The Complex Link Between Determinants of Health and Cancer Outcomes
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Kat M. Aguilar, MPH, discussed findings on social determinants of health and cancer mortality and their practical implications for community oncology.
Kat M. Aguilar, MPH
A number of social determinants of health (SDOH) have been linked to cancer mortality, but the consistency of these associations across studies varies greatly. In a recent scoping review of 67 studies, significant differences in research methods and findings regarding the impact of various SDOH were revealed.
These SDOH included things such as race/ethnicity, insurance, education, and income. While most SDOH were associated with mortality in at least 1 study, these links were not consistently reported, highlighting the complex interplay between these factors and cancer outcomes.
This analysis was undertaken to understand the extensive literature on SDOH and cancer mortality within the US. The review examined studies published after 2019, and the findings underscore the intricate relationship between SDOH and cancer mortality.
In an interview with Targeted OncologyTM, Kat M. Aguilar, MPH, director of real-world research at Ontada, discussed these findings and their practical implications for community oncology.
Targeted OncologyTM: What are the most significant social determinants of health factors that community oncology practices should prioritize when assessing patient risk and developing interventions?
Aguilar: This was a scoping review that examined the evidence for social determinants of health and their association on cancer mortality. We observed that there was quite a bit of evidence published during this period that examined these associations. One of the key findings, however, is that there was a great deal of heterogeneity in terms of the research methodology used, the cancer populations considered, and then also the outcomes of those interventions.
We observed that there were a high number of social determinants of health that were associated with cancer mortality, but those were not consistently reported across studies. In particular, all social determinants of health were associated with cancer mortality in at least 1 study, but then they were contradicted by other studies. I think this alludes to the complexity of social determinants of health mediators and the role that health systems may play in controlling and controlling for social determinants of health. This points to the need for additional investigations, nationwide studies, including diverse tumor populations, to really understand how we can prioritize investment into interventions at target social determinants of health and which ones are really going to be most impactful.
How can community oncology practices effectively screen for and address the social determinants of health needs of their patients, particularly in resource-constrained settings?
This relates to the other study that we performed [regarding] the distress thermometer. The distress thermometer does allow patients to indicate specific concerns that they have. In particular, there is an area of the distress thermometer that allows patients to indicate practical concerns they have. These are concerns such as finances, transportation, [and] childcare. So, screening with a tool like the distress thermometer would allow clinics to identify the patients that would benefit from interventions.
What interventions or strategies have been shown to be most effective in mitigating the negative impact of social determinants of health on cancer outcomes, and how can these be implemented in community oncology settings?
I think that there is a lot of evidence that demonstrates that programs have a great deal of impact. The research that my colleagues and I have done has also shown that the health care system also plays an important role in mitigating the acts of social determinants of health. So while it was not discussed in this particular scoping review that we have done, we have published other studies that examined social difference of health and rural and outcomes and within the US Oncology Network population that we include in these studies, largely we not have not seen any large discrepancies with regard to patients with social with specific social health needs that we would have expected.
This was a surprising finding, because across the literature, there is this almost understanding that social determinants of health can negatively impact health outcomes. And in several of our studies, we actually have not found a trend. As we dug deeper, it appears that the characteristics of the health care system, especially evidence-based care guidelines, mitigate the adverse effects of social determinants of health and lead to more equal outcomes.
There's an important caveat here for patients to reach the health setting of the US Oncology Network, they have to be in that setting, so there are social determinants of health that will impact patients before they are eligible to receive treatment in the setting that may still continue to impact their long term health outcomes.
How can community oncology practices partner with community organizations and other stakeholders to address the broader social determinants of health that affect their patients?
The evidence strongly suggests that the collaborative approach is necessary. In particular, we need to work and engage with patients to understand what those needs are. I mentioned before in the distress thermometer, there might be a response of hesitancy to disclosing specific concerns that they may have in the context of community oncology. Is it perhaps because of stigma? As organizations and researchers, we need to identify ways to reduce that stigma and then also ensure that the information that they give us about their health-related social needs can have an impact and translate into interventions that provide them with a direct benefit. This kind of continuous circle will ensure that we are providing adequate care to our patients, as well as improving their overall well-being and outcomes.
