Abstract PS4-09-15: More than a number: Does the NCCN Distress Score Capture Key Social Determinants of Health Risks in Patients with Breast Cancer?

Abstract Introduction: Research has demonstrated that social determinants of health (SDOH) can impact time to diagnosis and access to treatment, leading to poorer outcomes and overall survival for cancer patients (pts). The National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) is a tool used to identify, monitor, and document a pt’s overall distress score (DS). This study aims to identify if the DT captures key SDOH risks for pts with breast cancer. Methods: Pts seen at North St. Louis County Siteman Cancer Center breast cancer clinics from 07/2023 to 06/2025 completed an optional 19 question, validated, screening questionnaire with real-time electronic medical record integration that categorized pts as “high risk” or “low risk” for individual SDOH factors based on responses. Categories of questions included financial resource strain, transportation availability, depression, food insecurity, and housing instability. Pts also completed the NCCN DT, which provided a DS of 0-10. We evaluated patients as “low distress” if DS <=4 and “high distress” if DS >4 based on established literature. We compared DS with risk category of several pertinent SDOH factors using the closest DT completed within 6 months of the SDOH evaluation. If a pt had unanswered questions on the questionnaire, those were counted as missing. Statistical testing was performed using ANOVA, t-test, and chi square analysis. Results: We evaluated a total of 268 pts who completed both the NCCN DT and the SDOH evaluation. 125 (47.5%) self-identified as Black and 131 (49.8%) as White. We found that pts who were high risk for depression on SDOH screening had significantly higher reported DS than those who were at low risk (p=0.0003). Pts at high risk for transportation difficulty were more likely to have a higher DS than those at low risk (p=0.03). Pts on Medicaid were more likely to have a higher DS than those on Medicare or commercial insurance (p=0.002). There was no significant association between risk of financial resource strain, food insecurity, or housing instability and DS (Table 1). We further investigated NCCN DS as a continuous variable and found consistent results, with no significant association of DS with high risk of food insecurity, financial resource strain, or housing instability. Conclusions: Our study evaluated the NCCN DT compared to a validated SDOH questionnaire in a diverse population. While the DT accurately identified pts as high risk for depression and transportation difficulty based on our SDOH screening tool, other key risk categories including financial resource strain, food insecurity, and housing instability were not associated with DS. Research has shown that these risk categories are linked to poorer clinical outcomes. Because certain high risk SDOH factors (or pts) were not identified based on the NCCN DT, this points for the need for more granular screening of SDOH in clinical practice. Citation Format: A. Golden, E. L. Podany, F. Fa'ak, B. Bowe, A. A. Davis. More than a number: Does the NCCN Distress Score Capture Key Social Determinants of Health Risks in Patients with Breast Cancer? [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-09-15.