Overcoming SDOH Barriers in Cancer Care: Susan Escudier, MD

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Social determinants of health (SDOH) significantly impact a patient's access to necessary health care interventions, especially those with cancer.¹

In an interview with The American Journal of Managed Care^® (AJMC^®), Susan Escudier, MD, a medical oncologist from Texas Oncology, discussed potential tools and implementations that could help patients faced with SDOH keep up with their treatments and increase equitable access to cancer care. Similarly, health-related social needs (HSRNs) refer to the unmet needs that also affect a person’s health. Factors such as stable, affordable housing, access to healthy food and transportation, and interpersonal safety have been negatively associated with cancer-related outcomes in patients when absent.¹

When HSRNs go unmet, it impacts patients’ ability to continue their cancer treatments, which include screening and prevention, diagnosis, survivorship, and end-of-life care.¹ One of the biggest concerns for Escudier is patient honesty negatively impacting their care. For example, she said some patients don’t feel comfortable sharing certain issues with their provider face-to-face. As a solution, Escudier proposed automated self-reported patient updates.

“I feel like making it easy for the patients to give us the information in a non-threatening way, and preferably that is automated,” she said. “I should be alerted when my patients complain of depression or pain.”

Furthermore, she also recommended collaborating with social workers or navigators to contact patients and encourage them to stay up-to-date in their care.

“If I'm in public health or an insurance company, I think those [tools] are very useful because the cancer burden is greater in communities that are close to industrial areas that have food deserts and don't have outside benefits,” Escudier said, describing ways policymakers can improve patient accessibility and resources.

Patient navigators can serve as a potential solution for low-income minority patients in cancer care. Their role is to help patients overcome barriers related to SDOH and unmet HSRNs. Additionally, their presence reduced utilization and cost outcomes for patients in cancer care.²

“I think they're useful to that extent of how we improve the health of the population,” Escudier said.

Outside of policy reform and payer, social worker, or lay navigator collaboration, Escudier also called for systemic environmental reform. By improving resources outside of immediate health-care-related interventions, like parks and walking trails, patients can take smaller steps to improve their health on their own.

“Kids should [also] get healthy lunches and things like that,” she said. “[And while] I don't see it being necessarily useful in a day-to-day practical clinic thing… I think as a research tool, a public health tool, I think they're very interesting.”

Escudier was a panelist at the AJMC's Institute for Value-Based Medicine^® held in Houston, Texas. During her discussion titled “No Outcome Without Access: Rewriting the Rules of Equity in Cancer Care,” she addressed systemic, financial, and research-driven strategies to advance equitable access and affordability in cancer care.

“We always knew [SDOH] were out there but didn't realize the scale of them and how many patients were affected by them,” Escudier said.

References
1. 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
2. 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