Scaling Social Determinants of Health Screening, Social Support and Anti-Racism Training to Reduce Inequities in Minority Cancer Survivor Health and Wellbeing in Washington, DC

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SUMMARY Despite improvements in cancer outcomes over time, significant disparities remain between Black and White cancer survivors. Social determinants of health (SDOH) explain up to 80% of health outcomes while clinical care is estimated to explain only 20% of health outcomes. The goal of this research is thus to simultaneously target unequitable health care systems and accelerate the evidence base for scalable social determinants of health screening and referral to reduce inequities in cancer survivor health and well-being. This project is intended to establish sustainable clinical-community linkages and improve survivor quality of life and social connection. Understanding the burden of social needs in this population, the available community resources, and solidifying integrated, closed-loop referral systems to address those needs is critical to improving quality of life for cancer survivors. The long-term goal of this research is to develop scalable interventions to address social needs and support for cancer survivors. The proposal aims to: 1) improve care coordination and information exchange through mapping available resources for cancer survivors across Washington DC and building a universal screening and referral process at three cancer centers in DC; 2) determine impact of Community Health Worker (CHW) support on breast and prostate cancer survivor health and wellbeing as measured through quality of life and social connection; 3) determine impact of anti-racism (inclusive of SDOH) training for staff and clinicians at three cancer centers on patient reported perceived discrimination. This proposal is responsive to RFA-DP-21-003 to evaluate the implementation, impact, and causal mechanisms of our proposed intervention to reduce racial inequities among cancer survivors. We include innovative approaches to linking clinics and communities drawing on systems engineering and social network analyses and supported by ongoing DC efforts to bolster health information exchange systems to address social needs. Led by a uniquely-qualified research team, this research has the potential for high impact because of the significant disparities in cancer outcomes comparing Black and White breast and prostate cancer survivors in Washington DC. Our approach is also integrated with existing community resources including key community- based organizations in the Washington DC region. Results from this study will provide the foundation for future research examining the intervention’s generalizability to other disadvantaged cancer survivors and sustainability of the proposed screening and referral system. Findings will also provide a basis for further research on CHWs to support our target population, to improve shared resources in supporting cancer survivors, and to maximize impact within the evolving health information exchange environment.