Social determinants of health (SDOH) encompass a broad range of social and economic nonmedical factors that significantly impact health outcomes.
These determinants are highly prevalent among patients with cancer and have been associated with adverse outcomes, such as treatment delays, morbidity, and mortality, underscoring the critical role of SDOH in shaping cancer prognoses.1
The integration of SDOH screening into the framework of cancer care and research offers a strategic approach to addressing these inequities. The systematic identification of these risks can enable healthcare systems and providers to tailor interventions, provide targeted support services, and coordinate with community resources to address existing health disparities. Moreover, the integration of SDOH screening aligns with broader efforts to deliver patient-centered care that recognizes the complex interplay between social factors and cancer care.
Despite the well-established influence of SDOH on cancer care delivery and outcomes, the prevalence of SDOH among patients with cancer in the US has not been well characterized, and these data are not represented in existing cancer data registries. Current studies suggest that the integration of SDOH screening within the outpatient oncology setting may improve access to high-quality and timely cancer care.
SDOH Screening at Accredited Hospitals
In 2024, the ACS distributed to ACS Commission on Cancer (CoC)-accredited programs a cross-sectional survey to assess SDOH screening practices in the outpatient oncology setting.
Of the 435 programs that participated in the survey, only 37.9% reported routinely conducting SDOH screening.2 These findings align with current trends among healthcare systems, with less than one-third reporting routine SDOH screening in community health and primary care settings.3,4
These findings suggest an opportunity to improve clinical workflows and protocols to aid in the identification and management of social determinants influencing cancer outcomes.
In the study, no differences were found in program type or geographic location between screening and non-screening hospitals, suggesting that SDOH screening may be integrated effectively across diverse organizational structures and geographic locations. The findings also underscore the need to develop standardized approaches to SDOH assessment across unique healthcare environments. This will set the stage for scalable implementation of standardized SDOH screening, which then can be adjusted to support the distinct operational capacities, resource availability, and patient populations of diverse cancer programs.
The study found that programs that routinely screened for SDOH demonstrated improved adherence to cancer care quality measures related to timely administration of adjuvant therapies for breast, colon, and lung cancers. Other studies have similarly suggested that interventions to screen for and address SDOH can reduce disparities along the continuum of cancer care across multiple disease sites and patient populations.5
Additionally, almost all participating programs indicated the availability of social work and patient navigation programs at their sites, highlighting the widespread recognition of the essential role of support staff to help patients navigate complex healthcare systems, address social challenges, and connect to community resources.
Along these lines, a recent meta-analysis demonstrated that patient navigation interventions were associated with increased screening rates for colorectal, breast, and cervical cancers, and findings remained consistent across patient populations.5 These services can foster community engagement and support tailored interventions to respond to the needs of individual patient populations across diverse settings.
Challenges to SDOH Screening Implementation
Cancer program administrators should focus first on standardizing the screening processes. The study found that there is significant heterogeneity in the use of SDOH screening tools, with many programs using instruments developed internally or embedded in electronic health records, which poses challenges to effectively and uniformly identify needs, collect discrete and standardized data fields that are comparable across different patient care settings, and develop interventions or optimize resource allocation.
Common domains were identified in the current screening tools used by programs in this study, including transportation difficulties, financial strain, social and emotional health, and food insecurity, which are consistent with other reports. In fact, the Centers for Medicare & Medicaid Services previously mandated the collection and reporting of select SDOH screening measures from hospitals reporting to the Inpatient Quality Reporting Program in 2024.
These SDOH reporting requirements have been expanded to the outpatient setting through separate regulatory channels. However, updates to this policy are ongoing, and their impact has yet to be determined. Ultimately, efforts are needed to inform the development of consensus guidelines and standardization of SDOH screening tools that can be integrated into oncology practice workflows.
Efforts to Support SDOH Screening
To date, feasibility of routine SDOH screening in the outpatient oncology and ambulatory care settings has been demonstrated in single institution and healthcare system studies.
A regional cancer center recently reported the feasibility and acceptance of routine outpatient SDOH screening for new evaluations of patients with gastrointestinal cancer, with broad support from multiple stakeholders including clinicians, staff, and patients.6
Notably, the screening process identified several SDOH needs among patients without significantly disrupting clinical workflow or prolonging overall clinic visit time, demonstrating that SDOH screening can be integrated without compromising the delivery of care or provider productivity. Further research investigating the feasibility and acceptability of SDOH screening in diverse outpatient oncology settings is warranted.
At a national level, there are opportunities to standardize SDOH screening and identify best practices for the integration of screening into existing healthcare system workflows. Standardization will improve the consistency of data collection, facilitate identification and management of social needs, and optimize resource use. National efforts also could support technological integration and policies that enable healthcare systems to embed SDOH screening as a routine and sustainable component of patient care.
Ultimately, the integration of SDOH screening into oncology practices has the potential to substantially improve cancer care outcomes across multiple levels. At the patient level, SDOH screening enables the identification of nonmedical factors that influence a patient’s ability to access and benefit from high-quality cancer care.
In addition to improving individual patient care, systematic SDOH screening will generate valuable data that can inform institutional-level strategies to effectively allocate supportive resources and implement targeted interventions to address common barriers. At the population level, SDOH assessments will identify structural drivers of cancer care disparities and guide the development of policies and initiatives to address these upstream determinants of health.
National Strategies to Advance SDOH Screening
The ACS CoC is dedicated to improving the quality of cancer care through accreditation processes aimed at establishing and raising standards of care. Recently, through the development and implementation of multiple large-scale national quality improvement (QI) collaboratives, improvements in the provision of local cancer care have translated into significant impacts on the way cancer care is delivered nationally.
Prior national QI collaboratives have aimed to address certain components of SDOH, including increasing access to smoking cessation resources, reducing missed radiation therapy appointments, and addressing barriers to equitable genetics access.7
The survey of CoC-accredited cancer programs highlights a strong consensus that the identification of systematic processes for SDOH screening remains an important priority for cancer programs. Nearly all programs reported an interest in participating in a national QI collaborative focused on improving SDOH screening and addressing SDOH-related needs.
National efforts would facilitate the sharing of knowledge and resources across diverse healthcare systems and enable the development of standardized workflows and screening protocols.
Such a collaborative could also foster the identification and dissemination of best practices for collecting SDOH data and connecting patients with community and clinical resources for identified needs. These data could then be integrated into quality metrics and improvement strategies, enabling healthcare systems to better align cancer care within the broader social context of patients, ultimately improving outcomes and reducing disparities at a population level.
Future research exploring how SDOH screening correlates with broader cancer care quality metrics, such as treatment completion, health-related quality of life, and clinical outcomes, is needed. Together, these efforts would enhance the integration of SDOH into the framework of cancer care and research, enabling cancer programs to better address the unique needs of their patient populations to ensure high-quality, multidisciplinary, and comprehensive cancer care delivery.
It is more critical now than ever for healthcare providers and systems to integrate SDOH screening into their practices to enhance cancer care delivery, improve outcomes, and reduce health disparities.
