Social Determinants of Health May Not Reduce the Likelihood of Receiving Newer Treatments In Some Cases, According to Expert


In a recent study, people who lived in disadvantaged or rural areas were just as likely to receive the second-generation medications as people in urban areas.

David Andorsky, MD, a medical oncologist and hematologist with the Sarah Cannon Research Institute (SCRI) at Rocky Mountain Cancer Centers, a practice of the US Oncology Network, Boulder, Colorado, sits down with Pharmacy Times at the 65th American Society of Hematology (ASH) Annual Meeting & Exposition, taking place December 9-12, 2023, in San Diego, California. Andorsky discusses findings from a recent study that looked at the impact of social determinants of health (SDOH) on the type of medication that is administered to patients with leukemia.

PT Staff: Can you provide an overview of a recent study that evaluates social determinants of health (SDOH) in patients with chronic lymphocytic leukemia or small lymphocytic leukemia (CLL/SLL) who received Bruton’s tyrosine kinase (BTK) inhibitors? What is the importance of evaluating SDOH and treatment patterns?

David Andorsky, MD: Sure, so this was a study of real-world medicine looking at approximately 2000 subjects with CLL/SLL within the US Oncology Network who started treatment with 1 of the 3 FDA-approved BTK inhibitors: ibrutinib (Imbruvica; Janssen Biotech, Inc.), acalabrutinib (Calquence; AstraZeneca), or zanubrutinib (Brukinsa; BeiGene, Ltd.). So we extrapolated data from the charts and we looked at the SDOH which were where they lived in a rural zip code or an urban zip code, whether they lived in an economically disadvantaged area, and which payers [if they had insurance] had Medicare, Medicaid, or commercial insurance. These SDOH are really important to look at because we do think they have an impact on the type of care patients receive. So if we're trying to address any imbalances or inequities in health care, we would need to know what's driving these inequities. And that gives us some clues to how to remedy them.

Image Credit: © Mongta Studio -

Image Credit: © Mongta Studio -

PT Staff: What findings did you observe and how might they reflect general trends in treatment administration?

David Andorsky, MD: So one thing we noticed was that, over the treatment period, the use of ibrutinib (which is the first drug in the class) went down and the second-generation BTK inhibitors acalabrutinib and zanubrutinib were used more frequently. This is what we generally expect, in oncology. When newer [and] improved drugs are introduced, they usually squeeze out the older drug that was the first in class. And that's exactly what we what we saw here is that that wasn't a surprise.

What we did see was that the SDOH that we looked at did not really seem to correlate with which treatment the patient got; meaning it didn't matter if you were in a disadvantaged area, you were still just as likely to get acalabrutinib and zanubrutinib as you were ibrutinib. Now, the 1 trend we did see, or the 1 association we saw, was that patients in rural environments were actually a little bit more likely to get the newer medications, which was a little bit of a surprise, I'm not sure what that finding means. There were relatively low numbers of patients in rural environments. So it could be by chance alone, the p-value was significant. That's where we want to look at in future studies.

PT Staff: Based on these findings, what is your general takeaway regarding medication administration based on SDOH?

David Andorsky, MD: I think it was a relatively small difference. And I think my takeaway from the study was that patients were largely getting the same types of treatments, whether or not they lived in a rural environment or urban environment or in an economically-deprived area, which I think is generally reassuring that, once patients get in the door and have access to 1 of these medications, they're going to get the one that their doctor felt like was the best and not just what happened to be available.

PT Staff: What was the impact of cost on medication administration?

David Andorsky, MD: So all these medications are fairly expensive. There are some differences between the 3 of them, but they're not very dramatic. So it's the total cost of each medication, and there was only a small difference between each of them. But that could be something [that] 1 could look at and say “Are patients in disadvantaged areas more likely to get one versus the other?” But we didn't see that type of association. I think maybe because, again, the price differences are not that great.

PT Staff: What else should be considered when evaluating the effects of SDOH in medicine?

David Andorsky, MD: I think you want to look also at outcomes. This phase of the study did not look at “Did patients live longer?” Or “Send the treatment for longer based on SDOH?” I think those are places where you might start to see some differences.

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