Social Determinants of Health and Cancer Care: An ASCO Policy Statement EDITORIAL COMMENT

Factors that affect access to health care and represent conditions out of an individual's control are collectively known as social determinants of health (SDOHs); health-related social needs (HRSNs) are related to these, being unmet needs that affect health and health care. In the United States, disparities in health care that are related to both SDOHs and HRSNs are prevalent despite years of research and efforts to minimize them. This article is a policy statement reflecting the American Society of Clinical Oncology (ASCO) stance and endorsed policies surrounding cancer health equity, rural health, and cancer prevention. Its purpose is 2-fold: to reaffirm the commitment of ASCO to addressing factors that influence cancer care and outcomes and to establish a policy framework for advocacy surrounding SDOH-related issues. Personalized medicine has come a long way in cancer treatment, and treatments that reflect an individual's disease have increased response rates, survival, and avoidance of ineffective therapies and reduced treatment toxicity; this, however, does not address factors such as HRSNs, which continue to impact individuals' health care and response to treatment. Research has characterized the association of HRSNs with health, and yet they are rarely included as variables or assessed in clinical trials. To optimize the impact and help address these issues, the data must be gathered and included in trials and considered in the implementation of personalized cancer treatment. Currently, the approach to collecting data about SDOHs and HRSNs is ad hoc and has no standardized method for what data to collect or how to collect it. Systematic data collection and the use of consistent proxy variables for those that are difficult to obtain are needed for any real data analysis or implementation of results to occur. The current methods of data collection inhibit the identification of at-risk populations and the assessment of any impact that is made. Steps must be taken to integrate data collection into standard clinical practice as well as in settings of clinical trials, case reports, and sociodemographic banking studies. Implementing intervention even with good and reliable data can be difficult; steady progress has occurred in cancer treatment with the implementation of precision medicine, but nonbiologic factors are not often considered. Measuring SDOHs systematically and striving to address factors that will affect the response to cancer care will require planning and longterm infrastructure, but the benefits are significant enough to motivate these changes. There are pilot programs across the country that are attempting these interventions, yet to sustain the positive change these programs can make requires integration of the interventions into the health system, which is not always easy. Intervention in SDOHs and HRSNs can and must occur at many levels to be effective, with collaboration from public and private stakeholders and at all levels of government. Federal support should include funding to support programs attempting to address SDOHs both for community-based organizations and higher-level organizations such as local and state public health programs. Additionally, funding should be provided for research to validate the effectiveness of intervention models. The recent update from the Department of Health and Human Services provided an approach for addressing SDOHs, including improving data collection, quality, and standardization; improving connectivity between health and social service agencies; and collaboration across all government entities. As these goals come to fruition, policies and interventions will hopefully be both developed and implemented in an effective way. Integrating social and clinical care is essential in overcoming the barriers to quality care that exist as SDOHs and HRSNs. Research has shown that these factors have significant impact on overall health and well-being, and if treatment plans are able to account for these factors in any way, it will improve the delivery of and response to cancer care in the future.