Grant Number:	5R01CA298021-02 Interpret this number
Primary Investigator:	Heintzman, John
Organization:	Ochin, Inc.
Project Title:	Healthcare Access, Utilization and Outcomes Across the Cancer Care Continuum: Understanding the Impact of Contextual Drivers and Screening
Fiscal Year:	2026

In the United States (US), nearly half of patients with a history of cancer report experiencing adverse contextual drivers of health including financial hardship, food insecurity, unstable housing, and transportation difficulties. Contextual factors 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 contextual drivers and healthcare use across the cancer care continuum is limited. Community health center patients experience more adverse contextual drivers of health, have lower use of many cancer services, and suffer poor cancer outcomes across numerous cancer types. The lack of data on contextual drivers among patients suggests that the extent and magnitude of the burden of these contextual factors are not well defined, nor is the association between contextual drivers of health and cancer care outcomes. To fill this gap, we propose a longitudinal, multi-level study of the associations between screening for contextual drivers of health, contextual drivers themselves, and cancer outcomes using data from a community health center (CHC) network across more than 40 states and including over 7 million patients. This robust and unique electronic health record (EHR)-based dataset will include clinical, utilization, multi-level contextual factors, tumor registry, and death data. Specifically, we aim to (1) define the use, and variation, of contextual drivers screening in community health center patients; (2) determine the prevalence and type of contextual drivers discovered by screening and the associations with the receipt of recommended cancer preventive screening services, and (3) using novel CHC network data linked to cancer registry data from Oregon, Washington, and California, determine whether contextual drivers screening, and the contextual drivers identified, are associated with stage at cancer diagnosis, treatment initiation, and cancer mortality. 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 contextual drivers serve as barriers to receipt of quality cancer care, as well as the importance of integrating contextual drivers screening within the healthcare setting to improve cancer outcomes.




Health-related social needs and distress in cancer patients and survivors: A global scoping review of food, housing, and transportation insecurity.
Authors: Rajan S.M. , Tran V.H. , Darius A. , Ochoa-Dominguez C.Y. , Davies M.C. , Duran E.A. , Telles V.M. , Rodriguez K. , Sabater-Minarim D. , Bhoo-Pathy N. , et al. .
Source: Preventive Oncology & Epidemiology, 2026; 4(1), p. 2691340.
EPub date: 2026-07-06 00:00:00.0.
PMID: 42730133
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