Social determinants of health and disparities in cancer care for patients with metastatic breast cancer in Mexico.
Journal
JCO Oncology Practice
Publisher
American Society of Clinical Oncology (ASCO)
Date Issued
2025
Author(s)
Chavarri Guerra, Yanin
Verduzco-Aguirre, Haydee Cristina
Esparza-Orozco, Maria Fernanda
Ramos Lopez, Wendy Alicia
Alvarado, Montserrath
Cruz-Zermeño, Mayte
Morales Centeno, Lilia Elena
Cruz Medina, Anabel
Martinez Maza, Daniela
Rodriguez Morales, Claudia
Heredia Barreda, Jose Alejandro Adrian
Sánchez-Reyes, Roberto
Talamantes, Enrique Isay
Quintero Beulo, Gregorio
Escobar, Mario
Type
text::journal::journal article
Abstract
Background: Patients diagnosed with metastatic breast cancer (MBC) in low- and middle-income countries (LMICs) face poorer outcomes than their counterparts in high-income countries. Social determinants of health (SDH)—including housing, food security, employment, and education—have been increasingly recognized as critical non-medical factors influencing access to care and cancer-related outcomes. We aimed to describe SDH among Mexican patients with MBC and examine their association with treatment adherence, receipt of standard therapy, and survival. Methods: This was a prospective multicenter cohort study including patients from three public cancer centers in Mexico City. Eligible participants were adults with MBC receiving first- or second-line systemic therapy. A trained patient navigator conducted structured interviews at baseline and every three months over one year using validated questionnaires (SDH needs, SEAMS, FACT-G, and BPI). Treatments were categorized as standard or non-standard based on NCCN guidelines. Associations between SDH and clinical outcomes were explored using chi-square tests. Linear mixed models were used to assess longitudinal changes in health-related quality of life. Survival was estimated using the Kaplan-Meier method and compared with the log-rank test. Results: A total of 324 patients were included (mean age 58.1 years; 99.7% female). At baseline, 92% reported at least one SDH-related need, most commonly employment (77.5%), housing (55.2%), and food (45.7%). The mean number of SDH needs at baseline was 3.1±1.8, remaining consistent across timepoints. Receipt of standard treatment was lower among those with needs in utilities (47.6% vs. 69.1%, p= 0.001) and education (58.0% vs. 69.0%, p= 0.046). Median SEAMS scores improved slightly over time (35 to 37). Median follow-up was 12.1 months (95% CI, 12.05-12.15). One-year overall survival was 85.0% (95% CI, 81.0–89.0), with no differences based on presence (p = 0.61) or number of SDH needs (p = 0.51) at baseline. The presence of any SDH need was significantly associated with FACT-G scores (p = 0.002) throughout the follow-up period. FACT-G scores were consistently lower in patients with any SDH need, and no significant interaction was observed between time and presence of any SDH need (p = 0.481). Conclusions: SDH needs were highly prevalent and persistent among patients with MBC in Mexico and were associated with lower likelihood of receiving guideline-concordant care and lower quality of life. Addressing these social barriers through targeted interventions may be critical to improving treatment equity and clinical outcomes in LMIC settings. ©The authors ©American Society of Clinical Oncology.
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License
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How to cite
Chavarri Guerra, Y., Verduzco-Aguirre, H. C., Esparza-Orozco, M. F., Ramos Lopez, W. A., Alvarado, M., Cruz-Zermeño, M., Morales Centeno, L. E., Cruz Medina, A., Martinez Maza, D., Rodriguez Morales, C., Heredia Barreda, J. A. A., Sánchez-Reyes, R., Talamantes, E. I., Quintero Beulo, G., & Escobar, M. (2025). Social determinants of health and disparities in cancer care for patients with metastatic breast cancer in Mexico. JCO Oncology Practice, 21(10_suppl), 223–223. https://doi.org/10.1200/op.2025.21.10_suppl.223