NCCN Policy Summit: Addressing the Social Needs of Patients with Cancer

This blog post is on the National Comprehensive Cancer Network (NCCN) Oncology Policy Summit: Measuring and Addressing Health-Related Social Needs in Cancer. This event was held virtually and in person in D.C. on Tuesday, September 12, as part of the NCCN's annual policy summit series. 

At the most recent NCCN Oncology Policy Summit in D.C., speakers and panelists across the cancer care continuum stressed a commitment to advancing health equity and addressing the health-related social disparities patients with cancer face. Discussions focused on new recommendations for screening, the role of value-based care models, and potential policy solutions to address the effects of social drivers of health. In addition, conversations highlighted several innovative approaches and the concerted efforts being made to make cancer care more accessible and inclusive for all patients.

While analyzing critical components to delivering comprehensive cancer care, the NCCN working group proposed 4 new core recommendations to be assessed in all patients with cancer at least once a year and at every care transition point. They include:

• Transportation Access
• Housing Security
• Access to Food
• Financial Security

These recommendations also include additional details on specific practice, policy, and guideline strategies to make sure these needs are screened for and addressed in a thoughtful, educated, empathetic, and culturally sensitive way. “At NCCN, we know that caring for people with cancer must go beyond the clinic in order to achieve the best possible outcomes,” said Crystal S. Denlinger, MD, FACP, senior vice president and chief scientific officer at the NCCN during the first panel session of the day. “Health-related social needs (HRSN) must be accounted for as a standard part of the multidisciplinary health care team.”

Yelak Biru, MSc, president and CEO of the International Myeloma Foundation, echoed Dr. Denlinger’s sentiment. “Our recommendations call for education, advocacy, and engagement so that patients, social workers, providers, and policymakers can understand why and how to measure and address HRSN,” Biru said. “We asked ourselves, ‘what practice, policy, and guideline recommendations will help close the health-related social need care gaps patients face?’”  

According to Biru, these questions can be answered through the implementation of routine screening for HRSN, advocating for policies to make that possible, extending care beyond clinics, and driving policy reforms that promote patient-centered care delivery. “We hope these actions can redefine cancer care, making it comprehensive, accessible, and equitable,” she concluded.

Delivering Comprehensive Cancer Care  

“When someone gets a diagnosis of cancer, their life often gets turned upside down, and simple things suddenly become difficult,” said David W. Baker, MD, MPH, FACP, executive vice president, Healthcare Quality Evaluation and Improvement at The Joint Commission, as the day’s second panel began. “People with cancer may have trouble paying for care or may struggle to come in to see a doctor 2 or 3 times a week. If these HRSN are not addressed, patients may not be able to adhere to treatment plans, meaning their health and even their life is threatened.”

Building on Baker’s insight, Eucharia Borden, MSW, LCSW, OSW-C, FAOSW, vice president of Programs and Health Equity at Family Reach said, “I’ve sat with families who after a cancer diagnosis, tell me they are worried about being able to buy food.” “I’ve had patients ask me, ‘How can I afford to skip work to go to chemo[therapy]?’ Treatment requires more than medicine. To truly improve health outcomes, we must ensure that patients' basic needs are met.”

Danya Garner, PhD, RN, NPD-BC, OCN, CCRN-K, president, Oncology Nursing Society, shared her perspective on the role patient-centered care plays in oncology nursing. “As one of the most trusted professions, nurses understand and promote the principles of the whole person,” Dr. Garner said. “Addressing the physical, emotional, psychological, and social needs of every patient is critical to survivorship. This is what oncology nurses provide to patients and their families every day.”

Each panelist emphasized that questions regarding the social needs of patients should only be asked when there are adequate arrangements in place to implement potential solutions. Without action, panelists believe screening could increase feelings of distress, shame, and mistrust among patients. To prevent that from happening, screenings should be followed with connections to relevant community-based organizations working to address these HRSN.

Policy Solutions

The third and final panel session of the day featured a diverse group of healthcare experts who analyzed the best policy solutions to address HRSN among patients with cancer. To begin, Darcie Green, executive director for Latinas Contra Cancer shared the organization's mission to view cancer as a social, economic, and gender justice issue. She stressed the urgency of addressing the economic and social despair many patients with cancer face, particularly in the Latinx community. “I am here today because the clients we serve are in deep economic and social despair. They are facing these inequities every single day,” Green said. “It's a huge and very urgent matter for us as people struggle to provide for themselves and their families and then are diagnosed with cancer.”

Green also discussed the organization's efforts as a facilitator of crucial health education, patient navigation, advocacy, and support services to underserved communities. “We believe that there are some policy choices that we make that facilitate this, and that there are policy choices we can make that can change it,” she said.

Rose Baez, MSN, MBA, managing director, Network Quality Innovation and Measurement, Blue Cross Blue Shield Association, highlighted her organization’s dedication to health equity, demonstrated by the launch of their comprehensive health equity strategy in 2020.

“We've been doing a lot of work here and we have partnered with the National Minority Quality Forum in putting forward recommendations to the Office of Management and Budget,” Baez said. “We recommend Congress support public-private partnerships to address social needs by leveraging technology-driven solutions and community-based organizations that can improve outcomes for populations at risk of poor health outcomes.”

Juny Simpson, head of health equity, Customer Engagement at Genentech, provided insights into the company's commitment to developing patient-centered solutions. “At the heart of my work is early disease detection and education meant to motivate and encourage all historically marginalized communities to seek care earlier and not in the most expensive stage of care or with more disease burden,” she said.

Simpson went on to discuss a change in philosophy that now influences Genentech’s operational strategy. “Back in 2020, we changed our operating model to do what we call, bring health care local to ecosystems,” she explained. “What that did was force these local teams—because we believe health equity is local care is delivered locally—to really examine the unique barriers for patients and then collaborate with stakeholders at the local level to seek and provide solutions.”

As panelists delivered their closing thoughts, Bláz Bush, MEd, executive director for LGBTQ+ Health Programs, Stanford Medicine, shed light on how the LGBTQ+ community can experience harm while trying to access health care. “LGBTQ+ individuals who need to access cancer-related screenings and treatment may face critical disparities from lack of engagement with the healthcare system due to negative experiences and mistreatment,” Bush said. “Best practice recommendations to create an affirming environment for patients have existed for over a decade now—it’s time to implement them across the healthcare system.”

The shared insights from these healthcare leaders and advocates exhibit a collective commitment to health equity. The organizations they represent, in their various capacities, recognize the necessity of recognizing the importance of health equity and are working to close cancer care gaps and eliminate disparities.