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Addressing Systemic Inequities in Cancer Care: A Multi-Stakeholder Approach
Cancer care in the United States, while continually advancing, remains plagued by significant disparities. These inequities aren’t simply about access to cutting-edge treatments; they are deeply rooted in systemic issues surrounding health-related social needs (HRSN) – often referred to as social determinants of health (SDOH) – and require a collaborative, multi-faceted approach to resolve. Recent discussions among leading oncology professionals highlight the critical need for proactive intervention,improved data infrastructure,and a renewed focus on patient-centered communication.This article delves into these key areas, offering insights from experts across the payer, provider, and innovation landscapes.
[Image Suggestion: A diverse group of healthcare professionals collaborating around a patient chart, symbolizing teamwork and patient-centered care.]
The Impact of Social Determinants on Cancer Outcomes
HRSN encompass the non-medical factors that influence health outcomes. These include, but aren’t limited to, access to transportation, stable housing, nutritious food, financial resources, and social support. For cancer patients, these factors can dramatically impact their ability to adhere to treatment plans, attend follow-up appointments, and ultimately, achieve positive outcomes.Patients facing challenges in these areas are demonstrably more likely to experience delayed diagnoses,receive suboptimal care,and suffer poorer survival rates. Ignoring these factors is not only ethically problematic but also contributes to increased healthcare costs due to complications and emergency room visits.
Community Oncology: A Frontline Defense
Community oncology practices are uniquely positioned to address these non-medical needs. Unlike large, centralized hospital systems, community practices often have a deeper understanding of the local patient population and the specific challenges they face. As Susan Sabo-Wagner, MSN, RN, OCN, NEA-BC, Vice President of Clinical Innovation at American Oncology Network (AON), emphasizes, “We have unique opportunities to sort of fill the gaps and provide the resources necessary for patients to be able to get to treatment, to meet adherence needs, and things like that.”
Though, effective intervention requires a proactive approach. Historically, identifying HRSN has been a retrospective process, occurring after treatment has begun or even after issues have arisen. Sabo-Wagner advocates for standardized screening for HRSN before treatment initiation, combined with ongoing monitoring for individual barriers.This allows care teams to anticipate potential problems and implement solutions before they derail a patient’s care plan. This proactive stance is a cornerstone of value-based care models, which prioritize outcomes and patient well-being over simply delivering services.
[Image Suggestion: A graphic illustrating the various social determinants of health – housing, food security, transportation, financial stability, etc. – and their impact on a patient’s cancer journey.]
The Payer Viewpoint: Data Delays and the Pursuit of Value
Payers also recognize the importance of addressing HRSN, but face their own set of challenges.Simone Ndujiuba, PharmD, BCOP, Senior Principal Clinical Oncology Pharmacist for Prime Therapeutics, highlights a significant hurdle: the delay in receiving claims data for infused drugs. “There is a significant delay-often 3 months-in receiving claims data…which complicates adherence evaluation.” This lag makes it tough to assess the effectiveness of interventions and demonstrate the value of addressing HRSN.
Despite these challenges, payers are motivated to provide appropriate, early therapy to minimize the total cost of care. However, structural barriers within the healthcare system often impede these efforts. Improved data sharing and streamlined claims processing are crucial steps toward aligning payer incentives with the goal of equitable cancer care.
Data Infrastructure and the Need for a Holistic view
A recurring theme throughout the discussion was the critical need for better data infrastructure. Alti rahman, MHA, MBA, CSSBB, Chief Strategy and Innovation Officer at AON, argues for extending the principles of health information exchange beyond the medical realm. “We talk a lot about health information exchanges that are out there that can track longitudinal data about patients, but that same thing needs to happen on the public health side, to track what the experience has been [with] transportation, housing