How social determinants of health affect patient outcomes

June 15, 2020

Factors such as financial security, food security, social isolation, housing security and more impact all aspects of a patient’s care.

Over the past decade, a growing body of clinical evidence has shown that social determinants of health (SDOH)- the conditions in which people are born, grow, live, work and age, as defined by the World Health Organization (WHO)  – can be as important to a patient’s outcomes as their genetics. Factors such as financial security, food security, social isolation, housing security, addiction, access to transportation and health literacy impact all aspects of a patient’s care.

This is especially true in cancer treatment. More than 90 percent of participating oncologists said SDOH significantly impact outcomes for cancer patients according to new research by Cardinal Health Specialty Solutions. The findings are based on surveys of 160 U.S. oncologists from a mix of community- and hospital-based practices conducted in February through April 2020. It’s the latest in an ongoing series of reports designed to help physicians, manufacturers and other healthcare stakeholders understand trends and changes impacting specialty medicine.

Two-thirds (68%) of the participating oncologists said at least half of their patients are negatively impacted by SDOH. Financial security/lack of health insurance (83%) stood out as the most significant burden, followed by access to transportation (58%), health literacy (53%) and social isolation (43%).

Notably, the survey was designed, and most of the responses were received, before the onset of COVID-19 pandemic in the U.S. The SDOH issues uncovered in the research have become even more relevant in the face of the current healthcare crisis. Those who lack financial security, education, employment or housing are at greater risk of being infected with the virus and may not be able to access appropriate medical care. In some cases, as in cancer, these disparities have led to higher mortality rates.

The Need for More Resources

In recent years, the United States has seen a shift in greater awareness of the importance of SDOH and toward a more comprehensive approach to healthcare: Medicare Advantage plans have been authorized to cover non-medical benefits, and some large commercial payers are making investments to help patients with food, transportation and housing.

Yet the survey findings indicate oncologists see the need for more resources. Nearly 70%of participating oncologists said they often or always discuss social determinants with their patients.  However, 81% acknowledged that they and their staff were time constrained in their ability to adequately address those same topics. 

Participating oncologists assigned responsibility for assistance programs across the players in the healthcare space, including government, non-profits, commercial payers, hospitals and pharmaceutical manufacturers. Oncologists said assistance was most needed in three areas: cost of medicine (79%); transportation (57%); and tools to improve patient understanding of disease and treatment (29%)- yet a strong majority (76%) said that assistance programs are not readily accessible. 

The survey clearly shows that social factors are critically important to a patient’s outcomes. There is no simple solution, and oncologists believe that everyone in the healthcare system must play a role in finding solutions. As the COVID-19 pandemic continues to unfold, along with its economic impacts, these issues will remain critical in the months and years ahead.

Bruce Feinberg, DO, is Vice President and Chief Medical Officer for Cardinal Health Specialty Solutions.