Thriving while surviving: Understanding the social needs of cancer survivors

There is growing recognition of the important role that social needs such as access to food, housing, and transportation play in health care, as research has demonstrated their impact on physical and emotional well-being in a number of patient populations.

Now, in a study published in Current Oncology Reports, a collaborative team led by researchers from the School of Social Policy & Practice (SP2) has conducted a scoping review to determine what is known about the unmet social needs of U.S. cancer survivors.

“This is a neglected population,” says SP2 associate professor Tamara J. Cadet. She adds that while institutions have developed ways to celebrate the completion of treatment, and research has focused on the psychological needs of survivors—adjusting and coping—“there are also all these social needs that we know nothing about.” Understanding those needs, she says, is essential to developing effective interventions to address them.

“The goal is to compile the available evidence and present what the literature tells us on a topic,” says SP2 assistant professor Meredith Doherty. “[A scoping review] can help describe or map the landscape of what the scientific research on this topic looks like so that we can build from there.”

Analyzing data on a set of individual-level needs such as food security and housing from six databases, the researchers found that unmet needs, especially financial toxicity—the financial burden associated with chronic illnesses such as cancer—are prevalent among cancer survivors. Importantly, they also found that these unmet needs are negatively linked to quality of life, mental health, and adherence to care.

“Unmet social needs are associated with greater use of the emergency room, longer hospital stays, and people coming in with more advanced conditions—pain and uncontrolled symptoms—because they weren’t able to see a doctor earlier,” says Doherty.

“We know if we’re not addressing these needs, we’re going to have bad outcomes,” adds Cadet, who also has a secondary appointment in the School of Dental Medicine. “And we don’t want bad outcomes for people who've already conquered cancer.”

Although this research focused on cancer survivors, it has broader implications.

“Cancer and its costs are a concern for everyone,” says Doherty. “But this research also applies to any serious, chronic illness because of the way our health care system is set up and financed—unmet social needs have a direct and deleterious effect on health and treatment outcomes.”

With this better understanding of the impact of unmet social needs in this population, Cadet and Doherty are turning their attention to interventions.

Doherty is currently wrapping up a randomized control trial examining the impact of providing $1,000 per month to patients with advanced cancer on Medicaid. Social work, she notes, is uniquely able to “work both on the immediate practical needs of the communities that we serve and simultaneously try to address root causes.”

Cadet, on the other hand, is developing a brief food insecurity tool as part of a pilot study with a team at the Ann B. Barshinger Cancer Institute at Lancaster General Hospital. “We can’t change income, and we can’t necessarily change housing,” explains Cadet. “But when you think about food [you can ask]—are there pantries? Are there food vouchers? That kind of thing.”

Cadet and Doherty see this work in the broader context of health care, encouraging collaboration across the healthcare continuum to help provide better care for patients and reduce individual and institutional costs.

“Ultimately, the economic cost of not addressing social needs is just ridiculous,” says Cadet. “We’re just going to see people come back, and then we will watch our health care system get strained and become more expensive and, in some cases for some populations, inaccessible.”

Tamara J. Cadet is an associate professor and co-director of the Ph.D. in Social Welfare program in the School of Social Policy & Practice with a secondary appointment in the Division of Community Oral Health at the School of Dental Medicine at the University of Pennsylvania. She is also a senior fellow in the Leonard Davis Institute and the Center for Public Health, director of the Program in Community Engagement Innovation at the Penn Center for Cancer Care Innovation, and assistant director for Community Outreach and Engagement at the Abramson Cancer Center.

Meredith Doherty is an assistant professor at the School of Social Policy & Practice, a senior fellow in LDI, and faculty at both the Center for Guaranteed Income Research and the PC3I.

Other authors are Chelsea Brown, Sam Kirk, and Rory Weal of the University of Pennsylvania; Julie Berrett-Abebe of Fairfield University; Emily Hallgren of the University of Arkansas for the Medical Sciences and Larner College of Medicine; Tess Thompson of the University of North Carolina at Chapel Hill; and Krutika Chauhan of the University of Washington School of Medicine.

This work was supported by the American Cancer Society (MRSG-19–086-01-CPPB) and the National Cancer Institute (R37CA277778), the National Institute on Aging (1K23AG062795), and the Abramson Cancer Center Support Grant from the National Cancer Institute (5P30CA016520).