The COVID-19 pandemic disrupted numerous sectors of the U.S. economy—from food production to healthcare infrastructure—which contributed to the filing of 30 million unemployment claims. The financial strain put an additional burden on cancer patients who experienced disruptions to their care, including the cessation of life-saving treatments. Disruptions in cancer care appear to have been more pronounced in patients from underrepresented communities.
According to researchers at the Dana Farber Cancer Institute, Black and Hispanic patients had fewer cancer-related outpatient visits during the pandemic and were less likely to see an increase in telehealth adoption. This barrier exacerbated existing health-related disparities, such as access to care and delayed treatment and diagnosis, which are tied to social determinants of health (SDOH).
SDOH are, according to the World Health Organization, the social, physical and economic conditions under which people are born, live, work and age. Identifying and understanding the SDOH that influence treatment and diagnosis is important in addressing the disparities that exist in cancer care and is fundamental for improving health outcomes for disadvantaged patients. According to a Cardinal Health survey of 160 oncologists, 68% said that at least half of their patients are negatively influenced by SDOH, with financial insecurity and lack of insurance representing the most significant SDOH challenges.
Effectively addressing these SDOH will require a holistic and integrated response from healthcare providers, pharmaceutical companies, payer organizations, government entities, patient advocacy groups and nonprofit organizations. Failing to take action risks deepening inequities, creating new divisions and undermining societal resilience.
To better understand how social factors contribute to disparities in cancer care, ZS analyzed melanoma patients’ treatment journeys and assessed recent efforts by pharmaceutical and medical device companies to overcome SDOH by boosting access to their treatments and aiding in efforts to improve early diagnosis.
To paint a clearer picture of how certain SDOH influence cancer care, we chose to take a closer look at skin cancer, or melanoma, because it is an easier cancer to detect, and has a relatively simple treatment regimen and a large sample of patients. Melanoma also has a very high survival rate—early-stage patients have a 99% chance of survival and up to 94% of patients treated for melanoma undergo surgery, which is the standard of care for this diagnosis.
Our analysis, which derived insights by running real-world data captured from multiple sources through a machine learning model, evaluated the influence of SDOH on early diagnosis, treatment after early diagnosis and treatment after late diagnosis. We looked specifically at social determinants such as access to care, disease characteristics, the patients’ living conditions, physiology, age, gender, race and income level.
Our topline findings revealed that SDOH had significant impacts on health outcomes, including the timing of diagnoses. For example, individuals in high-income households—defined as households with annual incomes of at least $100,000—had an approximately 8% greater chance of receiving an early melanoma diagnosis than did those in lower-income households. We also found that women had roughly a 6% greater chance of being diagnosed early, as compared to men.
Social factors also had an impact on treatment following an early diagnosis. Access to a dermatologist in the early stages of diagnosis can increase a patient’s chances of being treated with surgery by about 17%. Our analysis found that underrepresented patients had a lower chance of being treated by surgery following an early diagnosis, with Hispanics undergoing surgery at a 16% lower rate as compared to white patients. High-income patients underwent surgery after an early diagnosis at an approximately 13% greater rate than patients in low-income households, defined as households earning $30,000 per year or less.
Among patients who were diagnosed late with melanoma, those under the age of 68 had a 12% higher chance of being treated with branded drugs. Likewise, high-income individuals had approximately a 6% greater chance to be persistent on, or continue taking, branded therapy as compared to patients from low-income households.
As the pharmaceutical industry becomes more aware of how SDOH can influence outcomes and access to care, the makers of cancer treatments have stepped up their efforts to reach those in need. Several pharma companies have launched efforts to combat various SDOH that lead to inequity. For example, Bristol Myers Squibb and Johnson & Johnson have committed $300 million and $100 million respectively to combat racism, to increase clinical trial diversity, to raise disease awareness and to improve access among medically underserved populations. Gilead Sciences and Roche’s Genentech are working to understand disparities in health based on demographics and patient personas.
Because SDOH influence various stages of cancer treatment, pharma organizations should develop well-defined business objectives that align with both the organizational vision and their long-term success strategies. Initiatives that focus on developing a standardized treatment pathway will help pharma to provide the right care to all patient groups.
Pfizer, for example, is working with Emory Glenn Family Breast Center and Grady Memorial Hospital’s Avon Foundation Comprehensive Breast Center to develop a care pathway and to implement assessments that will improve outcomes for Black breast cancer patients. This helps to counter implicit biases against patients from minority groups that can result in unequitable health outcomes.
Pharma companies should align initiatives where they could have the most impact to curb disparities among patient populations. For example, to help low-income individuals that are hesitant about pursuing treatments due to high out-of-pocket costs, pharma companies can collaborate with organizations that offer financial coaching to patients and families. Or, they can adopt or expand co-pay assistance programs. In addition, because early diagnosis is correlated with higher survival rates, pharma companies could partner with nonprofits and tech startups focused on early detection. Some tech companies are already working on apps and resources to aid in early diagnosis, such as the algorithm developed by Google AI that can help with the early diagnosis of skin cancer through a smartphone app.
Grappling with SDOH and the inequities that result is a societal challenge. However, having the right data has helped stakeholders to come together in targeted ways to make a difference.
Pharma should continue to follow the example of organizations that have taken steps at the local and national level to improve education, increase cancer awareness, standardize treatments, strengthen patient-provider relationships, boost publicly funded health plans and diversify clinical trial participants. Pharma also can partner with nonprofit groups to address healthcare gaps in specific geographies and study how unconscious biases affect the creation of standardized treatment pathways.
Addressing inequalities in healthcare will take a collective effort and require that healthcare stakeholders throughout the ecosystem come together to identify long-term solutions.