SDOH in Oncology: How Mapping Postal Codes Impact Care is a Key Step to Improve Results
notes: This is the second article in the three-part series.
To improve health care and clinical trial recruitment in general, it is crucial to understand the impact of non-medical factors on individual health. Geography, education, racial disparities, race, income and age all affect health outcomes. In oncology, some analysts believe that these social health determinants (SDOHs) can explain the occurrence of a large number of cancers. They directly affect cancer risk, the possibility of survival, early intervention and the effectiveness of health equity.
The digitization of data makes it easier to aggregate and analyze patient data based on its zip code and other related data and link it to different people’s health outcomes. In a webinar held by Medcity News and Purplelabⓡ, Steve Emrick, Senior Vice President of Purplelab for Clinical Information Solutions and HealthNexus(™) conducted this observation:
“We know that depending on your postal code in this country, you may be prone to different types of diseases such as asthma, cancer or other diseases with other postal codes. Because we have more data today, it's easier to do these analyses than before. However, the problem is that you'll be more likely to determine your range for all of this data and how you determine the range of various data, how you'll be able to determine your range, and how you'll be able to measure your range. The result is a huge challenge.”
So, how do socioeconomic barriers affect people with non-small cell lung cancer (NSCLC) and how can they improve their outcomes? There is a strong correlation between socioeconomic adversity and higher incidence of lung cancer, late diagnosis and poor survival results.
To ensure optimal outcomes for cancer patients, early detection is crucial. School quality in postal codes and incomes is directly related to whether a person is diagnosed at an early or advanced stage. People living in rural areas often have limited opportunities in facilities that provide low-dose computed tomography – the use of medical imaging tests, which have a lower radiation volume than a standard CT scan. They are used to screen for lung cancer in high-risk individuals, such as current or former smokers. Limited financial resources and access to transportation may also hinder timely screening and diagnosis. Differences in testing may mean that molecular genetic testing is not available to detect potential mutations, such as epidermal growth factor receptor (EGFR), which may drive therapeutic decisions and obtain targeted therapies.
Medicaid recipients, uninsured or underinsured individuals are also vulnerable because they tend to get less access to care and the initiation of treatment is delayed. It is necessary to lower the age for people to screen for lung cancer, especially given the data that NSCLC is often diagnosed with race and ethnic minority when young. However, non-white and Hispanic patients are unlikely to receive the necessary imaging, such as PET and CT scans, at the time of diagnosis.
SDOH factors, such as having to travel long distances to medical facilities, spending more than 30% of their income on housing and low broadband internet access, can directly affect their condition when starting treatment. The greater the social vulnerability, the less likely they are to start treatment within 30 days of diagnosis. For individuals diagnosed with NSCLC, each week from diagnosis to treatment is associated with an increased risk of mortality.
Where NSCLC patients live can also inform treatment options. Living in an area, especially away from metropolitan areas, where there is a shortage of primary care, or a doctor who does not take a new patient may lead to an increased likelihood of receiving radiation therapy treatment, even if the surgery is a standard of care for resectable NSCLC.
Financial commitment to cancer patients creates social needs related to economic health. This name prevents the patient from getting prescribed treatment. The risk is that Medicaid beneficiaries cannot close out of emerging, promising therapies.
Differences in the quality of surgical care may result in patients undergoing fewer lymphadenectomy and minimal invasive procedures. They may be unlikely to be operated by a thoracic surgeon.
source: CDC
According to the CDC website, the social vulnerability index refers to demographic and socioeconomic factors (such as poverty, lack of transportation and crowded housing) that can adversely affect communities experiencing hazards and other community-level pressures. The highest portion of the index initiates surgery at a median of 34 days after diagnosis. This number is twice the lowest quartile of the exponential (17%).
In the context of SDOH, housing stability is also an important consideration. The lack of stable housing or transportation programs creates logistical challenges that can keep medical appointments or affect the onset of treatment. It can also affect medication or care plan adherence, treatment effectiveness, and patient well-being.
All of these SDOH factors can make the clinical trial recruitment task for patients with NSCLC, even if significant advances have been made in cancer treatment. Historical distrust – stemming from examples such as the infamous 1932-1972 Tuskegee study, which denied the treatment of syphilis by black prisoners – also played a big role.
This distrust is related to health literacy, which is another aspect of SDOH. Lowering health literacy can amplify understanding of challenges in health care and timely care. and some of the factors mentioned earlier in this article that can limit access to information to support medical decision-making. It can lead to insufficient understanding of screening benefits, treatment options, and clinical trials, resulting in a lack of opportunities for early intervention and optimal care, thereby increasing health disparities.
Healthcare providers and policy makers need real-world data (RWD) platforms that collect and analyze SDOH data to identify specific barriers and vulnerable patient populations, which can enable them to develop targeted interventions to improve health equity. The social responsibility to improve health equity is obvious. But life science companies can change so many lives by using the RWD platform to better understand the barriers facing underserved patients and then work with healthcare organizations and regional governments to address these barriers to improve outcomes for NSCLC patients.
photo: Tumsasedgars, Gate Image
