Sarcoma patient narratives with respect to the social determinants of health: A thematic analysis

OBJECTIVES: Sarcomas are rare, mesenchymal tumors that require multimodality treatment provided by multidisciplinary teams. This study seeks to better understand sarcoma patient narratives and quality of life in relation to the social determinants of health (SDoH). 

METHODS: Eligible patients who were diagnosed with sarcoma, treated by our institution's orthopedic oncology team, and identified with at least one social risk factor were contacted about participating in a semi-structured interview. SDoH information collected included (1) Economic Stability, (2) Access to Health Care, (3) Neighborhood & Physical Environment, (4) Social & Community Context, and (5) Education Access and Quality. Interviews were then recorded, de-identified, transcribed, and coded by reviewers. The validated Framework Method for qualitative research was used to summarize themes. Descriptive statistics were used to summarize the percentage of participants that identified with each SDoH concern. 

RESULTS: 100% of patients (N = 17) discussed how quality and access to healthcare affected their experience. 88.2% of participants expressed the importance of transportation. 29.4% of participants discussed how they thought their educational background affected their cancer care. Other common themes centered around social support, employment, financial security, and insurance. 

CONCLUSION: Our research elicited ways in which SDoH affected the care experience of patients with sarcoma. The identified domains offer clinicians valuable information into non-clinical factors, such as employment concerns or transportation issues, that may affect care for patients with sarcoma. Interdisciplinary care providers (social workers, psychologists, financial navigators) may also help promote open dialogues with patients about their social circumstances and actively facilitate connections to institutional resources or community support systems.