1846P - Social determinants of health in studies assessing toxicities associated with immune checkpoint inhibitor treatment: A systematic review

Background

Immune checkpoint inhibitors (ICIs) have improved survival for patients previously deemed incurable. This progress has, however, been offset by inequities known to perpetuate adverse outcomes for certain groups, influencing access to treatment and survival rates. Whilst Patient Reported Outcome Measures (PROMs) have been shown to improve outcomes for those receiving ICIs, little is known about their association with health inequities. This review aims to identify the extent to which social determinants of health (SDoH) are addressed in studies assessing the use of PROMs in ICI treatment.

Methods

Standard databases were searched for quantitative studies published between 2008-2023. Results were reported according to the PRISMA statement. Included studies used at least one PROM in the reporting of outcomes to identify and manage immune-related adverse events in adults receiving ICIs. The inclusion of SDoH was evaluated using the PROGRESS-PLUS framework designed to assist with the identification and classification of equity-relevant characteristics known to influence health outcomes.

Results

31 studies were included. The most frequently reported PROGRESS-PLUS measures were age, place of residence (100%) and gender (97%). 33% of studies referenced race but not ethnicity or culture. A further 33% documented educational status and 10% captured socio-economic status (SES). More limited collection of equity-relevant data in RCTs compared to cohort and cross-sectional studies.

Conclusions

Currently, studies of PROMs in ICIs overall collect a limited range of equity-relevant data. Even SES, a factor known to influence health outcomes is poorly documented. Little reference is made to the intersectionality of factors such as race/ethnicity/culture/language highlighting the complexity of the issue. Developing PROMS accessible to all patients combined with consistent reporting of health inequities will support clinical progress that encompasses those historically underserved, improving care and outcomes across broader demographics.

Clinical trial identification

CRD42023457063.

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

National Institute for Health Research Biomedical Research Centre at the Royal Marsden NHS Foundation Trust and the Institute of Cancer Research Grant B180.

Disclosure

All authors have declared no conflicts of interest.