Social Determinants of Health in Cancer Care

American Society of Clinical Oncology (ASCO)
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Social Determinants of Health in Cancer Care

ASCO presents Social Determinants of Health in Cancer Care, a podcast series in which oncologists, patients, advocates, and other thought leaders in health equity, turn a spotlight on actionable methods to provide equitable access to cancer care despite nonbiological factors.

  1. 04/12/2023

    Global Health Equity: Women, Power, and Cancer: A Lancet Commission

    In this episode, guest host, Dr. Christopher Cross, Director of Global Health Equity Strategies at ASCO moderates a discussion with the Dr. Ophira Ginsburg Co-Author of the Lancet Commission on women, power, and cancer and Dr. Julie Gralow, an advisor to the Commission.  Dr. Ginsburg and Dr. Gralow share their insight into social determinants of health in cancer and prevention among women and global efforts underway to advance health equity. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Christopher Cross: Welcome to ASCO's Social Determinants of Health in Cancer Care Podcast. I'm Dr. Christopher Cross, Director of Global Health Equity Strategies at ASCO. I'm joined by Dr. Ophira Ginsburg, Senior Advisor for Clinical Research Center for Global Health at the National Cancer Institute, and Dr. Julie Gralow, Chief Medical Officer, and Executive Vice President of ASCO. In this episode, we will discuss social determinants of health, focusing on women, cancer, and prevention. Thank you both for being a part of our podcast, we're excited to have you on. Dr. Ophira Ginsburg: Thanks so much. My pleasure. Dr. Julie Gralow: Thanks, Chris. Dr. Christopher Cross: So, we'd like to start the conversation with asking our guests, how do you define social determinants of health and cancer care? Dr. Ophira Ginsburg: Well, social determinants of health, according to the World Health Organization, I'm sure as you know, is really looking at a person's background that leads them to health inequities or health inequality. So, it has to do with the conditions under which people are born, how they develop, grow, live, work, age, and all the sort of forces and systems that shape their daily living conditions. With respect to the interaction of women and cancer with respect to the social determinants of health, as we put forward in our commission report, really, gender has an influence on all of these factors. And not just gender, but the other intersectional aspects of a person's identity that can serve to compound and influence in a negative way their opportunities to understand what their risks of cancer are, to avoid those risks, to seek and obtain respectful, prompt, timely quality cancer health services. And this also influences the way in which women interact with the health systems for cancer as care providers, whether it's clinicians, et cetera, or also, is the unpaid caregivers, as we sometimes call them, informal workforce. There's nothing informal about it. Dr. Julie Gralow: And I would agree with the Ophira's definition. I think of it as the environment in which people are born, live, learn, and work, and how it impacts health. And so, that can include economic stability, education access and quality, healthcare access and quality, the neighborhood and the environment in which the person lives. And then the social community context, the family, the relationships, all of those can combine to impact health. Dr. Christopher Cross: Thank you for those responses. What does social determinants of health for women mean at a global level, Dr. Ginsburg? Dr. Ophira Ginsburg: Global is local. So, we see social determinants of health, and by the way, also commercial determinants of health, which would be wrong not to include in this discussion as greatly impacting the aspects of opportunities to seek and prevent cancer, et cetera, everything we just discussed; this happens also on a global level. So, as we show in our commission report where a woman lives does greatly influence cancer incidents, mortality, survival, and also, very importantly, who that woman is in her community. Whether she's living in a circumstance situation or there are identity factors that render her structurally marginalized will impact also on her lived experience of cancer. And we have nine stories that highlight and offer some human aspect to what people are going through, whether they're care providers or women living with the experience of cancer on a personal level, the different countries and context in our report. Dr. Julie Gralow: With respect to social determinants of health and women, particularly at a global level, I think women interact with cancer in so many ways. I mean, the easy way to think about it is women with a diagnosis of cancer, but we've also got women working to reduce their risk of cancer and detecting it early. We've also got women in the workforce, health professionals, researchers, we've got women as policymakers, and in the home environment, we have women as caregivers. And they are much more frequently the decision makers for everybody in the family with respect to healthcare related issues. So, women interact with cancer in so many different ways, and those social determinants of health mean that women are more commonly subject to discrimination. It can be discrimination due to their gender, but also, their age, their race, their ethnicity, their socioeconomic status. And as Dr. Ginsburg has pointed out that this can marginalize them. And these factors can restrict a woman's rights and her opportunities to reduce her risk of getting cancer. And it can be a barrier to early diagnosis to achieving quality cancer care. And we've got this whole (which is really predominantly portrayed in there) unpaid caregiver workforce that is almost all female around the world. And this can hinder a woman's professional development as well. Dr. Christopher Cross: When you were talking, Dr. Gralow, it made me think of hearing about the story of the former First Lady Rosalynn Carter. Her father passed away when she was around 13 or 14 from cancer, and she said she had to become the caregiver as like the oldest sibling. And talking about that in wake of her passing, in her advocacy for mental health and caregiving, I think is right along this conversation that people may not be experts as you two are, but they have lived experiences where they've had to step into these roles. And so, thank you for bringing to light the global context. Like you were saying, Dr. Ginsburg, local is global, and I think this is something that everybody can relate to. Now, let's get into the work that you both are doing. Can you tell our audience about Women, power, and cancer: A Lancet Commission and your role and any of the key findings you may want to highlight? Dr. Ophira Ginsburg: Yeah, I'm happy to take that one on. To start with, I was very fortunate to have a conversation with the editor-in-chief of the Lancet, Dr. Richard Horton, several years ago now, three years ago actually. And we at that time, were making kind of note of where we were at some three years after the publication of a three-part series called Health, Equity, and Women's Cancer that was published in the Lancet that was specifically oriented around breast and cervical cancer, and the difficulties and challenges women have in obtaining equitable access to care. And to some extent, we commented on what we don't know about, for example, the children that are left behind when a woman dies of one of these cancers. And we emphasized the importance of more research in that area. This led to my pitching proposal for a commission, and this was approved, and we published an initial commentary (Richard and myself) in July of 2020 that led to the commission that we now have as a major report in the Lancet that was published on September 27th, and excited to speak about that. I might just emphasize a couple of key data points in the report that I think the listeners would be interested to know. Well, for the first time, we were able to show the number of women's lives that could be saved if just four risk factors were addressed. So, we found that 1.3 million women's lives would be saved if tobacco, alcohol, obesity, and infections could be controlled. Now, why is this important for women? Well, it's important for men as well, and I know people often ask, “Why did you focus on women?” We can get to that if people are interested. But to emphasize the importance of the preventability and lack thereof, we know what is contributing to a large proportion of cancer in women, but what many people don't know is what the numbers actually show with respect to premature mortality and how that relates to maternal orphans, that I just mentioned that hadn't been really addressed before. So, when you look at the number of men and women with cancer, it's roughly equal. It's almost 50/50. Now, men are more likely to die of cancer than women. About 44% of all cancer deaths occur in women, so it's not that much less. But when you look at the number of women experiencing cancer under the age of 50, in 2020 alone, of the 3 million adults diagnosed with cancer, two in three were women. That was a data point hiding in plain sight, we produced that. That was published in advance of this report in the Lancet Oncology with a few of us on the commission. And then in the commission report, we really dug into the preventability of premature deaths, and we found that 1.5 million women could be spared, a death under the age of 70 due to cancer if everyone had access to primary prevention and early detection strategies that we know work and we know exist. And another 800,000 women's lives could be saved premature deaths below the age of 70 if every woman everywhere diagnosed with cancer had access to optimal care. In 2020 alone, 1 million children lost their mothers due to cancer, just that year. And when we looked at the prevalence, so the number of kids who were without their mothers who were still children in 2020, it's seven and a half million. This was work done by our colleagues at IARC, Dr. Valerie McCormack group, and many of us were on that report as well. So, these are big numbers and I think that's what's gotten people talking about this. Dr. Julie Gralow: I was fortunate to be invited by Dr. Ginsburg early in the formation of this commiss

    33 min

  2. 06/11/2023

    Social Determinants of Health at the Global Level

    In this episode, guest host, Dr. Surendra Shastri is joined by Dr. Timothy Rebbeck to discuss social determinants of health at the global level and the impact on cancer care, prevention, and control. Dr. Surendra Shastri is a Professor, Department of Health Disparities Research at MD Anderson Cancer Center. Dr. Timothy Rebbeck is the Vincent L. Gregory Professor of Cancer Prevention at the Harvard T.H. Chan School of Public Health and Professor of Medical Oncology at Dana-Farber Cancer Institute. Professor Rebbeck also serves as the director for the Zhu Family Center for Global Cancer Prevention Harvard TH Chan School of Public Health and the Center for Cancer Equity and Engagement at Dana Farber Harvard Cancer Center.  TRANSCRIPT  The guest on this podcast episode has no disclosures to declare. Dr. Surendranath Shastri: Hello everyone. Welcome to ASCO's Social Determinants of Health in Cancer Care podcast. My name is Surendranath Shastri and I serve as Professor in the Department of Health Disparities Research, the Division of Cancer Prevention and Population Sciences at the MD Anderson Cancer Center. Joining us today is the very renowned Dr. Timothy Rebbeck, who serves as a Professor at the Dana-Farber Cancer Institute and Harvard T.H. Chan School of Public Health. In this episode, we will discuss social determinants of health with a global perspective and what impact those have on cancer care in general with a little specific attention to cancer prevention and control.  Thank you, Professor Rebbeck, for agreeing to be a part of our podcast.  Dr. Timothy Rebbeck: Happy to join you today.  Dr. Surendranath Shastri: Thank you very much. We are really blessed to have you on this podcast. So let's get the podcast rolling. We would like to begin the conversation with a simple question: How do you define social determinants of health in cancer care, particularly those in prevention? Dr. Timothy Rebbeck: So I think the definitions that we need to be thinking about are really very specific to the questions we're trying to address. So there are many ways one could define social determinants. They are generally, in the United States at least, consequences of the legacy of historical, political, economic, and social influences, particularly for minority populations; those of the legacy of slavery and other related discrimination and segregation activities that have happened over many, many years and centuries, really. So that's not really an answer to how we define it, but I think that way we define it in terms of the research question or the clinical or public health question, and that using those variables that we define, we should be able to identify different groups who have specific needs or for whom we need to create interventions or prioritize activities to eliminate disparities.  Dr. Surendranath Shastri: So speaking about social determinants of health in cancer care, particularly in the US, looking at the global perspective, I'm sure you'll agree that the social determinants might not be the same for people living in the US as compared to, say, people living in countries in South America or people living in Asia. So let me ask you a direct question pertaining to your work because you have been working globally and you have a lot of multicentric studies: Have you seen real life differences in social determinants of health based on geography and country in some of your multicentric studies? For example, you have this very large score study where you're looking at population groups of different backgrounds. So something like that?  Dr. Timothy Rebbeck: Yes, absolutely. I would say that the categories or domains of social determinants are not fundamentally different in different parts of the world. They all involve things like access to care, insurance and payment, education and knowledge, things like that. Those are common to anywhere in the world. But the manifestation of those social determinants is really quite different in different parts of the world. So we can assume that a lot of the same factors are acting, but they are magnified in places that are low resource because the health systems and the governmental payer and care systems are quite different. The specific activities or limitations, barriers, vary by country or system. And so I think that we can think about the same problems as being universal worldwide, but the manifestation and specific things that we need to address in a particular region or country will vary quite a bit.  Dr. Surendranath Shastri: Understood. So you would also agree that even within the same country, you will find huge disparities between populations and between people of different social classes if I'm permitted to say that? Dr. Timothy Rebbeck: Yeah, absolutely. And so, not unlike what we see in the United States, there are people that can afford access to the very best health care in the entire world. In Africa, for example, where I do a lot of my work, the very wealthiest people can get on an airplane and fly to France or England and get their care there. And the poorest in the United States or in Africa or South America have significant barriers to obtaining the best care. And in fact, in places like Africa low resource countries, the care is, maybe for the lowest socioeconomic groups, the lowest income groups in those countries, the barriers are really substantial and probably lead to the incredibly late diagnoses, high mortality rates that you see in a lot of low and middle income countries.  Dr. Surendranath Shastri: Absolutely. I completely agree with you because even in my personal experience, there are a couple of countries in sub-Saharan Africa which have maybe just one or two pathologists and just general pathologists - they're not even cancer pathologists.  So, it's tough for them to access good quality health care.  So I have read some of your work, and you speak about neighborhood, social and natural environment. Could you explain that a little bit?  Dr. Timothy Rebbeck: Yeah, I think that when we think about environmental as an exposure, there are a lot of different classes of what environment could mean. And again, it depends a lot on the question, the goal that we have in defining these different characteristics and what we want to do to ameliorate disparities. So most environment that we tend to think about is individual level exposures. So radon exposures or cigarette smoking or sunlight, whatever those may be, we think about individual level exposures. And those are, of course, incredibly important.   But I think that there are other levels of exposure that we might want to explore. One of those is the neighborhood and contextual environments that are all around us. So where we live has an impact on our health, and particularly in the context of disparities, the neighborhood in which you live may determine your access to care. It may determine your access to healthy food. It may determine exposure to pollution, all kinds of levels that we may or may not be able to measure in a person, but we can measure in a neighborhood or an area context. Thinking about those gives us an additional layer of information about the kinds of risks people face as a group or as a neighborhood. And very importantly, they allow us to think about policy solutions. So if we can identify types of areas, say very polluted areas or areas that have very poor access to health care, those areas can be identified as having a particular need, and that need might be able to be addressed by policy or funding or things like that. And again, I would say that's true in the United States, but it also is true in Africa or India or South America or any place where neighborhood exposures and neighborhood level factors vary, which they do everywhere. So we can learn from that, and particularly we can learn to make policy decisions. Dr. Surendranath Shastri: Absolutely. We have large slums in many parts of Africa, as well as Asia. In India and South Asia particularly, you have large slums. You have large slums in Indonesia. So all those neighborhoods in the US—of course, you just mentioned, and the red line districts were historically denied all possible care and facilities - those districts also will be having all these problems. One example that immediately comes to my mind in the US is the smoking rates are very high among the African American Black people. Neighborhoods where you have a majority of African American Black people living, the second hand smoke exposure rates are going to be really very high. Is that what you meant by saying neighborhood social? Dr. Timothy Rebbeck: Yes. So that's part of it. I mean, I think that individual level smoking exposures may affect the individual and may affect people in their household, but there are larger level factors that are acting. So, for example, tobacco companies target neighborhoods based on who lives there. It's not uncommon for a tobacco company to have offers for cigarettes, coupons, and vouchers that will be used in neighborhood stores in low resource neighborhoods. They will target their advertising.  For example, we know that African Americans tend to smoke menthol cigarettes more than other kinds of cigarettes, and that's really been a consequence of advertising and targeted marketing by tobacco companies to specific groups of people in specific neighborhoods. So there's all sorts of different levels at which neighborhoods are disadvantaged because of the socioeconomic position they're in, of historic segregation, redlinings, other social determinants, and also the targeting by companies or businesses around specific neighborhoods as well. So there's a lot of levels at which these impacts are occurring. Dr. Surendranath Shastri: Excellent examples, and I've personally seen all of those, so I know exactly what you're talking about.  So another interesting area where you're work

    19 min

  3. 02/10/2023

    Community and Organizations Addressing Food Insecurity

    In this episode guest host, Dr. Reggie Tucker-Seeley, moderates a discussion with two leaders from two remarkable organizations with the mission to provide food to those that are facing long-term illnesses like cancer.  In this episode,  the importance of the community and organizations addressing food insecurity and providing needed interventions are highlighted by Alissa Wassung, Executive Director at Food is Medicine Coalition and Alyssa Baldino, Associate Director of Nutrition Services and Therapeutics at Project Angel Food. TRANSCRIPT  The guest on this podcast episode has no disclosures to declare.  Dr. Reggie Tucker-Seeley: Welcome back to ASCO's Social Determinants of Health and Cancer Care podcast. I am Dr. Reggie Tucker-Seeley. We are continuing our conversation on “Community and Organizations Focused on organizations addressing Patient Needs in the Cancer Community.” I'm joined by Alissa Wassung, Executive Director of Food Is Medicine Coalition, and Alyssa Baldino, Associate Director of Nutrition Services and Therapeutics at Project Angel Food. In this episode, we will discuss a patient and household need that often gets overlooked following a cancer diagnosis, and that is food insecurity. We are fortunate to be joined by two people from amazing organizations with a mission to provide food to those that are facing long-term illnesses. First, we have Food Is Medicine Coalition, which is a national organization that provides evidence-informed medical, food, and nutrition interventions to critically and chronically ill people while working to advance public policy surrounding food and nutrition. And second, we have Project Angel Food, located in Los Angeles, California, and is a part of the Food Is Medicine Coalition, which prepares and delivers healthy meals, comfort, and hope to people impacted by serious illness.  So, given that both of our guests today are named Alyssa, we're going to say Alyssa B and Alissa W to distinguish between our two guests. So, thank you both for being part of our Social Determinant of Health conversation focused on communities and organizations. Alissa Wassung: Thank you so much for having us. We're so excited to be here. Dr. Reggie Tucker-Seeley: Great. Let's dive right in. And this first question is one that we ask all of our guests, and that is: What does Social Determinants of Health in cancer care mean to you? We'll start with you, Alissa W. Alissa Wassung: I would have to say that it means making sure that everyone who is coping with cancer has everything that they need to survive and thrive through the process. From our perspective as caregivers in the community for over 40 years, a lot of this knowledge and wisdom comes from our roots in the HIV epidemic and seeing how the toll of illness can take on a person and also their caregiving structure, that it affects the whole family. So really, having that holistic, person-centered view of what wellness and health means through a diagnosis like cancer, making sure that we are showing up for the food piece and paying attention to the rest of it as well. Alyssa B? Alyssa Baldino: I've been a dietitian for nearly 15 years, and someone's ability to manage their chronic illness is so heavily influenced by their environment and the resources available. So, education is obviously a good building tool to help someone work within their resources, but it only goes so far. So, the more holistic you look at, especially cancer clients, the better you can help someone, the more you understand all the outside factors that affect their lives. Dr. Reggie Tucker-Seeley: Thank you for providing those perspectives. Social Determinants of Health feels like such a broad term. It's often described as where we live, learn, work, and play, and that's everything. So, would you consider food insecurity as a social determinant of health? Alissa Wassung: Absolutely. The ability to nourish oneself as you are supporting your own body through treatment and recovery is foundational to what we understand about health. I think what's different for our organizations is that food insecurity can be reduced to hunger. And certainly, our programs, medically tailored meal and medically tailored grocery programs that also provide the services of a registered dietitian that helps people with the education piece and some of the more clinical pieces like what's called medical nutrition therapy, are so much more than just addressing the hunger piece. So, food insecurity is absolutely a social determinant of health. So, in a spectrum, I would say food insecurity can be really addressed in the prevention phase and what we are doing is more on the treatment side of that food insecurity spectrum. Alyssa Baldino: Education as registered dietitians is so powerful and can be a great tool for clients. But as a medically tailored meal provider, it's also empowering to be able to provide the food we are educating clients to nourish themselves with. So, in addition to the education piece through medical nutrition therapy, we're also able to provide the food as a resource to help address the treatment and the food insecurity.  Dr. Reggie Tucker-Seeley: So, it sounds like both of your organizations go well beyond just the notion of checking the box of "Are you hungry, are you food insecure, yes, or no?" I'd love to hear more about your organization. So, Alissa W, can you tell us a bit more about Food Is Medicine? Alissa Wassung: The Food Is Medicine Coalition's history is really the history of our partner agencies, and so many of them got their start, as I briefly mentioned before, at the height of the AIDS pandemic back in the 1980s. And this was a time when HIV was not as understood as it is today. It was tremendously stigmatizing, and it was scary for some. Our communities across the country stepped into that space and brought hope and dignity to that situation in a time when there wasn't a lot of service available for folks. This was volunteers going into people's homes and bringing them food, as they recognized the effects of HIV, which included wasting, and tried to help people be as healthy as they could be when there was no treatment available.  The biggest realization during this time was that folks in this situation needed more than just access to food. They were too sick to shop or cook for themselves. And so, people were delivering groceries and they got left on the counter and just stayed there. And so, the recognition that people needed more than a meal, they needed meals tailored for their illness and delivered to their home so that they could live as long as they could with the illness that they had. Registered dietitians were actually foundational to this process because their services and understanding how to combat wasting or side effects of medication when it came on the scene was foundational to people actually eating. Appetite tends to be one of the first things to go when someone is sick, and that is certainly true in cancer care. And so fast forward to a time when most of our agencies expanded their missions, now serving people living with multiple illnesses in communities across the country. What's very different about our clients is that they actually tend to be living with multiple illnesses at once. So, a client where I used to work at God's Love We Deliver, which is our non-sectarian, nonprofit peer agency in New York City, about 40% plus or so of folks were living with four or more illnesses at once. So very much trying to address the complexity of that situation with access to compassionate nutrition care.  We do all of this in the community with the help of thousands of volunteers a year and the support of our communities through philanthropy. Because despite the awesome intervention and its life-saving results, there still is no dedicated federal funding for what we do.  Dr. Reggie Tucker-Seeley: I'd love to hear from Alyssa B. Alyssa Baldino: We were founded 35 years ago by Marianne Williamson. That name might sound familiar. As Alissa W. was saying, we started out of the HIV/AIDS epidemic. We started out to provide food for people who didn't have food. They needed a lot of calories, and as medications got better for HIV/AIDS, about 20 years ago, we shifted to medically tailored meals and started providing meals to, actually cancer patients was one of our first groups that we started providing medically tailored meals to. And then kidney disease is something we address, diabetes, heart disease. And usually how patients find us is through their doctor and also, I like to think we're pretty well known in Los Angeles. We have a lot of celebrity support that gets our name out there. Harry and Meghan made deliveries for us. Like Alissa was saying, volunteers, so we have the spectrum of volunteers. Patients are generally referred to us from medical providers and a lot of the cancer centers. Dr. Reggie Tucker-Seeley: Well, in two words, you mentioned Harry and Meghan. If you just have to say their first names, then you know that they're famous. So that's amazing.  I'd like to talk about how both of your organizations partner with healthcare delivery systems and healthcare organizations. Can you talk a little bit about how you partner and whether or not you're housed within healthcare systems or you're outside of healthcare systems? We'll start with Alissa W.  Alissa Wassung: Oh, my goodness, what an incredible question. That would only take us about five hours to discuss, so we'll try to keep it brief. So FIMC is an organizing entity. We organize service providers, so we don't provide service specifically, but we know a lot about how best to provide service. So, we gather together, as you heard earlier in the podcast, to advance equitable access to medically tailored meals and medically tailored groceries through policy change, research, and evaluation, and best practices. The way that that translates into ou

    32 min

  4. 04/09/2023

    Community and Organizations Addressing Financial Toxicity - Part 2

    In this Part 2 episode guest host, Dr. Reggie Tucker-Seeley, discusses the importance of the community and organizations meant to address the social needs of patients as they navigate their cancer journey and the financial burden on the household following a cancer diagnosis. Dr. Tucker-Seeley is joined by Carla Tardif, Chief Executive Officer at Family Reach and Eucharia Borden: Vice President, Programs and Health Equity at Family Reach, whose mission is to remove the financial barriers standing between cancer patients and their treatment.  TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Reggie Tucker-Seeley: Hello and welcome to ASCO's Social Determinants of Health and Cancer Care podcast. I am Dr. Reggie Tucker-Seeley, Vice President of Health Equity at Zero Prostate Cancer and Chair of ASCO's Health Equity and Outcomes Committee. I'm joined today by Carla Tardif, chief executive officer at Family Reach, and Eucharia Borden, vice president of programs and health equity at Family Reach.  In this episode, we will discuss the importance of the community and organizations meant to address the social needs of patients as they navigate their cancer journey. There are many needs that cancer patients face and one of the biggest is the financial burden on the household following a cancer diagnosis.  We are lucky to have two change makers from the organization Family Reach with us here today. Family Reach is an organization in Boston, Massachusetts that dedicates their work to removing financial barriers with financial education, financial planning, resource navigation, and emergency funds to patients and caregivers.  Dr. Reggie Tucker-Seeley: So there is a discussion in healthcare services research now about whether the service to meet some of those patient social needs should be within the healthcare organization or the system, or whether community organizations should address those. And so, as a patient-focused organization, how does your organization partner with healthcare practices and systems? Carla Tardif: Yeah, so that's a great question. There is not one answer. We all have to be involved in this conversation. We all have to be able to step in with financial resources, having the conversation to normalize the conversation around finances and health. One of my north stars is to make financial health a standard of care because it affects your care so much. So, yes, patients need to hear about it in the healthcare system. We partner with over 1000 cancer care centers in this country, working with over 4000 oncology social workers in those hospitals. We give them our financial education program. They have access to an online portal to talk to my team of licensed social workers and resource navigators. That is a really critical intersection with the patient.  And we partner with nonprofits, as Eucharia shared, throughout the country who are working with patients because many patients do not feel comfortable talking about their finances in the healthcare system. How is this going to affect my care? Will I get a generic drug? Will I be invited to a trial? So they say nothing. If a parent has a child with cancer and a social worker sees that they cannot provide for their children, they could actually lose their children. The children could be removed from the home. This is the fear in talking about your finances in the healthcare system.  So the advocacy organizations outside the healthcare system play a critical role in trust, as Eucharia said as well. Many of them are under-resourced. Many of them don't have the financial interventions that we have. So that partnership is critical. Then we have our website. So many people are just googling, looking up on the internet to take matters into their own hands - “How can I get financial support? How do I figure this out? Where do I get help?” So the answer really is every one of us needs to be educated and armed with the resources and the financial assistance to support patients when they have the courage to ask for help and to raise their hand that they're in trouble. Dr. Reggie Tucker-Seeley: Are there infrastructure needs that policymakers could address here? Because it sounds like there are just so many holes in our social safety net that people are falling through. But how can policymakers help us address this issue? Eucharia Borden: That's a loaded question, but it's a good question and it's a question that we do need to be asking. Carla is a part of the Cancer Moonshot and this is certainly something that's being discussed at that level on a number of fronts. But also as we think about the fact that people are living in different states and different counties in different jurisdictions within those counties, one of the things that is so important but so often overlooked is the power of advocacy. I think we jump to policy immediately, but I always like to think about advocacy with a big ‘A’ and a little ‘a’ because they're different but both relevant.  So if we think about advocacy with that big A, those are those big policy initiatives, things that are moving legislation forward and that kind of thing. But there's also advocacy with a little a. But it doesn't mean that it's less important, it just means that it doesn't rise to that level, perhaps of like a big policy or legislative initiative that moves forward. But what about the advocacy that can happen in communities? Because sometimes that's the thing that we really need to be doing, even as we think about something like Medicaid expansion, not something that every state did, and so even as you try to address that, well, that's going to be state dependent.  As we enter into these spaces where we think about policy, we need to think about the varying levels of that policy work that occurs. But also this is another place where we don't need to cut out patients and their families. They are some of our best advocates for change because they bring that human element to whatever conversation they're a part of, just like we're doing here, to humanize a term like financial toxicity. So there are so many grassroots ways that people can be involved and I think they should be involved. Carla Tardif: We saw after COVID there were a lot of relief programs. SNAP benefits were expanded and housing relief and mortgage forbearance. So these are things that we had been talking about pre-COVID. It was a heavy lift and I was told we were out of our lane and I was out of my lane. I mean, I'm just sitting here shaking the trees saying, “This is what we're seeing. We've got to do something about it.” “We can't.” COVID hit “You can! We've seen it! There it is!” So that gives me some hope. So the data we are collecting, all of these programs, all of these intersections, we are really unearthing data to tell this story.  When they just cut the SNAP benefits back, we were inundated with cancer patients who are food insecure because they've lost that. COVID is over but cancer is not. And all of the things people were afraid of was COVID - fear of getting sick, isolation, job loss, housing insecurity, food insecurity, that's cancer. Those programs need to continue for the cancer community. It will affect survival rates. So policy is important. Dr. Reggie Tucker-Seeley: One of the themes that's been woven through this conversation is the shame that families may be feeling as they are attempting to manage the financial burden of having cancer and the financial toxicity that comes with that. Do you find that patients are open about discussing their social needs and are they more likely to discuss their needs with their physician or do they prefer to have this discussion with a social worker or other members of the care team or administrative staff? Eucharia Borden: No, not all patients are open about discussing their social needs. Not even just their financial needs but even their more broad social needs. However, when they are, they tend to discuss their needs with the members of their team that they feel most comfortable with. So these are people that they've started to feel like they can trust or people that they begin to understand sort of what their roles are and they think well maybe this is the person I should talk to because they've started to build relationship with them. But the reality is that different kinds of needs are discussed with different team members. It's just kind of how that works.  Some patients are very much unaware of who is actually a part of their treatment team. Because, as you think about someone bringing up a need, well, maybe they didn't know that they had an oncology social worker on their team because they didn't have a need that the other team member they were talking to thought rose to the level that they needed to talk to an oncology social worker. In fact, I often had the experience as a licensed clinical oncology social worker for people not even knowing that I'm part of the team. And when they did find out that I was part of the team they had no idea what I actually did.  Because if we go back to that conversation about systems, social workers are a part of many systems and unfortunately we are a part of systems where we're there when there are just problems. People think we're there just to take children. We're there to do those unpleasant things that are sometimes necessities. But I remember a patient coming to my office one day, quite unhappy about being sent to my office. Knocked on my door and came in, literally with her arms folded, sat down, and said, “My surgeon sent me to you, but I don't need a social worker. So I don't know what I'm here for. But why don't you tell me what you can do for me?” And I said, “Well, why don't we talk about why your surgeon sent you to me?” That's where I had to start that conversation because that's what she came in with. “I'd heard this term social worker. I

    23 min

  5. 07/08/2023

    Community and Organizations Addressing Financial Toxicity - Part 1

    In Part 1 of this episode guest host, Dr. Reggie Tucker-Seeley, discusses the importance of the community and organizations meant to address the social needs of patients as they navigate their cancer journey and the financial burden on the household following a cancer diagnosis. Dr. Tucker-Seeley is joined by Carla Tardif, Chief Executive Officer at Family Reach and Eucharia Borden: Vice President, Programs and Health Equity at Family Reach, whose mission is to remove the financial barriers standing between cancer patients and their treatment.  TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Reggie Tucker-Seeley: Hello and welcome to ASCO's Social Determinants of Health and Cancer Care podcast. I am Dr. Reggie Tucker-Seeley, Vice President of Health Equity at Zero Prostate Cancer and Chair of ASCO's Health Equity and Outcomes Committee. I'm joined today by Carla Tardif, chief executive officer at Family Reach, and Eucharia Borden, vice president of programs and health equity at Family Reach.  In this episode, we will discuss the importance of the community and organizations meant to address the social needs of patients as they navigate their cancer journey. There are many needs that cancer patients face and one of the biggest is the financial burden on the household following a cancer diagnosis.  We are lucky to have two change makers from the organization Family Reach with us here today. Family Reach is an organization in Boston, Massachusetts that dedicates their work to removing financial barriers with financial education, financial planning, resource navigation, and emergency funds to patients and caregivers.  Thank you both for being a part of our Social Determinants of Health podcast series in this episode focused on community and organization. Carla Tardif: Thank you for having us. Dr. Reggie Tucker-Seeley: Let's start the conversation with the question that we like to ask all of our guests. What does social determinants of health and cancer care mean to the both of you? Carla Tardif: It's a great question and there are so many buzzwords now around this topic, so I really appreciate the opportunity to even define some of them, like social determinants of health, like financial toxicity, like health-related social risks and how are they different and what do they mean. We talk about social determinants of health being more about societal impact on people according to where they are born, live, work, play, and pray. And we talk about financial toxicity as the financial impact that a cancer diagnosis has on a family. Financial toxicity is a word that we say often and that really is about cancer affecting your finances and your finances affecting your cancer. And what does it mean when work is stopped, income is cut, out of pocket expenses, the cost of care, and how does that affect your ability to access care and adhere to treatment which will affect your survival rate? And then I'll pass it to you Eucharia, because I love her definition of social determinants of health. Eucharia Borden: Thank you so much for having me here today. I think one of the first things that we need to put out there is that our professional language is full of jargon, and patients often don't understand things like social determinants of health, financial toxicity, what do these things mean to them? Which is why at Family Reach, we talk about meeting their basic needs, meeting their needs in areas like food, transportation, housing, and utilities, because that is also something that's important when you're approaching patients and working with patients who really do have financial toxicity - to make sure that you're on the same page with them about what their needs are and therefore what kinds of problems you're helping them to solve. Dr. Reggie Tucker-Seeley: My first question is for you, Carla. Can you take us to the beginning? How did Family Reach get started and what led you to work with this organization? Carla Tardif: Family Reach was started by two families out of New Jersey who both lost their child to cancer, pediatric cancers. And they saw firsthand spending so much time in the hospitals overhearing conversations that families did not have heat, they were being evicted, they were hungry, they couldn't pay to get out of the garage after they'd been there for weeks. So the families both saw this side of cancer and when their children passed, they got together and said, we need to do something about this. And they started Family Reach.  And how they started was they raised money. They did a golf tournament, and they took those funds back to the hospital social workers and said, this money is not for the hospital. This money is for the families that you interface with that we know are hungry, are in homes without heat, and cannot put gas in the car to get to and from treatment. That's how it started. They functioned like this as a volunteer organization, a pure labor of love for 12 years. And they had three hospital partners that they worked with in New York; New York Presbyterian, Memorial Sloan Kettering, and then Dana-Farber.  I lost a dear friend to brain cancer not long out of college. My friend Pat Kelly played in the NFL. He was diagnosed with brain cancer. He would bring Jets players through the pediatric floors to meet the kids, as so many athletes do. And Pat would call me to say the same thing. “Carla, I just saw a husband and wife fighting at the vending machine. They're so hungry, they have enough change for one snack, and they cannot agree on the snack. Do something.” He called me once because there was a single mother crying on the curb. Her two-year-old had brain cancer and she had no money to go pick her four-year-old up at preschool. And she was just scared and lost and done. So he kept calling me to tell me to do something.  A few weeks before he passed away, I went to say goodbye to him. I was holding his hand with a few of our college buddies in the room. He squeezed my hand, and said, “Look me in the eye and promise me you are going to fix this.” So clearly, having no idea what this was, I promised him that I would fix this. So I spent the next two years really searching, what is this? And I found Family Reach. And I approached them and said, told them my story, and said, “Can I help you? You have a model I can scale.” Work with the hospitals. They identify the families, pay bills directly, literally get in there and have a tangible impact on that day. So I spent two years meeting with families, meeting with social workers, doing grocery shopping, sitting in hospital rooms, really trying to understand this side of cancer that people don't talk about, where there is a lot of shame and a lot of fear, but clearly affects their ability to survive and affects the whole family. That was 16 years ago. Dr. Reggie Tucker-Seeley: 16 years ago. Speaking for the cancer community, we are so grateful that you have kept your commitment to your friend at the bedside.  Eucharia, you are the Vice President of Programs in Health Equity, and several organizations have created senior roles to lead health equity efforts, really to address some of those examples that Carla was mentioning. We know that cancer doesn't discriminate necessarily by socioeconomic circumstances, but the issues that Carla mentioned are disproportionately impacting certain groups. So what does health equity mean to you at Family Reach and what are your responsibilities in this area? Eucharia Borden: There are so many organizations that have created roles focused on health equity, some of them more specifically than others. Some of them are kind of rolled up into diversity equity and inclusion positions. Some are more specifically focused on health equity, and they're not the same I have to say. One of the things that I love at Family Reach is that so many people talk about doing the work, and we're actually doing the work. That's what's different about our health equity initiatives.  In fact, through our cancer equity initiative, we're actually meeting patients where they are. And as a social worker, meeting people where they are is something that's like Social Work 101. It's one of the first things they teach us. And then through the early days of the pandemic, this phrase of ‘meeting people where they are’ was suddenly mainstream, which is kind of surreal for me and other social workers because we're like, “Wait a minute, that's what we've always done!” And unfortunately, because it has become this mainstream term to meet people where they are, it's not actually happening all the time.  And so as I think about what health equity means for Family Reach, it means not just having actions that are performative, but to actually say, you'd like us to tell you about what our cancer equity initiative means. Let me give you the examples of how we're meeting Black and Hispanic patients in particular. Our cancer equity initiative, for example, is focused in two areas. One of those is through our community partners. And these community partnerships are partnerships that we form with organizations that are serving 90% Black or Hispanic patients with cancer.  And trust is the other thing that I have to bring into this conversation. It's really important to establish trust with the people that you're serving. Let's face it, like, you started us off with this question, Reggie, cancer doesn't discriminate, but many of the centers where people get their care, well, they do. And so even when it comes to seeking help. People are often not doing that for a variety of reasons, but one of those reasons is because, unfortunately, their system’s involvement, even before coming into healthcare, has taught them that systems are not set up for me, they're not set up to help me, they're not here to meet my needs.  And so what we've done is partnered in communities where people alread

    20 min

  6. 03/07/2023

    Data Gathering to Assess Patients Needs - Part 2

    In this episode, guest host Dr. Maysa Abu-Khalaf, Director of Breast Medical Oncology at Sidney Kimmel Cancer Center – Jefferson Health examines the role providers play in collecting social determinants of health data from cancer patients to assist with receiving the care they need. Dr. Abu-Khalaf is joined by Dr. Luis Raez, Co-Director of Memorial Cancer Institute of Florida Atlantic University and Whitney Renau, Patient Care Coordinator of Hematology and Oncology from North Florida and South Georgia Veteran Health Services. TRANSCRIPT The guests on this podcast episode have no disclosures to declare.a Dr. Maysa Abu-Khalaf: Social Determinants of Health in Cancer Care podcast. I'm Dr. Maysa Abu-Khalaf, Director of Breast Medical Oncology and Interim Chief of Cancer Services at the Sidney Kimmel Cancer Center at Jefferson Health. I'm joined today by Dr. Luis Raez, Co-director of the Memorial Cancer Institute at Florida Atlantic University and Florida Cancer Center of Excellence, and Whitney Renault, patient care coordinator of hematology and oncology for North Florida and South Georgia Veteran Health Services. Thank you both for being a part of the conversation on data gathering.  Dr. Luis Raez: It's a pleasure to be here. Whitney Renau: Thank you for having me.  Dr. Maysa Abu-Khalaf: In this episode, we will discuss the challenges and barriers to collecting and documenting social determinants of health information for patients after a diagnosis of cancer. Our guests will share their experience in collecting social determinants of health information from patients and share who in their clinical team has been tasked to assist in obtaining this information. Last episode, we discussed data gathering from a patient's perspective, but we'd love to know why you both believe it's important to address social determinants of health and social needs when providing care for your cancer patients.  Dr. Raez, would you like to just give us your thoughts on the importance of social determinants of health?  Dr. Luis Raez: Yes. Thank you. I am a medical oncologist. I'm a director of the cancer center here at Memorial and South Florida. It's a public healthcare system. I practice lung cancer. And as much as the social determinants of health topic is a topic that many medical oncologists believe is not ours, that is in the realm of the social worker or somebody else, there's no way to avoid that. Because when you are providing the best target therapy of the world or the best immunotherapy of the world, and the patient has insurance, and you see that the outcomes are not the outcomes that you see in the clinical trials, you see that there is something else other than the biology that has an influence. That is why I consider the social determinants of health very important. In our own cancer center, we have several publications about target therapy, immunotherapy in black patients or Hispanic patients that clearly show inferior outcomes, despite the fact that they are getting the same drugs, the same doctors, the same care that we provide. That's why we're considering our healthcare system, as I said, Memorial Healthcare system, that very important topic that we have been trying to address for the last years. Dr. Maysa Abu-Khalaf: Thank you so much. Whitney, would you like to add to this? Whitney Renau: Absolutely. Exactly. It indirectly affects all the outcomes or overall disease survival. If they can't get to the treatments, if they don't eat well during the treatments, if they don't have support during the treatments, it's going to negatively impact all of the outcomes. We do a great job in being able to pay for the drugs and have great regimens, but if we can't get them to the drugs and the regimens and keep them coming, they're going to have overall poor disease survival rates.  Dr. Maysa Abu-Khalaf: Absolutely. Thank you for that. Well, let's touch on the physician and clinician perspectives. Dr. Raez, there has been a lot of interest in evaluating the impact of SDOH and patient social needs on cancer care delivery. Can you tell our listeners how you ask your patients about SDOH and their social needs and does it happen during the clinic visit or at a later time point? Dr. Luis Raez: The point of collecting the data of SDOH is the first step because even though you don't have an idea what is the impact of this, that is why in our healthcare system, we are 2000 doctors, we have created a dashboard of SDOH, social determinants of health, that basically we collect 13 of them from social connections, tobacco use, depression, transportation, physical activity, etc.. So this is a dashboard that is embedded in the EMR. So when the physician opens the EMR, if he has, on the left side, the vital signs, the dashboard of SDOH is on the right side with the medications, allergies, everything. So in that way, the physician cannot really ignore it because it's part of his dashboard.  So we figured out this working with Epic Systems, Epic is one of the most popular EMRs in the United States and this has the capability to do that. So, we were working at the level of the healthcare system, not only for cancer but for everything else. Now that we have these 13 SDOHs, what we do is we are trying to flag a green or red, depending on what deficiency the patient has. You know, if the patient has food insecurity, there is a red. If the patient has transportation it is a green. So the physician can easily see if there is any red in the SDOH dashboard that can bring awareness about if there is something wrong that needs to be addressed. And as we said before, I cannot expect that the patient will have a great outcome if I'm looking at a bunch of reds in the SDOH dashboard, despite the fact that I have the best chemos in the world on the left side. Dr. Maysa Abu-Khalaf: And are you as a physician collecting this information during the clinic visit? Or is there someone in your office that does that before they go into the clinic space to see you? Dr. Luis Raez: The dashboard, we already have the template of the dashboard, and then it's being populated by the social workers. When you get a new patient, you come as a new patient in the cancer center, you interview the social workers, the nutritionist, the multidisciplinary team, and then we start to populate the dashboard. But as you understand, also collecting data one time is not enough. The necessities can change. The patient may have transportation one year, next year, no. So, once that dashboard is created and kept by the social workers, the medical assistants in each visit briefly ask the patient if something has changed. The same when they change age, any of your medication has changed, and the medical assistant has to fix it if you have a new drug or not, the medical assistant keeps track of the dashboard whether it is updated or outdated. Dr. Maysa Abu-Khalaf: Okay, wonderful. So it's continuity of care. It's not something that you just would do one-time point. Every time they come in, the MA makes sure that it's updated, and you as a physician, during the clinic visit, will address any of the social needs that are identified or flagged to you. Dr. Luis Raez: Yeah, or if I cannot address them because some of them are out of my expertise, for example, the patient may be the patient lost insurance. Now it's January 2, and the patient lost insurance. But at least if I see that red flag, I refer the patient to the social worker immediately because now we need to fix insurance. The patient just lost insurance or something like that. You cannot pretend to ask the doctors to fix these things by themselves because the doctors are really very reticent, very negative about doing more clicks. That's why when you present this to the doctors, the first reaction is everybody goes to the back like, “Oh, my God, they're giving me more work.”  But it doesn't have to be like that. That's why we work as a team. We want you, at least at the minimum, that the doctor has to do, is notify the social worker, send a- it’s a couple of clicks in the EMR. So we know that this needs to be addressed. We are not asking the doctors to fix things because otherwise, the doctors get against this because they think it's more work for me in the less time, and I don't get paid anything extra, and it's not my problem. It's not like that. It's the same thing when you see that the blood pressure is high, and you notify the nurse to give a pill. Now the SDOH has red flags, and I will notify the social worker to please fix this or the nutritionist or somebody else in the cancer center that can address this.  Dr. Maysa Abu-Khalaf: And I think that's very important because this comes up a lot. How much work is it? Can you really fit it in during a clinic visit? And the way that you've outlined this, it's a team of clinicians and staff that need to address this collectively and longitudinally. It's not a one-time point where you address it and you move on.  Whitney, can you tell us, since your work has been with veterans, are there templates or guidelines that you found useful when asking patients about SDOH and social risks?  Whitney Renau: Great question. Thank you. And that sounds like, again, one of the reasons my job exists is to help physicians, such as yourself, be able to keep determining along the continuum of care what's going on with the vet and if they are having changes. We use the NCCN distress thermometer and problem list, and the nurses actually in our infusion are seeing every single patient and assessing them upfront, and then if they score higher than a four they're being sent to the social worker to be able to assess for needs support. And then we actually are creating a consult to kind of flush out of that assessment into also mental health providers. Depending on what, as Dr. Reyes was saying, where the needs are, we might have consults to both social worker an

    22 min

  7. 05/06/2023

    Data Gathering to Assess Patients Needs - Part 1

    In this episode, guest host Dr. Leslie Hinyard explores the importance of collecting social determinants of health data from patients to assess needs and the best practices to collect this data in an oncology setting. We enlist expert insights from Wenora Johnson, a cancer survivor and patient advocate, and Krista Nelson, an Oncology Social Worker at Providence Health and Services and past President of the Association of Community Cancer Centers. TRANSCRIPT The guest on this podcast episode has no disclosures to declare.  Dr. Leslie Hinyard: Hello, everyone, and welcome to ASCO's Social Determinants of Health and Cancer Care Podcast. I'm Dr. Leslie Hinyard, Chair of the Department of Health and Clinical Outcomes Research and Executive Director of the Advanced Health Data Institute at the St. Louis University School of Medicine. I'm here with Krista Nelson, past President of the Association of Community Cancer Centers and an Oncology Social Worker at Providence Health and Services. And also, Wenora Johnson, a cancer survivor, and patient advocate. Thank you both so much for joining us in this conversation on data gathering, the patient's perspective.   And we're going to dive right in. Social Determinants of Health, or SDOH, as we like to refer to it, represent nonmedical factors that affect health, that is, the characteristics of where we live, work, and play that influence our health. These social determinants are only recently being explicitly considered in medical context. Currently, there's no consensus on what questions should be asked of patients, who should be asking questions about SDOH, and how the information will be used to improve patient care.  In this episode, we will be discussing the importance of collecting SDOH data from patients in order to assess needs. We hope to discuss best practices to collect SDOH data in an oncology setting from both the patient and provider perspectives.  Now, I'd like to start with you, Krista. Social Determinants of Health have been a topic at the forefront of public health conversations, especially with COVID-19. Can you tell our listeners how you define this term? Krista Nelson: Yes. Thank you so much for checking in and for this opportunity to talk about Social Determinants of Health. As an oncology social worker, we've known that Social Determinants of Health impact patients' outcomes, and we see it every day. And the National Academies of Science, Engineering, and Medicine came out in 2019, right before the COVID-19 pandemic, they came out with a report talking about the importance of integrating social needs care into the delivery of health care to improve the nation's health. So, when I think about Social Determinants of Health, just like you had just said, it's the environment or the conditions in which people are born, grow, work, worship, live, and age. And it's how all those forces and systems shape the conditions of their daily life. So, when I think of cancer patients and Social Determinants of Health, I think of socioeconomic status, education, job security, food stability, housing, social inclusion, and all the environmental factors that really construct a patient's environment.  Dr. Leslie Hinyard: Thank you so much. Wenora, as a cancer survivor and a patient advocate, how do you define social needs and why is it important for patients to self-report these social needs?  Wenora Johnson: That is a great question. And then I actually look at it in four different ways. I think first and foremost about my psychological needs. And those needs are just basic for human survival, like food, water, clothing, housing, and then finally just overall health and quality of life. That second one is going to be my safety needs. Protection from violence and theft, emotional stability, and well-being. And then what we're all feeling a pinch of lately is financial security. And then my third one is love and belonging needs, having close bonds with our family, friends, physical and emotional intimacy, interacting with social groups, all of this provides us with the feelings of love and connection we need not only just to survive, but to thrive off of. And then finally, fulfillment of our full potential. This can be in just caring for others, improving things like our artistic abilities like cooking, music, athletics, and then experiencing new things in life, traveling, things like that, that just do a lot for our physical psyche. So, there's so much when it comes to social determinants that can affect us as patients. And self-reporting these needs are just essential and can be at the same time difficult for patients to do.  Dr. Leslie Hinyard: Now, speaking of difficult things that patients can do, Krista, in your work, what are the most commonly reported needs or social risks that you encounter reported by patients?  Krista Nelson: Well, I really loved what Wenora just said, and I think that really articulates exactly what I'm hearing day-to-day in the work as an oncology social worker. Right away, I think the biggest struggle or the reason we get notified of a patient having needs is around financial toxicity. So, we know that finances and medical bankruptcy is caused, number one, by a cancer diagnosis. But if you think about your socioeconomic status, it really impacts everything that we do. It's our ability to be able to get to treatment. It's an ability to get healthy food, it's an ability to be able to take time off of work and actually get to the treatment. It might mean, “Gosh, do I have someone who can watch my children? And can I pay for screening, can I pay for childcare to go to screening? Am I going to prioritize that? And most of all, do I have access to insurance and good health care?” So, I'm hearing a lot about that.  The other thing I think I hear a lot about is social isolation. And when Wenora spoke about it, about your community, what I heard her saying is her community and having that sense of love. And when I think about social isolation, sometimes a trigger for me is when someone is coming in for a giant cancer surgery and needs a ride to the treatment. Now, you may think, what does that tell me as a social worker? But what that tells me is that this person may not have a giant community of people around them to help them if they have no one who can bring them in for this big surgery. A lot of times when I'm working with physicians and we're meeting with patients, there is so much isolation out there that I remind doctors, this might have been the only time that this patient was physically touched in the last year when you do your exam.  Other things that come up are housing insecurity. We're seeing a lot of that in the community where I live. And then also just access to healthcare and the ability to navigate it. A referral of a patient that I was seeing because the physician noticed that they had a lot of weight loss, and they were in breast cancer survivorship and there was some question of maybe dementia or access to food. And so, of course, I was eager to check in with this patient who lives in kind of a rural part of our state. And she was 80 years old. And when I went to talk with her, I was kind of wondering about depression. Is she not motivated to eat? What's happening here? And as I talked with her and I asked her about her appetite and I asked about finances, she shared with me that it was her teeth and that her teeth were broken, and she was having a hard time chewing. And I asked her specifically, was she interested in dental care? And she said, “No, not really at this place in my life.” But I was able to find some supplements through messaging our dietitian. But what also came out is that she said, “Well, I don't have a computer or a smartphone to be able to order this.”  So even though here we are in 2023, I do think there is a large population of people who don't have access to the resources that we think as practitioners or providers that maybe are more accessible. So, it's really important to meet with each patient where they're at and figure out the best plan for them.  Dr. Leslie Hinyard: Thank you, Krista. This next question is actually for both of you. In addressing these needs from a patient, who should they be having these conversations with? Now, should patients rely on their healthcare team or their providers to address their social needs? And do you believe patients are comfortable having conversations about social needs with their providers? And I'm going to go ahead and ask Wenora to speak first and then Krista, I'd love to hear your response as well.   Wenora Johnson: This is really such a great conversation because what I’m getting out of this is really that communication and teamwork are essential for providing just plain old good quality healthcare. And it can be difficult for patients to have these conversations with their healthcare team without feeling stigmatized or made to feel less than because they can’t adequately take care of themselves. I think of the example of my brother who suffered from mental health issues and he also had a late stage cancer, but a lot of times just felt powerless and unable to speak up because of his mental health diagnosis. His fear of being treated differently was real, and at times, this experience caused him to just shut down when it came to his own care.  And so as a big sister, this is where I had the opportunity to step in and be that virtual, more or less, caregiver for him and speaking up and being that voice for him. If nothing else, this is where it takes a village, an entire team to recognize maybe what symptoms or to help the patient when the patient can’t speak up. It means taking a little bit more notice of how your patients look, as Krista mentioned. Do they look well-fed and clothed? How are they getting to their appointments? Do they even have any close family or friends that they can talk to during their

    22 min

  8. 01/05/2023

    Reintroducing SDOH: Conversation with ASCO Past President Dr. Lori Pierce

    This episode sets the stage for the second season of the Social Determinants of Health (SDOH) in Cancer Care series. As the first African American president of ASCO, Dr. Pierce continues to build her legacy on her presidential theme, “Equity. Every Patient. Every Day. Everywhere.” We will discuss the landscape of SDOH in cancer care. Dr. Pierce will share what sparked her interest in SDOH and why she considers a focus on patient social needs a critical aspect of cancer care. In addition, to highlighting ASCO’s efforts and continued charge to make progress to address cancer health inequities. TRANSCRIPT The guest on this podcast episode has no disclosures to declare.  Dr. Reggie Tucker-Seeley: Hello and welcome to the second season of the ASCO Social Determinants of Health series. I am Dr. Reggie Tucker-Seeley, Vice President of Health Equity at ZERO - The End of Prostate Cancer, and Chair Elect at ASCO's Health Equity and Outcomes Committee. With me today is Dr. Lori Pierce, Professor with tenure in Radiation Oncology, and Vice Provost for Academic and Faculty Affairs at the University of Michigan, and Director of the Michigan Radiation Oncology Quality Consortium. Dr. Pierce served as President of ASCO in 2020 through 2021, and is the current Chair of the Board of the Association for Clinical Oncology. Welcome, Dr. Pierce. Thank you for joining us today.  Dr. Lori Pierce: I am absolutely delighted to join you today. So thank you for having me. And I am particularly thrilled to be talking about social determinants of health and to be the first of the 2.0 episodes of Social Determinants of Health. As you know, we had an initial series, and it really focused on some of the basics of the social determinants of health and really understanding the impact of these determinants on cancer care. And when we did the first Social Determinants of Health series, we really focused on trainees and early career oncologists because, of course, these are going to be our future leaders. So we had an advisory group made up of trainees and early oncologists, and they suggested various topics, and those topics then led to the series. So it is a thrill for me to be on the first episode of Social Determinants of Health 2.0.  Dr. Reggie Tucker-Seeley: Great. And I participated in that first round. So those first episodes were really meant to lay the foundation to introduce social determinants of health to the oncology community. And in this next set of episodes, what we're attempting to do is to answer the question of how to address social determinants in the cancer care delivery system to advance cancer health equity. While we've been talking about social determinants of health and public health, which is where I was trained for quite some time now, these discussions are relatively new in healthcare delivery and cancer care delivery and research. So in this next set of episodes, what we're hoping to do is to answer the question that I often get asked, that we all often get asked in the social determinants of health space by cancer care providers, by cancer care researchers and community organizations, is: What can we do? How do we actually address social determinants in the cancer care delivery system?  So in this episode, we will discuss where the current conversation is in cancer care delivery related to the social determinants of health and hopefully help to move from talking about this issue to action within the cancer care delivery system. And Dr. Pierce will share her thoughts on how far we have come and how far we have to go when it comes to addressing the social determinants of health and cancer health inequities.  So there's been an increase in the discussion about social determinants of health and patient social needs. However, I've realized in my own work related to health disparities and social determinants of health that not everyone comes to the table knowing what these terms mean. And one of our first podcast episodes was about defining terms. And our Social Determinants of Health Task Force introduced our definitions for these terms in our ASCO Daily News post that I co-authored with Dr. Surendranath Shastri of MD. Anderson. But Dr. Pierce, can you tell our listeners why these initial first steps of aligning on definitions is so important and how you define these terms for your practice and for your research? Dr. Lori Pierce: So I prefer to use a comprehensive community-based definition of social determinants of health. I know, as you said, there are different ways that we can define it, but I have generally used the World Health Organization's definition. It's a very comprehensive definition. Social determinants of health are really those non-medical factors that influence health outcomes. And they talk about these conditions in which people are born, grow, work, live, and age, so along the full continuum. And they talk about the wider set of forces and systems that really shape the conditions of our life from beginning to end. And quite honestly, these forces end up being related to power and money. You see that these forces include economic policies that will disadvantage one group compared to another and systems that have been in place for a long, long time, again that disadvantage one group relative to another. There are development agendas, there are social norms, social policies, and they are just political systems that are ingrained in our lives. And they then allow these social determinants of health which then influence health inequities. And the unfair and avoidable difference is that you see, no matter what country you're in, that health and illness follow a social gradient, with those who have the lower socioeconomic position in all cases doing worse. And obviously, we are in cancer, and we see that's reflected with respect to increased mortality rates for those who are in a lower socioeconomic status.  So that's the good news with using the social determinants of health definition as defined by the World Health Organization. But the downside is it's broad. And so, in order for it to be really useful, we have to decide how we are going to define it within our own practices, and then we have to define metrics. As you said, we can talk about social determinants of health forever, but the point is, what are we going to do? What changes are we going to make? And so you have to translate that into metrics where you can assess that there is change, change with regard to screening, change with regard to intervention. And we also have to take into account the intersectionality of so many of these factors. And we think about factors such as obesity, violence, poverty, stress, and communities. So many of these factors that are connected. And a good example is, let's say you have a patient where we have advocated weight loss to improve the patient's outcome both for their overall health and also to decrease the risk of certain cancers. And so you have this program, and you advise this person to exercise, and they're being very diligent, but you're not really seeing a change in outcome. Well, it's probably because they live in an environment where crime is such an issue, where they can't go outside and actively exercise. So again, we have to be aware of the intersectionality of so many of these factors that will hold us back from really moving the needle for social determinants of health.  Dr. Reggie Tucker-Seeley: That's such a great example. We come to the table not just, or we come to the healthcare delivery system, not just with that single issue that sort of brought us to care. We bring our whole selves to the care encounter. So it's important that those are recognized as we navigate that system. I think it's so important to have our leaders recognize the importance of social determinants of health. And during your tenure as ASCO President, you championed cancer health equity and elevated the focus on social determinants of health. So where do you hope to see ASCO go in addressing social determinants of health and health inequities? That is, how can we build on what you started during your term as ASCO president?  Dr. Lori Pierce: Well, first of all, I want to say that I strongly feel that we've come such a long way. So much of the groundwork was already in place at ASCO before my presidency. I mean, everything ASCO has done since ASCO existed has been to focus on the improvement of the care of patients. And a part of that, of course, is being able to weed out those inequities and make it an equitable system. So when I then became President, the stars were aligned. And ASCO, with the work they were doing, they had the infrastructure in place, and they could not have been more encouraging, more supportive of the work that we wanted to do. So one of the programs, as I mentioned earlier, the Social Determinants of Health, the initial set of podcasts, as you mentioned, really looked at some of the basics of social determinants of health. And we had things such as taking a Social Determinants of Health History, which you were a key part of that podcast. And it really focused on we as physicians have been taught to take a history, but if we don't ask the right questions, we won't be able to elicit the barriers that patients are facing, which are largely the social determinants of health. And we focused on the cost of cancer care. We focused on modifiable risk factors such as tobacco cessation. We talked about access. We talked about a lot of the basic tenets of social determinants of health.  During my presidency, we also focused on an initiative where we want to increase the accrual of minorities onto clinical trials so that everyone has equal access to trials. And we know this has been something that has been worked on by so many amazing researchers such as yourself through the years. And so we harnessed a lot of the ideas from many of our colleagues to really promote and put toget

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ASCO presents Social Determinants of Health in Cancer Care, a podcast series in which oncologists, patients, advocates, and other thought leaders in health equity, turn a spotlight on actionable methods to provide equitable access to cancer care despite nonbiological factors.

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  • Creador
    American Society of Clinical Oncology (ASCO)
  • Años de actividad
    2 k
  • Episodios
    18
  • Clasificación
    Apto
  • Copyright
    © Copyright by the American Society of Clinical Oncology
  • Mostrar sitio web
    Social Determinants of Health in Cancer Care

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