By Bianca Islam, MD, PhD, Case Western Reserve University/University Hospitals Cleveland Medical Center
As physicians and cancer researchers, we know the importance of treating a patient’s disease, but we must not forget about the barriers many individuals face in their daily lives just to receive care. One of my patients was diagnosed with early-onset colon cancer in her mid-30s. In addition to having to deal with that diagnosis, she also had to overcome a lack of transportation to get to her appointments, financial constraints that forced her to make hard decisions, and limited social support to help lift her up in this difficult time.
These social, economic, and physical conditions that affect people’s health, well-being, and quality of life—collectively known as social determinants of health (SDoH)—play a crucial role in influencing health behaviors and the ability to follow through with treatment plans. In the simplest terms, these are conditions impacted by where people are born, grow up, and live (i.e., neighborhood and physical environment); their place of work (i.e., employment and social support networks); and how they age. Many of these factors are beyond a person’s control, including the inherent systemic inequities embedded within health care infrastructure.
Patients from marginalized communities may lack access to early detection and preventive services, leading to late-stage diagnoses and poorer outcomes. Disparities in insurance coverage could prevent patients from affording certain treatments. Even characteristics of neighborhoods—such as sources of healthy food, the number of trees, opportunities for exercise—can impact cancer survivorship. Further, misinformation and mistrust must be overcome on both sides—certain communities lack faith in the health care system while some health care providers’ implicit biases affect the quality of care received by minority patients.
Making Strides in Addressing SDoH
By addressing issues such as poverty, education, and access to health care, we can create a more equitable health system. By understanding SDoH, we can create interventions that positively improve environmental and social factors, which will ultimately make it easier for patients to receive appropriate medical treatments. Going back to my patient with early-onset colon cancer, through community outreach programs we were able to provide her with transportation to appointments, connect her with financial resources, and offer psychosocial support. Interventions like these help to significantly improve treatment adherence and overall quality of life. Her case underscores the importance of addressing SDoH in providing holistic cancer care.
At the Case Comprehensive Cancer Center, we have implemented several innovative programs to address disparities on a wider scale. One notable example is our outreach initiative in partnership with local barbershops, where we provide education and prostate-specific antigen (PSA) screening services in a trusted community setting. One of our hospitals, the University Hospitals Cleveland Medical Center, also operates a mobile health unit that travels to underserved areas, offering screenings and follow-up care. These programs have significantly increased access to early detection and preventive services in communities that traditionally face barriers to health care.
Our cancer center was also recently awarded a grant from the Association of Community Cancer Centers (ACCC) to pilot a SDoH screening tool related to clinical trials engagement. The aim of this study is to address barriers to patients in urban and rural areas. We also recently offered cancer screenings (skin and gynecological) for the Thrive with Pride clinic at the LGBT Community Center of Greater Cleveland. This program’s goal is to provide culturally concordant care to the sexual and gender minority community.
Closing Critical Gaps in Care
As we work to make progress in addressing some of these disparities, certain areas are in critical need of improvement. For one, the inclusion of transgender individuals in cancer care protocols. Trans men will benefit from breast cancer screenings, and trans women will benefit from prostate cancer screenings. Cultivating culturally competent care should be another priority. Health care providers must be trained to understand and respect diverse backgrounds and identities. Addressing the digital divide is equally important. Many new health care technologies require internet access and digital literacy, which some patients may lack.
But technology can also play a role in closing some of these gaps. Advancements in artificial intelligence (AI) and machine learning are helping to identify high-risk patients and personalize treatment plans. For example, using AI to analyze social and environmental data, such as zip codes and green space availability, can help predict cancer risk and tailor interventions. Meanwhile, researchers at Case Western Reserve University, Cleveland Clinic, and University Hospitals are examining whether AI can help guide treatment for rectal cancer patients by analyzing medical images. Additionally, innovations in telemedicine have expanded access to specialist care for patients in remote or underserved areas, making it easier for them to receive timely and appropriate cancer care.
We need to continue advocating for policies that address cost and coverage disparities. This includes advocating for insurance coverage of telemedicine and AI-based interventions. Additionally, community-based participatory research and partnerships with local organizations can help tailor these technologies to meet the specific needs of different populations. Most importantly, when we implement any new technologies, we must ensure that health care providers are trained in using these advancements and understand the barriers faced by marginalized groups. It is vital to ensure that all patients, regardless of their background, receive equitable care, and working to address SDoH will help us achieve that goal.
The AACR Trust in Science Task Force is working to develop policies and practices to promote societal trust in science, including platforms that engage underserved populations to identify SDoH and ways to integrate social care solutions to promote health care equity. Additionally, the latest research on health disparities and the work being done to overcome them will be presented at the 17th AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, which will be held September 21-24, 2024, in Los Angeles.
Bianca Islam obtained her MD and PhD from the Medical College of Georgia. She completed her internal medicine residency and clinical gastroenterology and hepatology fellowship at Case Western Reserve University/University Hospitals Cleveland Medical Center. She is currently an NIH NIDDK T32 fellow in the laboratory of mucosal immunologist Fabio Cominelli, MD, PhD. Islam’s research focuses on the role of mucosal immunity in early/young-onset colorectal cancer development. She serves on the AACR Science Policy and Government Affairs Committee and previously served on the AACR Associate Member Council (2019-2022). She has also served as a scientific mentor in the 2022 AACR Scientist↔Survivor Program® and was a panelist at the “Strategies to Effectively Communicate Science to the Public” session during the AACR Annual Meeting 2024.
