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Cancer and Social Determinants of Health

Expanding Access to High-Quality Cancer Care

Socioeconomic status, race, and location can all have enormous impacts on the cancer outcome of a patient. When we think of a cancer diagnosis, we often think in stages or grades and forget that the day-to-day life of a patient has just as much of an impact on their long-term outcome.

The National Cancer Institute has found that poverty strongly increases mortality rates among liver, stomach, lung, and colorectal cancers. Studies have also shown that the cancer mortality rate is higher in rural areas of the United States where there are increased poverty rates, lower educational levels, and a lack of high-quality healthcare. Social determinants of health have an enormous impact on oncology treatment, and facilities must consider them when examining treatment plans and daily workflows at their facilities.

Social Determinants of Health and Cancer

So, what are the social determinants of health exactly? The World Health Organization defines the social determinants of health 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.” The Office of Disease Prevention and Health Promotion buckets the social determinants of health into five categories like economic stability, education level, healthcare access and quality, neighborhoods and built environments, and social and community context.

A recent survey of oncologists indicates that over 93% of physicians believe that social determinants affect long-term cancer outcomes in patients. The physicians who completed the survey also indicated that economic status and health insurance (often closely linked) played the biggest role in the health of their patients.

Karen Winkfield, MD, PhD, describes the social determinants of health that can impact people with cancer and how addressing these social determinants of health can help improve cancer outcomes in a recent podcast. She said, “Data suggests your zip code may matter more than your DNA when it comes to your cancer outcome.”

Physicians across fields might need to get creative to access and aide the most at-risk patients. For example, early colorectal screenings are strongly associated with better outcomes but according to the CDC, one-quarter of adults have not received adequate screenings.  The Colorectal Cancer Control Program has been working to educate patients in the primary care setting, particularly those in low-income and rural areas, about cancer screening to improve early detection.

Prostate cancer treatment sees similar setbacks with Black and Hispanic men being far less likely to receive treatment than White men.  The prostate cancer-specific mortality rate of Black men is reported to be more than twice that of non-Hispanic Caucasian men. New research indicates that this is not due to biological factors as once thought but rather a lack of education, resources, and health insurance coverage.

What Your Practice Can Do

Social determinants of health are one of healthcare’s most complex problems. It will take a united effort between facilities, local communities, and government organizations to increase rates of preventative screenings, better educate patients, and offer unique resources to oncology patients.  However,81% of surveyed oncology physicians indicated that very busy staff struggled to make the time to assist patients with complex social needs. This comes as no shock as care teams are already overwhelmed with daily management at their practice. Technology can play a tremendous role in alleviating certain pain points and reaching out regularly to patients.

Expanding Access to Care

Facilities can work to expand access for patients who may have trouble coming to appointments due to distance, work, or other factors.  A patient who lives in a rural area and drives to a clinic two hours away is unlikely to make the trek for a stomach ache. However, that stomachache may indicate issues with their treatment plan or progressing disease.  Patients, especially those who don’t speak English or who lack higher education, may be nervous to call the practice due to phone line complexities or a fear of not being understood.  Giving patients the ability to share symptoms remotely allows care teams to stay informed regarding a patient’s health and encourages them to come into the office if needed. Integration of ePROs (electronic patient-reported outcomes) into routine cancer care was associated with a 20% increase in overall survival compared with usual care.

Canopy's EMR-integrated ePRO-Based Patient Monitoring platform empowers patients to regularly report symptoms via an intuitive smartphone app, text message, or Interactive Voice Response (IVR) tool. Studies show that up to 50% of toxicities and associated side effects experienced by patients during treatment are not reported to their care team. Providing patients with the ability to regularly and easily communicate with their team can help improve long-term care.

Technology can act as the team member needed to ensure that the lane of communication between your practice and patients is wide open.

When examining your patient population, it’s critical to ensure that they can access your team regardless of the tools they have at home. The interactive voice response options provided by Canopy allow patients without broadband Internet or smartphones to still report symptoms. The patient app is also available in multiple languages allowing non-native English speakers to still communicate with your team.

Patients want to interact with care teams when given the opportunity with one study indicating that engagement with Canopy’s ePRO app and IVR system was 88% at 6 months, with 12-month retention greatest among patients 65 years or older.  Patients are ready and eager to engage with tools that give them autonomy over their healthcare journey. Recent data at a leading institution indicated that 88% of patients were engaged with Canopy within six months and 22% had a reduction in ER visits and hospitalizations.

Empowering Practices to Deliver More Equitable Care

Your team must identify which patients might need extra communication and monitoring. Canopy enables HRSN screenings for the entire population and allows facilities to offer additional resources and support to those patients. You can improve practice performance by identifying opportunities for intervention, visits, and increases in treatment persistence.

Standardized symptom triage and decision support have allowed teams to offer more equitable care without increasing their busy workloads. “The staff loves that you can skip around on the triage pathway, and you can complete them as the patient is giving you the feedback. They don’t sound like a robot when talking to the patient but can still offer a standardized experience,” said  Amy Ellis, Chief Operating Officer at Northwest Medical Specialities.

Additionally, remote symptom reporting reduces unnecessary visits for patients freeing up physician time. A  single-site study of 923 patients at Highlands Oncology Group utilizing Canopy ePRO, found that the majority of patient issues were resolved by nursing specialists and provider intervention was not required.  While over 29,000 reports were submitted by patients, the system was able to optimize and prioritize staff work, and only an even smaller 6%) required an office visit.

Technology can act as the team member needed to ensure that the lane of communication between your practice and patients is wide open. Contact to learn how our platform can standardize care, improve daily workflows, and ultimately, improve patient care.