Cancer Care Strategies Addressing Social Determinants of Health: Susan Escudier, MD

Captions are auto-generated.

Community navigators have been shown to decrease hospital utilization and increase patient access to equitable health care by helping patients overcome barriers related to social determinants of health.¹

In an interview with The American Journal of Managed Care^®, Susan Escudier, MD, FACP, vice president of Value-Based Care and Quality Programs for Texas Oncology and medical director for Value-Based Care for McKesson Specialty Health, spoke about care management strategies for patients with cancer. Escudier was also a panelist at the Houston Regional Institute for Value-Based Medicine on September 18. The panel discussed systemic inequities faced by patients in underserved populations and applicable strategies to equitable access to cancer care.

The first step to addressing equitable cancer care is acknowledging social determinants of health (SDOH), Escudier said. Increasing provider and payer awareness is pivotal in beginning to close the gap in equitable access to care.

“It's probably just as important to help deal with their housing insecurity or transportation issues as it is to accurately dose their chemotherapy,” Escudier said.

SDOH and health-related social needs (HRSNs) are significant indicators of whether an individual has access to quality health care. Furthermore, it also impacts their ability to access said health care, including their adherence to treatments, screenings, and follow-ups.²

One of the solutions Escudier proposed to increase patient adherence to their treatments was collaborating with social workers, and more specifically, community lay navigators. Previous studies have shown the presence of patient navigators to decrease hospital utilization and increase patients’ adherence and access to equitable cancer care.¹

“[With them] you increase the number of patients that actually make it to their appointment,” Escudier said. “They come in and get their testing done, and they're more likely to stay on their treatment.”

However, she also noted that payer navigators come at a cost, and while they may be beneficial to patients and relieve administrative burdens, they're likely an unsustainable tool without the help of payers.

“These are things that improve outcomes, but they require more resources than many small practices would have,” Escudier said.

Furthermore, insurance stability is another area of insecurity faced by patients battling SDOH.

“One of the heartbreaking things for me is when you have somebody who is working hard, maybe working two jobs, and now they get sick with their cancer, and their biggest fear is they're losing their health insurance,” Escudier said. “And it's a big fear for me too because I don't know how to get you through your treatment if you don't have the insurance to pay for it.”

Whereas some counties have more “robust” public health hospitals, not every county is the same, she said. SDOH has been shown to increase cancer mortality in at least 8 different areas.³

“What happens is people get sick, and they don't even want to go to the doctor because they can't afford to pay the bill,” Escudier said. “[Then] they show up with a more advanced disease.”

Overall, increased access to insurance and potential patient navigator support, Escudier said, are vital to improving patient outcomes amongst those with cancer. It would encourage patients to adhere to their treatments and potentially catch treatable diseases earlier.

References
1. Thompson MP, Podila PSB, Clay C, et al. Community navigators reduce hospital utilization in super-utilizers. AJMC. February 15, 2018. Accessed October 22, 2025. https://www.ajmc.com/view/community-navigators-reduce-hospital-utilization-in-superutilizers
2. Tucker-Seeley R, Abu-Khalaf M, Bona K, et al. Social determinants of health and cancer care: an ASCO policy statement. JCO Oncol Pract. 2024;20, 621-63. doi:10.1200/OP.23.00810
3. Pinheiro LC, Reshetnyak E, Akinyemiju T, Phillips E, Safford MM. Social determinants of health and cancer mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. Cancer. 2022 Jan 1;128(1):122-130. doi:10.1002/cncr.33894.