In this interview, Kat Aguilar, MPH, director of real-world research at Ontada, discusses findings from two studies presented at ISPOR 2025 that reveal critical gaps and complexities in the relationship between social determinants of health and cancer mortality, underscoring the need for broader, more nuanced research approaches.

Please introduce yourself by stating your name, title, and any relevant experience you’d like to share.

Kathleen M. Aguilar, MPH: My name is Kat Aguilar. I'm a director of real-world research at Ontada. I have been in this industry for over 15 years, focusing on research that combines health care technology with research to investigate patient profiles, treatment patterns, and outcomes. Most recently, my focus has been on using this information to examine social determinants of health (SDOH).

Could you provide an overview of your abstract and presentation at ISPOR 2025? Aguilar: At ISPOR 2025, I'm privileged to present the work of 2 research studies that my colleagues and I have done. The first one is a podium presentation that examines electronic health record (EHR)-based distress screening among community oncology practices. I'm also privileged to present a scoping review that my colleagues and I conducted that examined the evidence related to social determinants of health and cancer mortality.

Your review highlights that education, income, and employment were underrepresented compared to race, ethnicity, and insurance status. What are the implications of these gaps for future SDOH-focused cancer research?

Aguilar: Empirically, there's this assumption that social determinants of health impact cancer mortality. Logically, it makes sense, and it is supported by an abundance of research and literature out there. As we performed this scoping review, we found that the relationship is very complex.

The relationship exists. There are associations between social determinants of health and cancer mortality, but the direction and magnitude of those aren't necessarily what we would expect. There were some surprising findings in this, in terms of most, if not all, of the social determinants that were included in the scoping group being associated with increased cancer mortality in at least 1 study. However, they weren't associated in every study, and some actually showed converse effects. As we dug deeper into the literature, we found that this complex relationship is due to mitigating factors that are influencing the association and making it more complex than what we had anticipated.

As we think about future cancer research, we want to take into account the complex and cumulative nature of social determinants of health. These are acquired over a patient's lifetime, not just within the single health care setting, which a lot of these studies focus on. We want to consider the characteristics of the individual and also the places they reside, as that could be a powerful motivator as well. Additionally, when we do not find associations, we need to dig a bit deeper to understand why that relationship may be obscured and what other factors have come into play.

What key recommendations would you make for stakeholders, payers, policy makers, and health systems, based on the identified gaps in SDOH data and its impact on cancer mortality outcomes?

Aguilar: Evidence is still needed to address this. Social determinants of health are not a new concept. In the last 5 years or so, the term “social determinants of health” has really exploded in the published literature. However, as we think about the types of research being done, the data being included, and the methodologies, they are usually focused on a single determinant or two, as well as a single population.

We need to think about generating evidence that is broad. In the cancer population, this would be pan-tumor populations and nationwide studies, and we also want to use data that are robust enough to allow us to examine both individual characteristics as well as the characteristics of the places where patients reside, as all of that can contribute to the cumulative interplay between the social determinants of health.

Are there any other takeaways you'd like for the audience to take away from your research?

Aguilar: This is a call to action for more research into it. We identified some clear gaps. We have the capabilities—especially with real-world data and large data sets that are out there—to think about how social determinants interact with each other and how these ultimately impact cancer mortality and survival.