# Prevalence and factors associated with non-medical needs among adult cancer patients attending a tertiary care center in Kerala, India. A cross-sectional study

## TL;DR

This study finds that over half of adult cancer patients in Kerala, India, have non-medical needs like income or transportation issues, which are linked to younger age, lower education, and poverty.

## Contribution

The study is one of the first in India to assess multiple social determinants of health among cancer patients using a standardized tool.

## Key findings

- 60.8% of adult cancer patients reported at least one non-medical need.
- Common needs included employment/income (40.1%), transportation (22.9%), and utility bill payments (20.4%).
- Younger age, lower education, and poverty were significantly associated with higher prevalence of non-medical needs.

## Abstract

Social determinants of health (SDH) significantly influence cancer risk, treatment adherence, and prognosis; however, research assessing multiple SDH factors, particularly in the Indian context, remains limited. This study aims to determine prevalence of non-medical (social) needs and identify the factors associated with at least one such need among adult cancer patients attending a tertiary care center in Kochi, Kerala, India.

This cross-sectional study was conducted at a private tertiary cancer care center. A total of 362 adult cancer patients (aged ≥ 18 years, 64.3% female) attending the oncology outpatient department were consecutively recruited. Data were collected through structured interviews using the WellRx questionnaire to identify non-medical (social) needs. Associations between sociodemographic and clinical factors and the presence of any non-medical need were assessed and adjusted prevalence ratios (APR) were estimated with Poisson regression.

Overall, 220 patients (60.8%; 95% CI: 55.8%−65.5%) patients reported at least one non-medical need. The most commonly reported needs were employment or regular income (n = 145; 40.1%), transportation (n = 83; 22.9%), and payment of utility bills (n = 74; 20.4%). In multivariable analysis, patients aged < 50 years (APR 1.37; 95% CI: 1.01–1.84; p = 0.042) and 51–59 years (APR 1.42; 95% CI: 1.09–1.85; p = 0.008) were more likely to report at least one non-medical need compared to those aged ≥70 years. Similarly, patients with primary education (APR 1.50; 95% CI: 1.20–1.86; p < 0.001), secondary education (APR 1.28; 95% CI: 1.04–1.57; p = 0.020), and those belonging to below poverty line (BPL) households (APR 1.24; 95% CI: 1.02–1.50; p = 0.028) had a significantly higher prevalence of non-medical needs.

More than half of adult cancer patients reported at least one non-medical (social) need, highlighting the importance of routine social needs screening in oncology care. Targeted support is warranted for patients who are unemployed, have lower educational attainment, belonging to BPL households, or are aged 51–59 years.