Impact of health-related social needs (HRSNS) screening and targeted intervention through patient navigation on cancer care outcomes in rural South East Georgia

Background: Understanding individual HRSNs is essential to overcome barriers to treatment, deliver high quality care and achieve equity in cancer management (ASCO Policy Statement JCO Oncology Practice 20 (5) 2024). Navigation services tailored to social needs can prevent delay in diagnosis and cancer treatment that are otherwise associated with poor survival. We evaluated the factors related to a need-based utilization of navigation service and its impact on time to treatment initiation among newly diagnosed cancer patients from five counties in rural Georgia. 

Methods: Evaluation of HRSNs for navigation support was prospectively performed on all new cancer patients from 4/10/2024 to 12/02/2024 using standard SDoH (Social Determinants of Health) questionnaire administered prior to initial clinic visit. Patient demographics, diagnosis, stage, acuity level, co-morbidities were tabulated, and appropriate referrals were initiated for the cohort of navigated patients needing additional services. Higher level acuity care was determined from documented additional calls for patient education, care co-ordination and number of referrals placed for HRSNs. Association between patient, diseaserelated factors and use of navigation was determined using descriptive statistical analysis and time to cancer treatment initiation was obtained among navigated and non-navigated (control) new patient cohorts. 

Results: Of the total 83 new cancer patients, 43 patients needed navigation services based on SDoH questionnaire. Median age of navigated patients was 64 and 55% identified themselves as female. Of the navigated patients, most had breast cancer (n = 16; 37%) followed by thoracic or genitourinary cancer (n = 7, 16% in each group) and majority (n = 35; 81%) had 2 or more co-morbidities. More patients in the navigated cohort identified as Black or Hispanic (18% vs 10% non-navigated); had advanced stage at diagnosis (39% vs 22% nonnavigated) Half of the navigated patients needed higher level care (n = 21; 49%). With navigation services, patients avoided treatment delays and had similar time to treatment initiation as the control cohort. 

Conclusions: Assessment of patient-reported needs by implementing SDoH screening prior to initial visit is a feasible approach. Despite majority of our navigated cohort were advanced stage and moderate acuity level, with targeted intervention, no treatment delays occurred. Our pilot study data demonstrates that individual patient-centered intervention in this high-risk cohort can potentially aid decrease disparities in cancer care.