Current practices in social determinants of health screening in commission on cancer hospitals

BACKGROUND: Social determinants of health (SDOH) are associated with adverse cancer outcomes, yet the prevalence and impact of SDOH screening across Commission on Cancer (CoC)-accredited programs are unknown. We evaluated national SDOH screening practices and their association with adherence to CoC quality measures. 

STUDY DESIGN: A cross-sectional survey of 1,445 CoC-accredited programs (October-December 2024) was linked to National Cancer Database data (2020-2022). Adult patients treated at 435 responding hospitals (30.1%) were included. Programs were categorized by routine outpatient SDOH screening status. Multivariable logistic regression assessed associations between screening and receipt of quality measure-concordant care, adjusting for screening duration, age, race, ethnicity, Charlson Comorbidity Index, insurance status, rurality, and program type/case count. 

RESULTS: Of 435 programs, 165 (37.9%) reported routine SDOH screening. Screening programs more frequently treated ≥10% Medicaid/uninsured patients (29.1% vs 19.6%, p=0.023). Mean performance was higher at screening hospitals for breast radiation within 60 days (66.6% vs 64.6%, p=0.046), colon adjuvant chemotherapy within 120 days (84.6% vs 81.9%, p=0.018), and lung systemic therapy within 90 days (77.2% vs 75.4%, p=0.043). On adjusted analysis, screening for >3 years was independently associated with timely colon adjuvant chemotherapy (OR 1.05; 95% CI 1.01-1.07; p=0.033). Findings persisted after excluding safety net hospitals. 

CONCLUSIONS: Only one-third of responding CoC programs routinely screen for SDOH. Sustained screening was independently associated with improved adherence to time-sensitive colon cancer chemotherapy, supporting integration of patient-level SDOH assessment into oncology care delivery.