Understanding the Impact of Social Factors on Cancer Care Disparities

And while research into to how these factors influence health outcomes is not new, a recent study, “Evaluating Social Determinants of Health Related to Cancer Survivorship and Quality of Care,” has specifically examined how Black and white cancer survivors perceived the quality of care they received.

Darryl Somayaji, PhD, RN, CNS, CCRC, clinical professor, School of Nursing, and adjunct assistant professor of oncology, cancer screening and survivorship at Roswell Park Comprehensive Cancer Center, is the lead author of the study, which was recently published in Cancer Nursing.

Somayaji’s work includes studying how diagnosing, treating and surviving diseases like cancer differs for Black versus white individuals, and those living in underserved and under-resourced neighborhoods.

The team led by Somayaji analyzed data collected via patient questionnaire by the Southern Community Cohort Study (SCCS).

“My focus in research, patient care and education has always been cancer and health disparities,” Somayaji said, “so coming across this dataset that included cancer survivors with a high participation rate by African Americans supported my question: Do social determinants of health impact disparities in cancer outcomes?”

The dataset included nearly 74,000 individuals living across 12 southeastern states; Somayaji’s team extracted the responses of a subset of more than 1,100 adult cancer survivors identifying as either Black or white — specifically, their answers to questions related to quality of care. Their diagnoses included breast, prostate, lung and colorectal cancer. Greater than half of the participants were African American and recruited from community health centers. Nearly three-quarters of the sample were urban located. 

The team’s results showed race, household income and education as significant predictors of participants’ perceptions about the quality of care they received.

“We found overall that white participants were more likely to feel they received a better quality of health care when it came to testing, diagnosis and treatment compared with Black participants,” Somayaji said.

“The racial disparity held true even among better educated participants; while overall perception among both Black and white patients with more education was that they received better quality of care, the perceptions of white patients still trended higher,” Somayaji said.

The study acknowledges that multiple factors can influence a patient’s reported experience with quality of care. Additionally, the dataset had limitations: the questions were short and predefined for one point in time and the answers were self-reported perceptions.

The researchers noted that social determinants of health are a well-known concern related to timeliness in testing, diagnosis and in follow-up care for cancer.

“We know that late diagnoses are known to increase with being under- or uninsured or having lower education or household income, if a patient is not already being screened based on risk or symptoms. And we know that early detection saves lives,” said Somayaji, whose current research includes promoting lung cancer screening in urban primary care settings.

“We’re doing a better job with breast, colorectal and prostate cancer screenings, but not in all communities. And while we’re seeing more survivors of lung cancer, the rate for lung cancer screenings among eligible people is horrifically low. And most lung cancer screenings are free with Medicare and Medicaid [though eligibility depends on the individual insurance coverage plan],” Somayaji said.

“Even with more screenings happening, and even though more white individuals are diagnosed with lung cancer, Black individuals have worse outcomes. Our progress [toward equity] is slow, and it is slow because of structural racism.”

The SCCS data subset is also representative of individuals who are historically underrepresented in cancer research, and the intersections, and implications, are significant to ongoing study of and work toward equitable delivery of health care. Somayaji sees it as a grassroots effort and part of the future of how nurses are educated and how they operate in the workforce to contribute toward equity.

“This is really about paying attention to the individual’s experience, and that of their communities down to the granularity of neighborhoods,” Somayaji said. “When we think about these social determinants of health and how we know the resources people have access to could empower them to make informed choices, understanding these patient responses and perceptions on cancer care is key to assessing patient needs and barriers. It can help us to align health priorities toward quality health outcomes and reduce the burden of cancer.”

Co-authors with Somayaji include Heba Mohedat, PhD ’24, and Chin-Shang Li, PhD, University of Rochester.

Darryl Somayaji is supported by the University at Buffalo School of Nursing Patricia H. Garman Behavioral Health Nursing Endowment Funds. Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number U01CA202979. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

By TERRA OSTERLING