Abstract
BackgroundIntegrated social care may help to mitigate social risk factors in order to achieve more equitable health outcomes. In cancer centers certified according to the criteria set out by the German Cancer Society, every patient must be given low-threshold access to qualified social workers at the center for in-house social service counseling (SSC). Previous analyses have demonstrated large variation in the utilization of these services across individual centers. Therefore, this research aims at investigating whether SSC utilization varies regarding breast cancer patient characteristics and center characteristics presenting a unique approach of using routine data.MethodsMultilevel modeling was performed using quality assurance data based on 6339 patients treated in 13 certified breast cancer centers in Germany in order to investigate whether SSC utilization varies with patient sex, age, and disease characteristics as well as over time and across centers.ResultsIn the sample, 80.3% of the patients used SSC. SSC use varies substantially between centers for the unadjusted model (ICC = 0.24). Use was statistically significantly (P < .001) more likely in women, patients with invasive (in comparison to tumor in situ/ductal carcinoma in situ) diseases (P < .001), patients with both breasts affected (P = .03), patients who received a surgery (P < .001), patients who were diagnosed in 2015 or 2017 compared to 2016 (P < .001) and patients older than 84 years as compared to patients between 55 and 64 years old (P = .002).ConclusionThe analysis approach allows a unique insight into the reality of cancer care. Sociodemographic and disease-related patient characteristics were identified to explain SSC use to some extent.
Highlights
Integrated social care may help to mitigate social risk factors in order to achieve more equitable health outcomes
Data from 13 breast cancer centers were included in the analysis, providing information on 6339 primary cases. 5092 (80.3%) patients in the sample used social service counseling (SSC), and 1247 (19.7%) patients did not
Results of the univariate logistic multilevel analyses are presented in supplementary material 1: Correlations show statistically significant associations for sex, age, prior cancer diagnosis, T-staging, N-staging, Mstaging, therapy type and date of diagnosis (Tables 1.1– 1.6, 1.8–1.9, supplementary material 1)
Summary
Integrated social care may help to mitigate social risk factors in order to achieve more equitable health outcomes. Including health care workers providing social service counseling (SSC) into the professional team might help mitigating this psychosocial strain and giving practical assistance. Despite the well-described psychosocial burden associated with a cancer diagnosis, access to SSC is limited in many health care systems. This may be due to costs and reimbursement structures, lack of qualified staff, or lack of pathways that help patients find adequate providers [7]. The authors argue that integrated social care may help to mitigate social risk factors to achieve more equitable health outcomes. A recent survey implies that higher SSC frequencies in breast cancer centers might relate to decreased information needs regarding financial problems and problems with health insurance [10]
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