Screening for health-related social needs should be 'integral' part of cancer care
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Social determinants of health have become a key component of oncology research, providing insights into how factors such as race, ethnicity, socioeconomic status, and sexual or gender identity influence cancer incidence or outcomes.
This has prompted health systems to place greater emphasis on screening for health-related social needs, defined as a person’s unmet adverse social conditions — such as nutrition insecurity or housing instability — that can contribute to poor health and may be a result of underlying social determinants of health.
The National Comprehensive Cancer Network convened a working group to evaluate health-related social needs in cancer, identify barriers to screening for these needs, and develop recommendations to overcome these barriers.
“With increased attention on the impact that factors outside the health care system can have on health outcomes, NCCN believed it was important to explore this,” group co-chair Yelak Biru, MSc, president and CEO of International Myeloma Foundation, told Healio. “NCCN noted that there needed to be a distinction made between social determinants of health (SDOH) and health-related social needs (HRSN), and what optimal screening for these needs might look like in oncology.”
Healio spoke with Biru about the working group’s recommendations, the importance of screening for HRSN and what members of the clinical community can do when concerns are identified.
Healio: Why did NCCN convene this working group?
Biru: Systems are beginning to incentivize health care organizations to integrate HRSN screening through initiatives such as the Cancer Moonshot Initiative, CMS Innovation Center’s Enhancing Oncology Model and the Advancing Cancer Care MIPS Value Pathway. The working group provided an opportunity for a varied set of stakeholders — including patients and patient advocates, physicians, health information technology experts, pharma/biotech representatives, payers and administrators — to review the landscape of SDOH and HRSN in oncology. The goal is to identify core measures for screening, and to develop policy and practice recommendations for feasible, high-impact HRSN screening and measurement.
Healio: The group recommended screening people with cancer in four core areas to enhance overall care and well-being. Can you describe those assessment areas?
Biru: These measures include assessing transportation challenges to ensure patients can attend appointments; addressing housing security issues, such as homelessness or unsafe housing; screening for food insecurity to guarantee access to adequate nutrition; and assessing financial challenges related to treatment costs and lost wages. By identifying and addressing these fundamental HRSN, health care providers can offer more comprehensive support, fostering an environment in which patients can focus on their treatment and recovery with fewer obstacles.
Healio: How should screening be performed?
Biru: HRSN screening should be an integral part of clinical care, conducted as a discussion-based screening rather than a check-the-box exercise. Open-ended questions, empathy and cultural sensitivity are essential in these conversations, ensuring patients feel comfortable sharing their needs. Moreover, health care systems must invest in technology, staff capacity, training and education to effectively address challenges related to these patient needs. Policy changes, including reimbursement for HRSN screening visits and interventions, are crucial to incentivize health care providers to integrate these services comprehensively. Accreditation bodies and clinical practice guideline developers also should play a role in encouraging and supporting screening initiatives, thereby promoting equitable and holistic cancer care for all patients.
Healio: What should clinicians do when deficiencies or concerns are identified?
Biru: The working group recommends that clinicians take proactive steps when deficiencies or concerns are identified in any area of HRSN. For example, if transportation challenges are identified, clinicians should connect patients with available services — such as nonemergency medical transportation options — to ensure they can attend necessary appointments and treatments. If housing security concerns are identified, clinicians should facilitate connections to governmental and community resources that can provide temporary or stable housing solutions. If food insecurity is detected, clinicians should link patients to food assistance programs, local food banks or community resources that can provide regular access to nutritious meals. When financial challenges arise, clinicians should help patients access financial counseling services, provide information about available grants or subsidies, and connect them with organizations that can help alleviate the financial burden of cancer treatment.
Health care institutions should have ongoing partnerships with community nonprofit organizations, public service organizations and for-profit organizations to ensure any underlying HRSN are addressed. This may include providing parking credits or public transportation vouchers, referring to and expediting access to temporary housing or food banks, or educating patients about how to navigate insurance hurdles.
Healio: Why are these proactive steps so important?
Biru: Screening without a follow-up action to alleviate or address the problem will lead to added mistrust of the process and will have negative consequences. By taking these proactive measures and offering tailored support, clinicians can significantly improve patients' overall well-being and increase their ability to focus on their treatment journey.
Healio: What else can clinicians do?
Biru: Practicing oncologists and oncology providers can be crucial in supporting patients with inadequate social support or challenging home situations by adopting a holistic and patient-centered approach. Health care providers can collaborate closely with social workers and patient navigators to comprehensively assess patients' social support systems and home environments. Establishing regular communication channels with social workers enables the identification of specific needs and allows for timely interventions.
Health care providers can further facilitate support group referrals, encouraging patients to connect with others who face similar challenges. These support networks can provide emotional assistance, practical advice and a sense of belonging, mitigating feelings of isolation.
Additionally, oncology providers can engage community resources — such as local charities, religious organizations and nonprofits — that offer assistance with transportation, housing, food and financial aid.
Educating patients and their families about available resources is vital. Ensure that patients are aware of government programs, community services and charitable organizations that support people with cancer.
Healio: Do you have advice for how clinicians should approach conversations about health-related social needs?
Biru: Maintaining open and empathetic communication is essential. Oncologists and providers should create a safe space for patients to express their concerns and challenges. By actively listening and showing genuine empathy, health care professionals can better understand patients' needs, enabling them to offer tailored support and connect them with the appropriate resources, ultimately enhancing patients' overall well-being during their cancer journey.
Healio: Is there anything else you want to emphasize?
Biru: Clinicians should receive training in culturally sensitive care and cultural humility, being open to understanding their patients’ diverse backgrounds and beliefs. This awareness is vital when dealing with HRSN issues, as cultural differences can influence how patients perceive and access support services.
Partnerships with community leaders and organizations are essential. By collaborating with local community leaders, clinicians can gain valuable insights into the specific challenges their patients face. This collaboration can lead to the development of targeted programs and interventions that are culturally relevant and accessible.
Clinicians and health care organizations can play a vital role in advocating for policy changes at local and national levels. This can focus on affordable housing, workers' rights, paid leave or improved public safety. Addressing these systemic issues can significantly reduce the burden on individual patients.
Lastly, ongoing research and data collection are essential. By continually studying the impact of various social determinants on patients' health outcomes, providers can refine their approaches and interventions. Data-driven insights help tailor support services and interventions to the specific needs of different communities, ensuring more effective outcomes.
For more information:
Yelak Biru, MSc, can be reached at ybiru@myeloma.org.
Reference:
- National Comprehensive Cancer Network. Measuring and addressing health-related social needs in cancer. Available at: https://www.nccn.org/docs/default-source/oncology-policy-program/HRSN-WG-Recommendations.pdf. Accessed Jan. 5, 2024.
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