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Psychosocial Care in Oncology: The Impact of Social Determinants of Health

By Jennifer Bires

August 8, 2023
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This blog is the second in a 2-part series reporting on ACCC’s Call to Action: Delivery of Psychosocial Care in Oncology Summit. Read the first one here

We know that social determinants of health (SDOH) play a significant role shaping the overall well-being of individuals. For individuals diagnosed with cancer, we recognize that these social determinants can profoundly impact their care journey, affecting everything from prevention and diagnosis to treatment and survivorship. Studies show clinical care accounts for only 10% to 20% of health outcomes, while SDOH can impact as much as 80% to 90% of health-related outcomes. However, while the impact of SDOH on patients is becoming widely understood, we must acknowledge that these factors are impacting our own care teams as well. When SDOH hinders a patient’s access to care or critical resources that can facilitate better treatment outcomes, it is often frustrating and demoralizing for the entire care team. Compounded by workforce shortages, reimbursement struggles, and lack of resources, this can often be a formula for staff burnout. 

Recognizing this, supportive care leaders convened by the Association of Community Cancer Centers (ACCC) and its partners, the Association of Oncology Social Work (AOSW) and the American Psychosocial Oncology Society (APOS), and with support from BeiGene, met in Washington, DC in March 2023 for “A Call to Action: Delivery of Psychosocial Care in Oncology Summit.” Among many critical topics discussed was identifying barriers to providing and accessing timely and appropriate care for patients and caregivers experiencing psychological distress. Participants identified diversity, equity, inclusion, and access as key priorities in advancing psychosocial care. Additionally, the necessity of acknowledging the ways (directly and indirectly) that structural racism, implicit bias, and other inequities impact care in underserved communities was highlighted, as well as the urgency of promoting strategies to foster resilience and a health care culture that mitigates burnout among all members of the cancer care team.   

The Factors Influencing SDOH

The burden of cancer remains one of the most significant public health challenges worldwide. It poses physical, emotional, and financial burdens on individuals and their families. However, we now recognize that cancer does not affect everyone equally, as SDOH are significant drivers of health disparities. Individuals with limited socioeconomic status often face barriers such as limited access to healthcare, delays in diagnosis, and inadequate treatment options, which leads to higher mortality rates. Lower levels of education can result in limited health literacy, which leads to delays in seeking medical attention and difficulties in understanding complex treatment options.

For many, a cancer diagnosis can also lead to job loss or reduced working hours, resulting in financial strain, increased stress levels, and limited access to healthcare services. Further, social determinants, such as lack of health insurance, limited transportation options, and geographic barriers, can impede individuals' ability to receive timely and appropriate cancer treatment. Cultural and ethnic backgrounds can also influence health beliefs, attitudes toward cancer, and healthcare-seeking behaviors.

While strong social support networks can provide emotional and practical assistance during the cancer journey, individuals lacking adequate support systems may experience increased distress, depression, and decreased treatment adherence. Understanding these factors is crucial in addressing disparities and delivering culturally competent care to individuals with cancer. 

The Role of Social Workers

Social workers have a long history of identifying and addressing barriers to care and can play a vital role in mitigating the impacts of SDOH on patients with cancer. Social workers' expertise in addressing psychosocial needs, advocating for patients and resources, and connecting patients with support services can help patients navigate emotional challenges, cope with treatment-related stress, and enhance their overall quality of life. Often, they act as care coordinators, collaborating with healthcare teams to ensure seamless delivery of services, and they help patients navigate complex healthcare systems, access financial resources, and coordinate multidisciplinary care. However, the current state of the psychosocial workforce and resources are simply not enough to proactively assess and provide meaningful interventions to patients along the cancer continuum. 

While progress has been made under the Affordable Care Act to increase access to reimbursement for mental health services, summit participants and most stakeholders recognize that much remains to be done. Providing these services proactively requires adequate staffing, tools for assessment, and access to resources, particularly in rural and underserved areas. Adequate reimbursement can help mitigate these shortfalls, and stakeholders must work together to advocate for real change.

The Role of Payers

Integrating mental health screenings and referrals with trusted primary and specialty care can increase access, particularly in communities where stigmas about mental health services persist. Payers (eg, public programs such as Medicare and Medicaid) must acknowledge that mental health has traditionally been poorly delivered to underserved communities and include coverage policies that help to deliver equitable care, such as telehealth services and transportation to appointments. Additionally, policymakers should consider opportunities for enhanced funding of medical education opportunities, such as student loan repayment programs or additional residency slots, for traditionally underrepresented practitioners and those who would serve in underserved communities. 

Looking Forward

SDOH exacerbates disparities in diagnosis, treatment, and outcomes, and profoundly impacts the success of the care team. Advocating for change and ensuring sufficient staffing and resources that enable social workers to adequately meet the needs of patients will not only help alleviate SDOH barriers that directly impact the physical and psychological well-being of patients but also help mitigate burnout that can occur when team members experience moral distress over barriers that impact patients accessing care. The healthcare landscape is poised to embrace a more comprehensive approach to address these crucial factors, ultimately improving the lives of patients and health care providers.   

The ACCC Psychosocial Care in Oncology Summit education program is supported by BeiGene.

Jennifer Bires, MSW, LCSW, OSW-C, is an oncology social worker who oversees Life with Cancer, the psychosocial program for the Inova Schar Cancer Institute. 

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