, patients with higher stage disease had higher proportions of never-answered questions (p=0.001). Patients with Stage IV disease also underwent fewer SDOH re-screenings (p<0.001). Conclusions: Within our system, greater attention should be placed towards fully assessing patients’ HRSN, especially in those with higher stage disease. Patients should be screened at least once for interpersonal violence, ideally within the first year of entering the hospital system. SDOH screening at 6-month intervals may help to capture changes in HSRNs and assess the impact of resource interventions.