Identifying Individual Social Determinants of Health Could Reduce Barriers to Breast Cancer Care

Patients with breast cancer from marginalized communities and individuals from resource-poor regions face many challenges at both the patient and institutional levels that impact the quality of their care, according to Samilia Obeng-Gyasi, MD, MPH, who added that these barriers to care limit and worsen patient outcomes.

“[Barriers to care exist] not just at the patient level. There are also barriers at the institutional level, which can sometimes prevent patients from accessing care or participating in their care in ways that they find meaningful,” Obeng-Gyasi explained.

In an interview with OncLive^®, Obeng-Gyasi discussed the impact of social determinants of health on breast cancer care; highlighted disparities in access to care and treatment outcomes due to socioeconomic factors; and emphasized the importance of recognizing the inequities that form in individuals from resource-poor backgrounds.

Obeng-Gyasi is a surgical oncologist, an assistant professor in the Division of Surgical Oncology at The Ohio State University (OSU); and a member of the Cancer Control Program at OSU Comprehensive Cancer Center (OSUCC)—James in Columbus.

OncLive: How do social determinants of health, such as socioeconomic status, influence the prognosis and treatment outcomes for patients with breast cancer?

Obeng-Gyasi: There have been a lot of studies in this space, many of which have emerged over the past couple years since the COVID-19 pandemic. The pandemic showed us that there were significant inequities and disparities in terms of access to care, incidence of disease, and progression and mortality from disease.

It's been well established in both cancer and noncancer populations that individuals who are resource poor—meaning they don't have access to housing, food, transportation, and/or other social needs—are more likely to [present with] advanced stages of cancer. They are also more likely to not receive guideline-concordant care, and consequently, they have much worse mortality [compared with] their counterparts who are resource rich.

What are some specific challenges that these patients from marginalized communities face?

It's a combination of factors both at the patient level and at the institutional level. At the patient level, issues with access may have to do with social needs such as transportation and having someone to take a patient to an appointment. There can also be issues with health literacy and understanding the implications of medical decision-making, [which allow] patients to participate in your medical care.

At the institutional level, there can be [barriers] in place that make it difficult for people to access [information], such as having a website that's easily accessible or having systems in place where people can easily call and make appointments. These are all institutional things that prevent people from being able to access health care. Interpersonal relationships between providers and patients, cultural competency, and language that encourages inclusivity [all] provide patients with knowledge that they can utilize an understanding to help their decision-making.

What are some examples of interventions or strategies aimed to address social factors that impact these outcomes?

One of the biggest changes that we have [implemented] is that for all inpatients, we are required to collect information on social determinants of health. Previously, this wasn't routinely done. This is going to be impactful because now we're recording issues patients are facing regarding food insecurity, financial toxicity, or financial hardship. We are also recording things like stress. We are asking patients about the world that they live in [to evaluate the role of stress] on their disease. This is going to help us understand patients a little bit better, but more importantly, it will allow us to provide resources and services that can help patients as they try to navigate whatever illness they may have.

Another thing that has helped is patient navigation. Navigators are individuals who, essentially, shepherd or help patients through the health care system. They provide them with access to resources and in some centers, for example, even go to some of their appointments with them, depending on how the center is structured. [Navigators] help patients understand the process of navigating a complex health system, providing them with resources. This includes aid for transportation or giving them access to grants that may help offset the cost of utilities, essentially addressing their social needs so they can participate in their care in ways that are meaningful to them.

How do you navigate cultural or language barriers when communicating with patients from diverse backgrounds? How do you ensure that they receive equitable care?

Although I don't have expertise in terms of cultural or linguistic competency, the way to circumvent that is to provide trainings. There are experts who can help people with cultural competency, and there are also experts in health literacy and language who can help health systems [develop] ways for patients to feel included and understand what's happening to them with their health care.

Having people with expertise in [cultural and linguistic competency] train your staff is going to be the way that you can help improve interactions with individuals from historically, unintentionally excluded patient groups.