The Impact of Social Determinants of Health on Cancer Care

Cancer does not discriminate based on social status, race, income, or education, but that does not mean that it is an equal-opportunity killer. Evidence shows that overall, patients with poorer socioeconomic status also have poorer health outcomes compared with those with good socioeconomic status. The American Society of Clinical Oncology (ASCO) has recently launched a program to address the role of social determinants of health in cancer care and cancer outcomes.

“As cancer care providers, we have a responsibility to study not just how biology affects disease progression, but also to understand how social determinants affect the lives and cancer outcomes of our patients,” ASCO President Lori J. Pierce, MD, FASTRO, FASCO, said in a press release. “Now is the time for us to commit time and energy into understanding and addressing the systemic issues that affect the health of racial and ethnic populations in the United States,” Dr Pierce added.

Social determinants of health include factors that directly affect health and patient outcomes, including social context, economic stability, education, nutrition, environment, and the healthcare system itself. At the 2020 ASCO Quality Care Symposium, 2 experts discussed the impact of social determinants of health on patient care and cancer outcomes.

Using Distress Screening for Psychosocial Need

“Attempting to tackle such a fundamentally important problem can seem pretty overwhelming. It’s hard to know where to start,” acknowledged Cardinale B. Smith, MD, PhD, Associate Professor, Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.

Obtaining personal information about a patient can be challenging. Dr Smith and colleagues leveraged a psychological distress screening test, the CancerSupportSource tool, which was implemented as part of the American College of Surgeons Commission on Cancer accreditation.

“In our iteration of this customizable tool, we currently have 18 items, including 4 depression screening questions, 3 questions about psychosocial concerns, and 2 questions about transportation needs and health insurance or financial concerns,” said Dr Smith. She explained that at Mount Sinai cancer centers, distress screening is administered on the second visit and every 3 months thereafter.

Patients who meet the threshold of distress are contacted by a social worker within 24 to 48 hours of screening for a more formal psychosocial assessment. However, recent analysis of their data showed that 30% of patients met the criteria for distress. An additional 20% of patients had a transportation need, and 20% had financial concerns; these patients had previously been overlooked.

“We had this tool to identify distress,” Dr Smith explained, “but we weren’t looking at these data in meaningful ways to impact outcomes for patients.”

Dr Smith and colleagues are now attempting to use this information to connect patients with resources in the community and enhance community partnerships.

“We want to build out referrals through our electronic medical record and follow up to make sure those needs have been met and addressed by community resources,” Dr Smith commented. “We’re also looking for ways to incorporate more formalized screening of social determinants of health into standard of care. In an ideal world, every new patient would be seen and assessed by a social worker.”

Addressing Social Determinants of Health

Matthew P. Banegas, PhD, MPH, MS, Investigator, Kaiser Permanente Northwest Center for Health Research, Portland, OR, described a recent initiative implemented by his organization to address the socioeconomic and medical needs of its members.

In a survey of more than 1000 Kaiser Permanente members, 28% of respondents reported at least 1 unmet social or economic need that was a barrier to their health within the past year. A total of 80% of the respondents indicated that they would like help from their medical provider or their healthcare system to address their social health needs, Dr Banegas said.

To achieve this goal, Kaiser Permanente implemented the Thrive Local initiative, which is based on the following key components:

  1. Identification of the patient’s social needs by staff or community partners
  2. Connection used to find community, government, or healthcare resources to meet the patient’s social needs
  3. Information is provided on community resources and referrals are tracked with community partners
  4. Optimization of data to understand the patient’s social and medical needs, identify community-wide social care caps, and improve community health conditions.

“We’re working to create a community social health network that is able to connect members with unmet needs to appropriate resources through a community partner network to achieve their highest level of health,” said Dr Banegas.

According to Dr Banegas, building a shared technology platform is particularly challenging for patients with cancer, who have unique needs related to their disease and its treatment, as well as economic and social concerns. It will also be critical for each stakeholder to have an active role in the initiative from its start to ensure the greatest value to the partnership, he concluded.

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