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Welcome to the first issue of ASCO Connection in 2023—we are kicking off the new year with a wide-ranging issue and I want to draw your attention to a few stories in particular. 

A topic I often address in these letters is social determinants of health. There are a number of valid definitions for this concept; the World Health Organization describes social determinants of health as circumstances “shaped by the distribution of money, power, and resources at global, national, and local levels. The social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries.” I gained a deeper understanding of these factors while earning an MPH, and now they form the basis of much of my research on health disparities in gynecologic cancer outcomes. If we want to see meaningful improvement in health equity, we cannot neglect the role of social determinants of health and how the circumstances of our patients’ lives profoundly affect their well-being.

Dr. Carol Y. Ochoa, Dr. Tricia Kalwar, and Dr. Narjust Florez examine the impact of social determinants of health on the Hispanic/Latinx community, in the context of a 2022 Special Series published in JCO Oncology Practice. They begin with a short vignette and explore the factors that influence this patient’s care, including the language she speaks, where she lives, her reliance on public transit, and her coverage through Medicaid. The case presented is hypothetical, but as the authors note in the article’s subtitle, “A Tale From the Real World,” Hispanic/Latinx patients face these and other barriers to high-quality care every day. 
Language as a social determinant of health is also addressed in this issue, in which Dr. Kathryn DeCarli and Dr. Jonathan Marron present an ethical case study about medical interpretation services. They consider the actions that a cancer care provider must take, should take, and may take when provider and patient are not fluent in the same language. Their discussion is grounded in patient autonomy and cultural sensitivity.

Both of these articles note that workforce diversity and representation is a significant factor that must be addressed in our pursuit of health equity. A homogenous workforce cannot adequately meet the unique needs of the many patient populations that we serve.

Another topic close to my heart is palliative care; I am a gynecologic oncologist and boarded in palliative care. I believe in care for the whole person, and studies demonstrate that patients experience better outcomes when palliative care is integrated in their cancer treatment plan from the beginning. In October 2022 (in which we recognized both Breast Cancer Awareness Month and World Hospice & Palliative Care Day), ASCO and several partnering organizations launched a webinar series on breast cancer and palliative care. ASCO chief medical officer Dr. Julie R. Gralow served as one of the organizers of the series; she discusses the importance of early integration of palliative care. “No matter your discipline, disease site, or location, it’s all about making the patient feel better and living their best life,” she explains—a philosophy I wholeheartedly support.
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