Healthcare utilization and outcomes across the cancer care continuum: understanding the impact of social risk factors and screening among latino patients

The National Cancer Institute awarded Ochin, Inc. $1.267 million on September 23, 2025, under the Cancer Cause and Prevention Research program (CFDA 93.393) to conduct a longitudinal, multi-level study examining the associations between social risk screening, social risk factors, and cancer healthcare utilization and outcomes among Latino and community health center patients.

The study uses electronic health record data from a community health center network operating across more than 40 states, encompassing over 7 million patients. The dataset integrates clinical, utilization, multi-level social determinant and contextual factors, tumor registry, and mortality data. Research aims include defining variation in social risk screening practices among Latino patients compared to non-Latino whites; determining the prevalence and types of social risks and their associations with receipt of recommended cancer preventive screening; and using linked CHC network and cancer registry data from Oregon, Washington, and California to assess associations between social risk screening, social risks, and stage at cancer diagnosis, treatment initiation, and cancer mortality.

The period of performance runs through August 31, 2030, with work performed in Portland, Oregon.

The University of California, San Diego serves as a sub-recipient, with Dr. Banegas as Co-Principal Investigator providing oversight of study design, data analysis, and dissemination of results, and bearing primary responsibility for analysis of associations between social risk factors and cancer diagnosis stage, treatment initiation, and mortality. Oregon Health & Science University serves as a sub-recipient providing biostatistical expertise, overseeing data linking and cleaning, and supporting statistical analysis and manuscript development.

Abstract

In the united states (US), nearly half of patients with a history of cancer report experiencing social risks including financial hardship, food insecurity, unstable housing, and transportation difficulties. Social risks may have negative impacts on healthcare use and outcomes, such as delayed or forgone medical care, poor quality of life and increased mortality. However, research on the associations between social risks and healthcare use across the cancer care continuum is limited. Latinos experience more social risks, have lower use of many cancer services, and suffer worse cancer outcomes across numerous cancer types than non-latino whites. The lack of data on social risks among latinos suggests that the extent and magnitude of the burden of unmet social risks are not well defined, nor is the association between social risks and cancer health and healthcare outcomes. To fill this GAP, we propose a longitudinal, multi-level study of the associations between social risk screening, social risk, and cancer outcomes using data from a community health center (CHC) network (where latino patients disproportionately receive care in the US) across more than 40 states and including over 2 million latino patients. This robust and unique electronic health record (EHR)-based dataset will include clinical, utilization, multi-level social determinants of health, tumor registry, and death data. Specifically, we aim to (1) define the use, and variation, of social risk screening in latinos (overall and by place of birth) compared to non-latino whites; (2) determine the prevalence and type of social risks, and the associations with the receipt of recommended cancer preventive screening services, compared to non-latino whites; and (3) using novel CHC network data linked to cancer registry data from oregon, washington, and california, determine whether social risk screening, and the social risks identified, are associated with stage at cancer diagnosis, treatment initiation, and cancer mortality, comparing latinos (overall and by place of birth) to non-latino white patients. Findings will be disseminated across multiple patient and provider networks, and help inform patients, community practices, providers, and policy makers about the extent to which social risks serve as barriers to receipt of quality cancer care in latinos, as well as the importance of integrating social risk screening within the healthcare setting to improve cancer outcomes.