Cancer Care Disparities Persist Despite Tools to Address Social Barriers
New initiatives aim to address social determinants of health in oncology, while research reveals persistent disparities in treatment access and clinical trial participation for Black and minority cancer patients.
The Association of Cancer Care Centers (ACCC), in partnership with leading organizations, launched a nationwide quality improvement initiative to equip cancer programs with tools to identify and address social determinants of health (SDOH) barriers. ACCC developed an oncology-specific SDOH screening tool and a comprehensive resource library designed to help care teams systematically identify barriers such as housing instability, financial insecurity, transportation challenges, and health literacy gaps.
ACCC's SDOH screening tool includes questions on housing, employment, insurance, transportation, and social support, as well as awareness of and interest in clinical trials. The accompanying resource library offers national publications, videos, case studies, and links to local and state programs, enabling care teams to connect patients with timely assistance.
Five diverse cancer programs—AnMed Cancer Center in South Carolina, Christus Health in Texas, Mosaic Life Care in Missouri, Tennessee Oncology in Tennessee, and UH Seidman Cancer Center in Ohio—tested the SDOH tool over 6 months. Each site screened at least 25 patients and integrated findings into care workflows.
Across pilot sites, transportation and financial insecurity were most frequently identified. AnMed used the tool to connect patients with gas reimbursement programs and prescription assistance. UH Seidman faced challenges incorporating the tool into routine practice, underscoring the need for EHR integration and streamlined processes. Mosaic Life Care highlighted patient reluctance to discuss finances, particularly among Spanish-speaking populations, emphasizing the need for multilingual tools and culturally competent communication.
Pilot sites reported that many patients were unaware of clinical trial opportunities—65% at UH Seidman and 60% at Tennessee Oncology. Sites found that administering the tool in person—rather than by phone—improved completion rates.
Research reveals persistent disparities in cancer treatment access for Black and minority patients. A real-world study reviewed data from more than 18,000 patients enrolled in Medicare and more than 3,000 patients enrolled in the VHA, all of whom had metastatic castration-sensitive prostate cancer.
The study uncovered that 88% of Black patients and 83% of white patients enrolled in Medicare did not receive the combined treatment approach despite it being US FDA approved and recommended in treatment guidelines. When age and locations were accounted for, Black patients enrolled in Medicare were 32% less likely than their white counterparts to receive the combined treatment regimen. Additionally, the study concluded that Black patients on Medicare had a 20% higher likelihood of dying from prostate cancer than white patients.
Similar disparities were observed in the Veterans Health Administration. Black patients were 25% less likely than their white counterparts to receive the combined treatment. The chances of dying for those enrolled in this type of insurance plan was the same for both Black and white patients.
Data shows that participation from Black and African American patients in prostate cancer trials is significantly lower in comparison to other ethnic groups. Researchers investigated the underlying cause of this disparity, identifying several barriers preventing the enrolment of diverse patients in prostate cancer clinical trials. Three advisory boards, involving patients, advocates and physicians, identified common systemic barriers such as mistrust, socioeconomics, and poor trial execution strategies.
The study found that one way to better engage these minority communities may be through female caregivers such as wives and daughters, citing that they often play a highly influential role in treatment decision making. By developing out-reach programs targeting these decision-makers and partnering with sororities to disseminate information about prostate cancer, researchers theorize that clinical trial sites could better reach diverse patient groups. Mobile prostate cancer screening units are also working to enhance awareness of prostate cancer for Black men.
Researchers note that 80% of cancer patients in the USA receive treatments in a community as opposed to academic centres, and it has previously been suggested that increasing clinical trial recruitment at community centers may facilitate the involvement of patients from minority groups.
Pilot sites praised the SDOH tool's comprehensiveness but noted areas for improvement: simplify lengthy surveys to reduce patient burden, expand multilingual options to ensure accessibility for non-English speakers, address digital literacy by incorporating questions on technology access, and offer staff training on SDOH and strategies for navigating sensitive conversations.
Pilot sites plan to expand screening to additional departments, integrate tools into EHR systems, and share findings across their organizations. ACCC will continue refining resources and supporting education to sustain progress.