Social Determinants of Health and Health-Related Quality of Life Among Cancer Survivors: Analyses of the All of Us and NHANES Cohorts

PURPOSE: Health-related quality of life (HRQoL) is a critical aspect of cancer survivorship, influenced by various social determinants of health (SDoH) such as economic stability, education, and healthcare coverage. Understanding the association between these determinants and HRQoL is essential for developing interventions that improve the well-being of cancer survivors. METHODS: Cross-sectional analyses were conducted using data from 19,725 adults with cancer, including 15,754 from the All of Us (AoU) Research Program and 3971 from the National Health and Nutrition Examination Survey (NHANES). HRQoL outcomes were assessed pairwise with individual SDoH and using a cumulative SDoH risk score using binary logistic regression models. RESULTS: Higher economic stability, education, and healthcare coverage were significantly associated with better HRQoL outcomes. In the AoU cohort, those with higher family income were more likely to report very good (OR: 1.67; CI: 1.40-2.00) or excellent (OR: 1.85; CI: 1.54-2.21) quality of life. Similar trends were observed for excellent physical health (OR: 1.58; CI: 1.45-1.72) and mental health (OR: 1.45; CI: 1.28-1.64). The NHANES cohort showed consistent findings for excellent overall health (OR: 2.79; CI: 2.06-3.77), physical health (OR: 1.61; CI: 1.31-1.96), and mental health (OR: 1.60; CI: 1.29-1.98). Participants with fewer negative SDoH factors reported significantly better outcomes across all HRQoL dimensions. CONCLUSIONS: These findings underscore the association between SDoH and cancer survivors' HRQoL, emphasizing the need for targeted interventions and policies to address the adverse effects of negative SDoH factors. Reducing disparities is crucial for improving the quality of life of cancer survivors.