Despite major advances in cancer prevention and treatment, significant disparities in cancer care and outcomes persist.
The influence of social determinants of health (SDOH) on the continuum of cancer care has been recently recognized. SDOH are defined by the World Health Organization as the “conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”1
Drivers of SDOH encompass conditions that exist upstream, such as socioeconomic conditions, environmental conditions, institutional power, and social networks, which interrelate to ultimately influence downstream factors, including health behaviors, health conditions, and outcomes.2
Patients with socioeconomic disparity experience a 22% higher cancer mortality rate compared to those without socioeconomic disparity.3 Disparities exist not only in cancer mortality but also have been reported in incidence, stage at diagnosis, treatment, and survival.3 Mitigating social risks for patients with cancer may improve equity among underserved populations. While there is a growing body of knowledge about the influence of SDOH on cancer outcomes, less is known about how to successfully screen and address these determinants.
Healthcare systems are now being tasked with the responsibility to understand and address SDOH among their patients to improve quality of healthcare delivery and outcomes. Providers and systems are encouraged to integrate social care into the delivery of healthcare by screening for social risk factors and addressing identified needs by connecting patients with internal resources or external community-based services. In fact, recent policy by the Centers for Medicare & Medicaid Services has mandated the collection and reporting of SDOH screening measures from hospitals reporting to the Hospital Inpatient Quality Reporting Program.4
To date, single institution and healthcare system studies have demonstrated the feasibility of routine SDOH collection in the outpatient oncology and ambulatory care settings.5,6 However, challenges faced by healthcare systems seeking to understand and address SDOH include the lack of a standardized screening process and limited data on the efficacy of contemporary SDOH screening tools.
Implementation of SDOH screening tools that are integrated into healthcare delivery systems will support the collection of patient-centered data elements that can inform policy, payment redesign, and delivery of guideline-concordant care. Still, further work is necessary to evaluate workflow integration, standardize SDOH screening tools, and identify best practices to document and provide resources for identified needs and risk factors.
In a key step toward understanding how cancer programs can better address the unique needs of their patient populations to ensure high-quality, multidisciplinary, and comprehensive cancer care delivery, the ACS Commission on Cancer (CoC) will launch an SDOH Screening Survey among its CoC-accredited cancer programs in the coming months.
The study aims to:
- Determine current SDOH screening practices within the outpatient oncology setting
- Describe facilitators and barriers to SDOH screening
- Understand availability of resources to address identified needs
- Examine patient characteristics, institutional characteristics, and treatment and outcomes associated with SDOH screening
Community engagement has been increasingly recognized as an important step in translating innovative approaches to patients from diverse settings. Results of this study are critically important to increasing our understanding of how the needs of diverse populations can be identified and addressed throughout the continuum of cancer care.
The CoC is dedicated to improving survival and quality of life for all patients with cancer through accreditation standards and promotion of quality assessment and improvement. The study of SDOH screening and resources represents a unique opportunity to improve equity in cancer care delivery and to benefit the diverse population served by the ACS CoC cancer programs.
Details about the survey will be released in an upcoming issue of the Cancer Programs News. Email questions to cancerresearchprogram@facs.org.
