Impact of Social Determinants on Quality of Life in Socioeconomically Disadvantaged Cancer Survivors: A Mixed-Methods Study

Background: Socioeconomic disparities significantly impact cancer survivorship, influencing quality of life (QoL) outcomes. This study investigates the role of social determinants of health (SDH) in shaping QoL among socioeconomically disadvantaged cancer survivors in Riyadh City, Saudi Arabia. Methods: A mixed-methods design was employed, combining quantitative and qualitative approaches. The quantitative component included 200 participants who completed validated SDH and WHOQOL-BREF questionnaires. Pearson's correlation and multiple regression analyses were conducted to explore relationships between SDH domains and QoL outcomes. The qualitative component involved in-depth interviews with 20 purposively selected participants. Thematic analysis was performed to capture survivors' experiences and perceptions. Results: Quantitative findings revealed significant negative correlations between financial instability and QoL domains, particularly physical health (r = -0.45, p < 0.001). Multiple regression analysis identified financial instability (beta = -0.50, p < 0.001) and lack of social support (beta = -0.28, p < 0.05) as key predictors of reduced QoL. Qualitative findings highlighted three major themes: financial and structural barriers, psychological impacts, and coping mechanisms. Participants reported significant challenges related to healthcare access, fear of recurrence, and social isolation, while emphasizing the importance of family and community support. Conclusion: SDH significantly influence QoL among socioeconomically disadvantaged cancer survivors. Addressing financial, structural, and social barriers through equity-driven and culturally sensitive interventions is essential to improving survivorship outcomes.