Other Titles
Rising Star Poster/Presentation
Abstract
Background: Despite advancements in cellular therapy, disparities in access and outcomes persist, influenced by race, income, and insurance status. Neighborhood socioeconomic status (nSES)—encompassing factors like area-level income, healthcare access, and collective social resources—may further exacerbate these inequities. However, its influence across the full trajectory of care remains unclear.
Objective: This scoping review synthesizes literature on nSES and its impact on referral, treatment receipt, long-term follow-up care, and survival among patients undergoing cellular therapy.
Study Design: Following Joanna Briggs Institute guidelines, PRISMA-ScR standards, and an a priori protocol, five databases were searched in July 2024. U.S.-based studies linking nSES with cell therapy access and survival outcomes in patients with hematologic disorders were included. Evidence was selected and charted using Covidence software.
Results: Of 1,001 records identified, 23 studies were included, examining receipt (n=8), follow-up care (n=1), and survival (n=15) among patients aged <1 to 83 years. Studies collectively represented at least 214,468 adults and 5,665 pediatric patients. Neighborhoods were defined using four different spatial units, with ZIP code most common. Of 11 nSES measures, median household income was used most frequently. No study evaluated referral. Significant associations between nSES and cell therapy receipt were found in 7 of 8 studies (87.5%). Associations with survival (9 of 15 studies, 60%) varied by time point, survival metric, and therapy type. Patients in low nSES areas had lower early survival post-alloHSCT, though findings were inconsistent for autoHSCT.
Conclusions: nSES appears to be a critical determinant of cell therapy receipt and early survival, particularly among alloHSCT recipients. This observed vulnerability could reflect a period of immune reconstitution during which environmental exposures may have a greater impact on outcomes. However, findings are limited by heterogeneity of nSES measures. Future studies should address referral patterns, long-term follow-up, and disparities in autoHSCT and CAR-T, prioritizing diverse populations and stable spatial units. Consideration of donor nSES may also provide added insight. Clinically, efforts to improve access, follow-up care, and survivorship are needed.
Notes
References:
1. U.S. Census Bureau. Considerations when working with ACS data. U.S. Census Bureau, 2019.
2. Ahmed N, Shahzad M, Shippey E, et al. Socioeconomic and racial disparity in chimeric antigen receptor T Cell therapy access. Transplant Cell Ther. 2022;28(7):358-364.
3. Dehn J, Chitphakdithai P, Shaw BE, et al. Likelihood of proceeding to allogeneic hematopoietic cell transplantation in the United States after search activation in the national registry: Impact of patient age, disease, and search prognosis. Transplant Cell Ther. 2021;27(2):184.e1–184.e13.
4. Emole J, Lawal O, Lupak O, Dias A, Shune L, Yusuf K. Demographic differences among patients treated with chimeric antigen receptor T-cell therapy in the United States. Cancer Med. 2022;11(23):4440–4448.
5. Paulson K, Brazauskas R, Khera N, et al. Inferior access to allogeneic transplant in disadvantaged populations: A Center for International Blood and Marrow Transplant Research Analysis. Biol Blood Marrow Transplant. 2019;25(10):2086–2090.
6. Arcaya MC, Tucker-Seeley RD, Kim R, Schnake-Mahl A, So M, Subramanian SV. Research on neighborhood effects on health in the United States: A systematic review of study characteristics. Soc Sci Med. 2016;168:16–29.
7. Milbrath GR, DeGuzman PB. Neighborhood: A Conceptual Analysis. Public Health Nurs. 2015;32(4):349–358.
8. Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health. 2001;55(2):111–122.
Complete reference list attached as separate document file.
Sigma Membership
Alpha Zeta
Type
Poster
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Other
Keywords:
Cultural Context and Care, Cellular Therapy, Socioeconomics, Neighborhood Socioeconomic Status, Socioeconomic Status, Survival Outcomes
Recommended Citation
Dorlette, Danica Jhoelle; Mead, Olivia; Bossong, Lawrence; Hong, Sanghee; Shang, Jingjing; and Smaldone, Arlene, "Mapping Neighborhood Socioeconomics Across the Cellular Therapy Continuum: A Scoping Review" (2025). Biennial Convention (CONV). 100.
https://www.sigmarepository.org/convention/2025/posters_2025/100
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Invited Presentation
Acquisition
Proxy-submission
Date of Issue
2025-12-10
Mapping Neighborhood Socioeconomics Across the Cellular Therapy Continuum: A Scoping Review
Indianapolis, Indiana, USA
Background: Despite advancements in cellular therapy, disparities in access and outcomes persist, influenced by race, income, and insurance status. Neighborhood socioeconomic status (nSES)—encompassing factors like area-level income, healthcare access, and collective social resources—may further exacerbate these inequities. However, its influence across the full trajectory of care remains unclear.
Objective: This scoping review synthesizes literature on nSES and its impact on referral, treatment receipt, long-term follow-up care, and survival among patients undergoing cellular therapy.
Study Design: Following Joanna Briggs Institute guidelines, PRISMA-ScR standards, and an a priori protocol, five databases were searched in July 2024. U.S.-based studies linking nSES with cell therapy access and survival outcomes in patients with hematologic disorders were included. Evidence was selected and charted using Covidence software.
Results: Of 1,001 records identified, 23 studies were included, examining receipt (n=8), follow-up care (n=1), and survival (n=15) among patients aged <1 to 83 years. Studies collectively represented at least>214,468 adults and 5,665 pediatric patients. Neighborhoods were defined using four different spatial units, with ZIP code most common. Of 11 nSES measures, median household income was used most frequently. No study evaluated referral. Significant associations between nSES and cell therapy receipt were found in 7 of 8 studies (87.5%). Associations with survival (9 of 15 studies, 60%) varied by time point, survival metric, and therapy type. Patients in low nSES areas had lower early survival post-alloHSCT, though findings were inconsistent for autoHSCT.
Conclusions: nSES appears to be a critical determinant of cell therapy receipt and early survival, particularly among alloHSCT recipients. This observed vulnerability could reflect a period of immune reconstitution during which environmental exposures may have a greater impact on outcomes. However, findings are limited by heterogeneity of nSES measures. Future studies should address referral patterns, long-term follow-up, and disparities in autoHSCT and CAR-T, prioritizing diverse populations and stable spatial units. Consideration of donor nSES may also provide added insight. Clinically, efforts to improve access, follow-up care, and survivorship are needed.
Description
This session examines how neighborhood socioeconomic conditions shape access to and outcomes of cellular therapy — a treatment that uses stem cells or immune cells to fight cancer. Attendees will explore emerging evidence on geographic disparities in cancer care and consider opportunities for nursing research and practice to advance health equity.