Prospective Observational cohort study to Collect Granular Social Determinants of Health Data for Hematopoietic Cell Transplant Patients

Although patient (pt) social/financial barriers impact transplant (BMT) outcomes, comprehensive, granular social determinants of health (SDOH) data are not routinely collected across our field. We launched a single center, prospective, observational cohort study to determine BMT pts’ social/financial barriers to care (clinicaltrials.gov NCT06431347). Pts were eligible if ≥18 years & received BMT financial approval. The study opened 7/2024 to allograft & 11/2024 to autograft pts. A dedicated staff member recorded detailed SDOH data, after explaining why these data were needed. Pts reporting urgent financial needs were offered social work referral. We examined multiple social (low pt/caregiver educational attainment/ English language level or low pt confidence with written medical information) & financial [household income below median of our city ($60,000), cost-of-living/ medical expense insecurity, or high-risk of financial toxicity by COST-FACIT score ≤24] barriers by pt ancestry & graft source. From 7/1/24-10/2/25, 496 pts were screened for the study & most (473/497, 95%) enrolled; 10 (2%) died prior to enrollment & only 13 (3%) declined to participate. Of 473 enrolled pts [median age 62 yrs, range 19-82; 283 (60%) with acute leukemia/MDS/MPN; 315 European & 158 non-European ancestry], most (466, 99%) enrolled ±45 days from BMT. 148 received auto- & 325 allografts [37 (11%) HLA-mismatched]. In a sub-analysis exploring data collection acceptability, most participants felt the data collection process was comfortable & low effort. Overall, 62 (13%) pts reported ≥1 social barrier & 203 (43%) pts reported ≥1 financial barrier (Fig 1A). By ancestry, compared with Europeans, non-European pts had greater social & financial vulnerability, with >2x the proportion having ≥1 or ≥2 social barriers & >2x with ≥2 financial barriers (all p<0.001, Fig 1B). By graft source, similar proportions of auto & allograft pts faced social & financial barriers. Importantly, different SDOH measures classified different subsets of pts as vulnerable (Fig 2). Overall, 89 (19%) pts reported urgent financial needs, with 61 (13%) referred to social work & 44 (9%) receiving grant support &/or financial/resource counseling. We describe detailed SDOH data for pts across a department at a large cancer center & show the data collection process to be feasible & acceptable to pts with a very high participation rate. We demonstrate the application of these data to health outcomes research (ie highlighting non-European transplant recipients face high social & financial needs) & to pt care (ie supporting identification & addressing of urgent pt social/financial needs). Our work will support standardized SDOH data collection processes in the BMT field & across oncology, & inform pilot interventions to address social & financial barriers to care.