A survey of US oncologists and hematologists suggests they have limited time to assist patients with social needs, but many patients are impacted by social determinants of health (SDOH). Results from this survey were published in BMJ Open.

Researchers surveyed physicians in the Cardinal Health Oncology Provider Extended Network, a group of more than 7000 medical oncologists/hematologists practicing across the United States.

The physicians were asked to complete a web-based survey and participate in a series of live market research meetings held between February and April 2020. The physicians were compensated for participating and were unaware that they would be asked about SDOH at the time they agreed to participate.

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A total of 165 physicians completed the survey. They were based throughout the country — 44% from the South, 27% from the Northeast, 21% from the Midwest, and 8% from the West.

Respondents’ primary medical specialties were hematology/oncology (65%), medical oncology (33%), or “other” (2%). They saw a median of 20 patients per day and had been in practice for a median of 18 years. Less than half (41%) were participating in the value-based Oncology Care Model.

Survey Results

The survey consisted of 10 multiple-choice questions related to the impact of SDOH on patients and seeking physicians’ opinions about how the effects of SDOH should be mitigated.

All respondents said at least some of their patients are affected by SDOH, 4% said all or nearly all of their patients are affected, 24% said most are affected, and 40% said about half of their patients are affected.

Most respondents (93%) said SDOH have a significant impact on their patients’ health outcomes. The greatest barriers identified were financial security (83%), access to transportation (58%), and health literacy (53%). Other barriers included social isolation (43%), housing security (18%), addiction (12%), and food security (7%).

Most respondents reported talking to patients often (51%) or all the time (18%) about how SDOH affected their care. However, most respondents (81%) also said they and their staff have limited time to assist patients with their social needs.

Roughly three-quarters of respondents (76%) reported that assistance programs were not readily accessible. More than half of respondents said government organizations, non-profit organizations, and commercial payers should be responsible for delivering assistance to patients.

Half of respondents said hospitals or cancer centers should provide assistance, and 42% said pharmaceutical companies should provide support, such as copay assistance, free drug programs, or patient education.

“The physicians in our study identified a need for more accessible assistance programs and greater involvement from all stakeholders in addressing SDOH to improve health outcomes,” the researchers wrote. “Collaborative action by professional organizations such as the American Society of Clinical Oncology, the Oncology Nursing Association, and the Association of Oncology Social Work may be one avenue to drive this change.”

Disclosures: This research was supported by Cardinal Health. All study authors are employees of Cardinal Health and may own stock in the company.


Zettler ME, Feinberg BA, Jeune-Smith Y, Gajra A. Impact of social determinants of health on cancer care: A survey of community oncologists. BMJ Open. 2021;11(10):e049259. doi:10.1136/bmjopen-2021-049259