Social and Community Context Matter in Cancer Care
By Jennifer Kue, PhD, and Kristine K. Browning, PhD, APRN-CNP, FAANP
A person’s zip code often matters more than their genetic code when it comes to their health. Where we live and work, how connected we are in our community, and how much support we have are core social determinants of health that also significantly affect cancer health outcomes.
Social and community context involve (https://doi.org/10.1188/17.onf.20-23) a community’s psychosocial aspects, such as social integration, social support, discrimination stressors, and engagement. For example, a person’s relationships with their family, friends, and community may affect (https://doi.org/10.3322/caac.21586) their cancer outcomes. Additionally, geographically isolated neighborhoods lack important resources and services such as healthy, affordable food; health care and well care; and a place for safe physical activity—all essential for people to achieve their full health potential.
By assessing social and community needs, oncology nurses can better understand their patients’ social circumstances and identify and connect patients and families with resources to address gaps.
Research has shown (https://doi.org/10.1073/pnas.1511085112) that people who are well connected to others have better health and are more likely to recover from major health issues, whereas socially isolated and lonely individuals have increased (https://doi.org/10.1016/j.psychres.2021.113868) risks for developing cancer and dying from the disease. Identify patients who are socially isolated and live in communities that lack resources early in their oncology care, connect them with support, and routinely check in on their unmet needs.
Having a network (https://bit.ly/3P90HVb) of people or a community can help alleviate some of patients’ logistical burdens of living with cancer, reduce stress, and provide emotional support throughout diagnosis and treatment. Screen patients for social support needs by asking questions such as, “How do you get to your appointments?” “Who checks in on you when you’re going through treatment?” or “What are you eating at home?” Provide additional attention and community services for patients with inadequate or no support systems, and recommend support groups such as CaringBridge or Friend for Life Cancer Support Network.
More than 1 in 5 adults in the United States report experiencing discrimination (https://doi.org/10.1001/jamanetworkopen.2020.29650) while receiving health care. Discrimination harms individuals and groups; compounded over time, it can lead to long-term negative health outcomes.
Discrimination happens at structural (e.g., residential segregation) and individual (e.g., patient-provider communication) levels. For example, people who live in racially segregated neighborhoods have differentially adverse (https://doi.org/10.3322/caac.21586) health risks, such as stress exposure, limited healthcare resources, and few places to play and exercise safely, ultimately affecting health outcomes. Discrimination and negative encounters (https://doi.org/10.1007/s13187-021-02069-0) with a healthcare provider can lead patients to mistrust providers and the healthcare system and deter them from following preventive behaviors, such as cancer screening.
Collaborating with community health stakeholders—the people, organizations, and agencies that influence a community’s health—can help nurses address patients’ needs. For example, social service agencies may be able to provide patients with transportation to oncology or other health appointments, assistance with paying for medications or home utilities, and access to cancer support groups or networks. Community health workers can provide culturally appropriate services for racially and ethnically diverse populations in their own communities.