Disparities in cancer outcomes related to social factors are common, including income, health insurance, social support, and access to high-quality treatment. That's a bottom line Richard Wender, MD, Chair and Professor of Family Medicine and Community Health at Penn Medicine, believes the oncology community needs to know. A growing tome of evidence points to this. He recently wrote an editorial published in the journal Cancer about the findings of one such study (2022; doi: 10.1002/cncr.33890). The new data is a prospective analysis of cancer mortality and eight potential social determinants of health in a cohort of more than 29,000 adults (Cancer 2022; doi: 10.1002/cncr.33894). That new data reported a significant association between cancer mortality and six of those social determinants of health. Wender cites examples of the many other studies that point to the same conclusion in the editorial.
"The cancer care community should be intolerant of disparities in cancer risk and outcomes," he said. "Every cancer treatment center has an obligation to consider and address these factors." That point is underscored in the editorial; the burden of addressing these inequalities falls to those in the oncology community in addition to others.
"Creating integrated systems of care with shared goals of treatment-between oncologists, the entire treatment team, and hospitals-offers our best opportunity to address social needs," Wender noted. "Partnerships between larger cancer treatment centers or academic health centers and smaller hospitals are critical to increasing the likelihood that all patients benefit from advancements in management and care." In an interview, Wender shared the recommendations he makes in the editorial.
1 The editorial proposes several guidelines to help reduce disparities in cancer outcomes related to social determinants of health. Who are the guidelines for and which players will help move the needle in terms of making change?
"The principal target for the first guideline set is cancer treatment centers. This first set outlines steps that every cancer center must incorporate into routine care. Create a more diverse workforce that reflects the community and can confront implicit bias and structural racism. Screen for social needs. Deploying more resources to help people overcome barriers to care should be an expectation.
"I think the toughest recommendation to meet is helping people address financial toxicity. This demands policy change and innovative practice. Hospitals that are themselves in financial distress will have particular trouble addressing financial toxicity."
2 You also make recommendations for reducing the social and economic disparities that lead to disparities in health, and more specifically, cancer outcomes. What is oncology's role in addressing the root causes of these disparities?
"This second set of recommendations is particularly demanding. I actually think the cancer community and cancer treatment facilities are probably better positioned to follow these steps than most or any other disease-related program.
"Cancer care begins with reducing risk factors and cancer screening, and extends all the way to cancer diagnosis, treatment, and supportive care. Partnerships with community are vital to achieving prevention goals. Measuring outcomes at the level of the population, rather than the level of patients, is actually an expectation for National Cancer Institute-designated cancer centers and should become a routine.
"The cancer community can become powerful advocates for policy change that lessens the likelihood that cancer will lead to bankruptcy. So, yes, I think telling this story through the lens of the cancer patient is very important."
3 What further research needs to be done to better address and improve the social determinants of health, as they relate to cancer?
"There are so many research opportunities. Some are:
* randomized trials of screening for social needs at diagnosis and periodically through disease management;
* trials of different types of financial support through treatment;
* development of models of community health scorecards;
* studies of the effect of workforce diversity and health outcomes;
* continued studies of how best to deploy social work and navigators for patients in treatment;
* studies of various policies, such as expansion of Medicaid on cancer outcomes for people who need cancer treatment; and
* studies of routinely measuring process and outcomes by income, race, and ethnicity."