How oncologists view the impact of social determinants of health on patient outcomes
Featured expert
Vice President, Chief Medical Officer
Cardinal Health Specialty Solutions
Based on clinical evidence, we know that oncology patients facing financial security, food security, social isolation, housing security, addiction and other issues are prone to worse outcomes than patients without these challenges. These social determinants of health (SDOH) can be just as important as genetics. Defined by the World Health Organization (WHO) as “the conditions in which people are born, grow, Live, work and age,” these factors impact patients from diagnosis to treatment and through survivorship.
To better understand the impact of SDOH on specialty medicine, we surveyed more than 160 oncologists from community- and hospital-based practices earlier this year to assess their perspectives on the topic. The research was fielded in concurrence with a live summit event, hosted by Cardinal Health Specialty Solutions, in February 2020. Additional responses were collected using web-based surveys in March and April 2020. In total, we collected the impressions of more than 160 of practicing community oncologists.
The research, recently published in the seventh edition of Oncology Insights, provides a deeper understanding about the impact of SDOH on patients and their providers and how pharmaceutical manufacturers can help address core issues. Here are three key trends that can help expand understanding of this urgent issue.
Most oncologists reported SDOH significantly impact patient outcomes
The research underscores the pervasive impact of SDOH – 93 percent of participating oncologists strongly agreed or agreed that these issues impact the ability of patients to achieve optimal health outcomes. More than two-thirds (68 percent) of the participating oncologists said at least half of their patients are negatively impacted by SDOH.
The data suggests that oncologists struggle to address these barriers with their patients. Nearly all oncologists said they discuss SDOH with patients at least occasionally. However, 81 percent said time constraints limit their ability to adequately address SDOH.
Oncologists said financial insecurity/lack of insurance is the most significant SDOH challenge
Oncologists said financial insecurity/lack of insurance is the most significant SDOH challenge
The United States has made some progress in addressing SDOH. For instance, Medicare Advantage plans have been authorized to cover non-medical benefits. Some large commercial payers are making investments to help patients with food, transportation and housing.
However, participating oncologists said more help is needed. About three in four participating oncologists said that assistance programs are not readily accessible. The primary areas they say they need assistance with are:
- cost of medicine (79 percent);
- transportation (57 percent); and
- tools to improve patient understanding of disease and treatment (29 percent).
Only eight percent believed mental health assistance would provide significant value, and only one percent said they see value in addiction assistance. This is surprising given the documented rates of mental illness and addiction across the United States.
Notably, the survey was designed, and mostly implemented before the widespread impact of COVID-19 in the United States was apparent. With more than five million Americans losing health insurance coverage in the first six months of the pandemic, SDOH issues such as financial security, housing security, food security and mental health will most certainly have a larger impact on cancer patients than they did just a few months ago – indicating the need for support may grow in the coming year.
Participating oncologists said a wide range of healthcare stakeholders should take responsibility for addressing SDOH. These key players include government organizations (58 percent), non-profits (56 percent), commercial payers (54 percent), hospitals (50 percent) and pharmaceutical manufacturers (42 percent).
Nearly all participating oncologists said pharmaceutical manufacturers should be involved in supporting the social needs of patients. Only two percent disagreed. Oncologists said pharmaceutical manufacturers can play a larger role through:
- copay assistance programs (90 percent);
- free drug programs (70 percent);
- patient education programs (61 percent);
- adherence programs (42 percent); and
- transportation assistance (39 percent).
Overall, the findings provide valuable insights into how oncologists perceive the impact of SDOH on their patients – and how they are managing these issues in their practices. Given the health and financial impacts of the COVID-19 pandemic, these issues are likely to remain relevant for years to come.
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