Prevalence of Unmet Social Needs and Post-Transplant Outcomes Among Adult Sickle Cell Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplant

OBJECTIVES: Sickle cell disease (SCD) affects around 100,000 Americans. Selectively accessible, hematopoietic stem cell transplant (HSCT) is the only curative therapy for SCD. The main objective of this study is to explore the unmet social needs of a cohort receiving allogenic HSCT in a minority-serving transplant center and their post-transplant outcomes.

METHODS: A secondary qualitative analysis was conducted on evaluations completed by the social worker for adults seeking HSCT between 2014 and 2021. Evaluations focused on the patient's unmet social needs (i.e., living arrangement, support system, financial status) with intent to offer resources. The coding of interviews was completed using a standardized codebook, with two reviewers individually coding the data onto Redcap^TM. Discrepancies were addressed with the team. Clinical and demographic variables were extracted from the electronic health records. The derived dataset was analyzed, and descriptive statistics were reported.

RESULTS: 40 patients (21 female) were included. A total of 150 (median=5) unmet social needs were identified among the patients, with the most common being government subsidy dependency (n = 18), housing dependency (n = 18), financial dependency (n = 17), and transportation vulnerability (n = 17). Twenty of the forty patients were offered resources by the social worker to address their needs. Post-transplant, four of the ten patients with fewer than three needs were re-hospitalized within 100 days, seven of the fourteen patients with three to five needs were re-hospitalized within 100 days, and ten of the sixteen patients with greater than five needs were re-hospitalized within 100 days. There were three deaths post-transplant in this study.

CONCLUSIONS: We observed many unmet social needs within the entire cohort, with rehospitalizations being more common in patients with a higher number of social needs. Confirming these findings in a larger cohort to assess the impact on specific transplant outcomes is warranted.