Social determinants of health linked to more fatalistic cancer beliefs

New research from Thomas Jefferson University shows that greater cumulative exposure to adverse social determinants of health is associated with beliefs that cancer is unavoidable or is a death sentence. This can influence whether people choose to be screened for common cancers or seek treatment after diagnosis.

The study looked at survey data from Sidney Kimmel Comprehensive Cancer Center – Jefferson Health about cancer beliefs and social risk factors. Researchers considered the effects of race, sexual identity, food insecurity, housing insecurity, socioeconomic status, health insurance status, education level, social isolation and discrimination. The findings were published in the Journal of Psychosocial Oncology.

Among the 1,400 respondents from seven counties in Pennsylvania and New Jersey, 29% lived below the poverty level, 17% experienced housing insecurity and 15% had no health insurance.

The study is the first to show that cumulative adverse social risk factors correlate with increased cancer fatalism.

“Belief of fatalism is thinking you’re unable to do anything about it; if you are diagnosed, you’re going to succumb to your disease anyway, so why bother getting treatment,” says Nicole Simone, MD, the study’s senior author. “For example, some people don’t follow up on abnormal screenings.”

The study is also among the first to examine the total burden of social determinants on cancer beliefs. Previous research considered one or two factors, but it wasn’t representative of the real-world impacts of every adverse social factor.

“We made a continuum, looking at the total number of adverse events,” Dr. Simone says. “If you were above the median of two adverse effects, you were more likely to have that fatalistic attitude.”

The study’s findings suggest the importance of standardizing protocols to screen patients’ social risk factors.

“At our cancer center, a patient care coordinator or nurse asks those screening questions so we have baseline information,” Dr. Simone says. “This helps us identify at-risk patients.”

Jefferson radiation oncology resident Ayesha Ali, MD; post-baccalaureate student Sarah Burke; and medical students in Jefferson’s summer oncology program – Jaitri Joshi, Alexandria Smith, Brittany Smith and Kamryn Hines – contributed to the research.

By Lisa Fields