Specialized pharmacies are well positioned to address inequalities that affect outcomes.
While advances in screening, treatment and survival provide hope for cancer patients, data showing persistent disparities in health outcomes indicate that these benefits are not experienced equally. A recent study found that 5-year survival for patients under age 50 with colorectal cancer improved over 2 decades for white individuals, but not for those who are black, Hispanic, or Asian-American. In addition, black patients with multiple myeloma have more than double the death rate seen in white patients.1
However, the data show that differences in cancer care are not only experienced by populations based on race, as members of the LGBTQ+ community experience disadvantages compared to heterosexual patients in terms of screening, diagnosis and treatment.2 In rural areas of the country, data shows that LGBTQ+ individuals have a 17% higher cancer death rate.3 These and other widely documented cancer health inequalities pose a pervasive challenge that threatens health outcomes for cancer patients and the achievement of health equity in the United States.
Differences are most common among population groups defined by race/ethnicity/national origin, disability, sexual orientation, gender identity, geographic location, income, education level, and age.4 As we identify and learn more about cancer and the health disparities facing populations in this area, complex interrelated social determinants of health (SDOH) are increasingly seen as key drivers of individual and public health. Exploring SDOH in the context of cancer treatment within specialty pharmacies is critical to addressing SDOH and cancer health inequalities more broadly.
SDOH and cancer differences
To help clarify the increasing use of this term in the field, SDOH is defined as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide variety of health functions, and quality of life outcomes and risks.”5 Healthy People 2030 was approved by the United States Department of Health and Human Services (HHS) in June 2018 and developed based on recommendations from the HHS Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Goals for 2030. Healthy People 2030 groups SDOH in 5 domains: economic stability, access and quality of education, access and quality of health care, neighborhood and built environment, and social and community context.
Specialized pharmacies are in the treatment phase of the patient journey, with SDOH in this context encompassing numerous issues that can affect outcomes. For example, patients from disadvantaged communities may have more advanced cancers because of their living environment; behavioral and psychological risk factors; genetic predisposition; and lack of access to screening, prevention and quality healthcare. These patients may also not trust providers because of previously perceived discrimination or bias. Communication barriers, low levels of health literacy and financial toxicity are also higher-level challenges experienced among populations prone to health inequalities.3
Among disadvantaged groups and communities of color, the data show that unmet socioeconomic needs negatively impact cancer adherence.6 For example, it has been shown that black and Hispanic patients are twice as likely to experience financial toxicity as white patients, which can lead to financial coping behaviors such as skipping doses or rationing drugs. In addition, racial and ethnic minorities have a documented higher rate of adverse side effects (AEs) while undergoing cancer treatment.3
Tackling SDOH in specialized pharmacies
Achieving health equity requires action from all healthcare stakeholders. The National Academy of Medicine recommends 5 actionable ways to address SDOH: awareness, adaptation, help, alignment and
advocacy.7 Specialist pharmacies can use this approach to improve, refine and advance patient service and support in a way that promotes positive outcomes while addressing SDOH.
For specialty pharmacies, approaches that focus on awareness include ensuring leadership and staff understand SDOH and the resulting differences, as well as the importance of culturally competent care. Awareness in specialty pharmacies also includes efforts to analyze the structural components of the organization to uproot policies or practices that could inadvertently marginalize or stigmatize patients (or employees). It may also mean looking critically and continuously at programs and services, determining how cancer patients are tracked to the community and other supportive resources, identifying potential gaps, and tracking service delivery against SDOH.
Approaches addressing customization in specialty pharmacies include changes in policies and procedures, as well as providing support in clinical and non-clinical settings to better meet social needs that may impact patient health.
To address help in specialty pharmacies, approaches may include allocating clinical and other support resources to reduce barriers to care, provide patient navigation services, and promote adherence and minimize side effects and reactions.
Specialist pharmacies can adopt approaches that address alignment by developing and maintaining partnerships with other healthcare stakeholders, community partners, and local support agencies to address SDOH challenges and health disparities.
An important area for specialty pharmacies is advocacy, which can be achieved by ensuring that specialist pharmacy staff unite around the focused goal of expressing and promoting the need for change in conditions contributing to health inequalities within specialty pharmacies and out there.
Towards a more just future
Research indicates that cancer inequalities result from determinants within and outside the health system, including SDOH, racism and discrimination.6 While much remains to be done if we are to achieve equal opportunities for cancer health, it is important to remember that progress is being made toward that goal.
In the past 2 decades, the difference in total cancer deaths between black and white populations has halved. Effective interventions targeting SDOH and promoting equality have been proven to reduce inequalities while improving care for all patients.3
Specialized pharmacies are at a critical point for cancer patients. By understanding the impact of SDOH in the context of cancer treatment, specialty pharmacies can help improve outcomes and move
towards a fairer future for all cancer patients.
1. Persistent racial, ethnic differences found in survival rates for early-onset colon cancer. news item. American Gastroenterological Association. May 24, 2022. Accessed July 14, 2022. https://www.eurekalert.org/news-releases/953191
2. Cedars-Sinai Cancer: Erasing health inequalities for LGBTQ+. news item. Cedars-Sinai Lobster. May 19, 2022. Accessed July 14, 2022. https://www.newswise.com/articles/cedars-sinai-cancer-erasing-lgbtq-healthcare-disparities
3. AACR Cancer Inequality Progress Report 2022. American Association for
cancer research. Retrieved June 15, 2022. http://www.CancerDisparitiesProgress-Report.org/
4. Cancer Differences. National Cancer Institute. Updated March 28, 2022. Accessed July 14, 2022. https://www.cancer.gov/aboutcancer/understanding/disparities
5. Social determinants of health. Healthy People 2030. Accessed July 14, 2022. https://health.gov/healthypeople/priority-areas/social-determinants-health
6. Tong M, Hill L, Artiga S. Racial differences in cancer outcomes, screening,
and treatment. Kaiser Family Foundation. February 3, 2022. Accessed July 14, 2022. https://www.kff.org/racial-equity-and-health-policy/issue-brief/
7. Alcaraz KI, Wiedt TL, Daniels EC, Yabroff KR, Guerra CE, Wender RC.
Understanding and addressing social determinants to advance cancer health in the United States: a blueprint for practice, research, and policy. CA Cancer J Clin. 2020;70(1):31-46. doi: 10.3322/caac.21586