The importance of social vulnerability and exclusion in cancer prognosis and survival: a scoping review

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BACKGROUND: Cancer prognosis and survival are determined not only by biological and clinical factors, but also by patients' social environments. Social vulnerability, including socioeconomic deprivation, limited education, weak social networks, and social exclusion, can critically influence diagnosis, treatment adherence, and outcomes. This scoping review aims to synthesize the current evidence on the impact of social vulnerability and exclusion on cancer outcomes, comprising prognosis, survival, quality of life, and related psychosocial factors. METHODS: Following the Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines, a comprehensive search was conducted in PubMed, Scopus, and Web of Science for studies published between 2014 and 2025. Eligible studies included those evaluating associations between social determinants and oncological outcomes among adult cancer patients. RESULTS: A total of 32 studies were included, encompassing 92,291 patients. The majority were observational, including cross-sectional (n = 16), prospective cohort studies (n = 13) and retrospective studies (n = 3). The most frequent analyzed variables included marital and socioeconomic status, education and social support. Patients with stable social networks and higher socioeconomic levels showed better treatment adherence, psychological well-being, and survival; while social isolation, low income, and residence in deprived areas were associated with later diagnosis and worse prognosis. Several studies used validated indices to assess social vulnerability, such as the Social Vulnerability Index (SVI) and the Social Vulnerability Screening Index (SVSI). CONCLUSIONS: Social vulnerability and exclusion are important, yet often under-recognized or undervalued determinants of cancer outcomes. The integration of social assessment into the care of cancer patients would facilitate the implementation of individualized interventions tailored to each patient's social context and needs. Such an approach could enhance equity in access to care, improve treatment adherence, and enable the early identification and mitigation of factors associated with social exclusion or vulnerability, ultimately contributing to improved survival outcomes.

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