Association of unmet basic resource needs with frailty and quality of life among older adults with cancer-Results from the CARE registry

Background: Basic resource needs related to transportation, housing, food, and medications are important social determinants of health and modifiable indicators of poverty, but their role in modifying the risk of frailty and health-related quality of life (HRQoL) remains unknown. The goal of our study was to examine the prevalence of unmet basic needs and their association with frailty and HRQoL in a cohort of older adults with cancer. Methods: The CARE registry prospectively enrolls older adults (>= 60 years) with cancer. Assessments of transportation, housing, and material hardship were added to the CARE tool in 8/2020. The 44-item CARE Frailty Index was used to define frailty, and subdomains of physical and mental HRQoL were assessed using the PROMIS (R) 10-global. Multivariable analysis examined the association between unmet needs with frailty and HRQoL subdomains, adjusting for covariates. Results: The cohort included 494 participants. Median age of 69 years, 63.6% were male and 20.2% were Non-Hispanic (NH) Black. Unmet basic needs were reported in 17.8% (transportation 11.5%, housing 2.8%, and material hardship 7.5%). Those with unmet needs were more often NH Black (33.0% vs. 17.8%, p = 0.006) and less educated (<high school: 19.5% vs. 9.7%, p = 0.023). Compared to those without unmet needs, unmet needs were associated with higher odds of frailty (adjusted odds ratio [aOR] 3.3, 95% CI 1.8-5.9), low physical (aOR = 2.1, 95% CI 1.2-3.8) and low mental (aOR = 2.5, 95% CI 1.4-4.4) HRQoL. Conclusions: Unmet basic needs represent a novel exposure that is independently associated with frailty and low HRQoL and warrants the development of targeted interventions.