Background Socioeconomic status (SES) is a known factor frequently associated with health-related quality of life (HRQoL) in oncology, yet its impact in the setting of myelodysplastic syndromes/neoplasms (MDS) remains underexplored. Patients with higher-risk MDS may be particularly vulnerable in this respect, considering the high burden of symptoms and functional impairments imposed by the disease already at the time of diagnosis.

Objectives The primary objective of this analysis was to examine the prevalence of clinically important problems and symptoms in newly diagnosed patients with higher-risk MDS by their SES. The secondary objective was to assess the risk of impaired functioning and symptoms by different SES groups.

Methods We conducted a cross-sectional analysis of adult patients with newly diagnosed higher-risk MDS (according to the IPSS-R) enrolled in a large international prospective observational study by the GIMEMA. The SES was determined using three variables: level of education, employment status, and living arrangements. Each variable was scored as 0 (for low level of education, living alone, or no income) or 1 (for intermediate/high level of education, living with others, or receiving a salary/pension). The final SES index was computed by summing the scores for each variable, and each patient was classified into three categories: low (score 0-1), middle (score 2), and high SES (score 3). To assess HRQoL, all participants completed the EORTC QLQ-C30 at study entry. Prevalence of clinically important problems and symptoms were assessed using established thresholds for the QLQ-C30 (Giesinger JM et al. J Clin Epidemiol 118:1-8, 2020). This prevalence reflects the number of patients in each SES group reporting clinically important problems or symptoms that limit their daily lives, cause worry to them, or require help or care. Logistic regression models were used to assess the risk of impaired functioning or symptoms in the low and middle SES groups vs the high SES group. These models were adjusted for the following potential confounders: age, sex, time since diagnosis, transfusion dependency, ECOG performance status, and HCT comorbidity index.

Results Overall, 521 patients with higher-risk MDS were analyzed. The SES was available for 504 patients, who had a median age of 73 years (IQR 65.9-78.8) and a median time since diagnosis of 0 weeks (IQR 0-4.3). Almost half of them were classified as high SES (45.4%), 41.5% as middle SES, and 13.1% as low SES. Prevalence of clinically important problems was higher in the low SES group with respect to middle and high SES groups, across all the QLQ-C30 scales. For example, more than half of patients (59.1%) in the low SES group reported a clinically important level of fatigue, while this prevalence was 47.4% and 39.3% in the middle and high SES groups, respectively (p=0.013). Prevalence of clinically important pain was 53%, 39.2% and 27.1% in low, middle and high SES, respectively (p<0.001). Three out of four (74.2%) patients in the low SES group had a clinically important dyspnea, while this was 58.9% and 57.6% in the middle and high SES, respectively (p=0.045). In the functioning scales, the prevalence of clinically important problems in physical functioning was similar in the low (77.3%) and middle (74.2%) SES groups, but lower in the high SES group (60.3%) (p=0.002). For the cognitive functioning scale, the prevalence of clinically important problems was 43.9%, 32.5% and 25.8% in the low, middle and high SES groups, respectively (p=0.015). Logistic regression analyses revealed a similar trend, with low SES more likely to report impaired functioning or symptoms than those with high SES, independently of potential confounders. For example, patients in the low SES group had a statistically significant higher risk of reporting impaired pain (OR=2.84, 95% CI 1.55-5.24; p<0.001), dyspnea (OR=1.98, 95% CI 1.06-3.83; p=0.037) and cognitive functioning (OR=1.86, 95% CI 1.00–3.42; p=0.047).

Conclusions We observed that newly diagnosed patients with higher-risk MDS who have a low SES tend to report worse HRQoL outcomes compared to those with middle or high SES, suggesting that these patients are most in need of special attention. Future research should investigate whether such socioeconomic inequalities may also impact long-term treatment outcomes.

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2025
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