Survey of health care providers on social determinants of health and treatment decision-making for patients with HR+/HER2- metastatic breast cancer

INTRODUCTION: Social determinants of health (SDOH) are a range of nonmedical factors that contribute to outcome disparities among certain groups of patients; however, little is known about how SDOH affect treatment decision-making for patients with cancer, particularly those with metastatic breast cancer (mBC). This study sought to gain insights from physicians and advanced practice providers on the impact of SDOH on practice- and patient-level cancer care decision-making with a nationwide online survey. 

METHODS: The Social Determinants of Health in Metastatic Breast Cancer Survey was developed by the Association of Cancer Care Centers (ACCC) in partnership with Pfizer Inc, and in consultation with SDOH specialists. The 23-question survey captured experiences with SDOH-informed treatment decision-making for patients with cancer via multiple choice, Likert-scale, and free-response questions. ACCC-member physicians and advanced practice providers in the USA completed the survey between 23 January and 8 February 2024. 

RESULTS: Respondents (n = 145), a majority of whom were medical oncologists (60%), represented clinics from diverse geographic regions of the USA; approximately 65% of respondents' clinics served patient populations with ≥ 10% Black, Indigenous, or People of Color. Common comprehensive cancer care services were provided by at least 59% of clinics, and SDOH factors were assessed by approximately 75% of clinics at diagnosis. Navigation services were available for patients with mBC at approximately 75% of respondents' clinics. Financial considerations (51%) and the presence of a caregiver (35%) were the most frequently cited SDOH-related factors that impacted mBC treatment decision-making. 

CONCLUSION: The surveyed ACCC-member care providers displayed a high degree of awareness regarding SDOH impacts on their practice and patients, but resource limitations were identified as barriers to comprehensive, SDOH-informed cancer care. Harnessing existing resources from local and national advocacy groups, especially navigator training programs, is an actionable, real-world solution for improving mBC care for patients facing SDOH barriers.