He didn’t know about free hotel options available to him until last year, when a healthcare worker at Oncology Consultants, the practice where Mansfield had received treatment, learned of his struggle and connected him to lodging through the American Cancer Society.

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Mansfield was one of nearly 2,000 patients assisted by Oncology Consultants’ HOPE Initiative, which connects cancer patients with resources to address so-called social determinants of health, non-medical factors that can affect a person’s health outcomes. Studies show that challenges such as poverty, geographical isolation, low education, lack of public health infrastructure and lack of transport and housing can worsen mortality.

Often, however, patients don’t know how to begin tackling these challenges on their own, said Robin Arrambide, the lead nurse navigator at Oncology Consultants.

“If we don’t ask any questions, people don’t realize that living in that house with the wind blowing through it and the rain coming through the roof is not normal,” Arrambide said.

Accepts the routine

Mansfield was diagnosed with stage 3 renal carcinoma several years after working as a safety consultant during the 9/11 cleanup efforts at the World Trade Center in New York, where an estimated 91,000 workers were exposed to toxic dust, fumes and chemicals rising from rubble.

The cancer remained in his body after several operations, preventing him from working. He was referred to oncology consultants for treatment in 2015.

The World Trade Center Health Program covered his treatment, but he and his wife still had to carefully manage their finances to get the most out of workers’ compensation from his longtime employer and the 9/11 Victim Compensation Fund.

With no money in his budget for a hotel, he accepted the regular marathon trips to Houston as part of life, logging about 3,300 miles each year to and from his home, about 30 miles outside of Lufkin. He got used to taking a nap in the car before appointments and stopping at rest stops to sleep when the drive back proved too demanding.

HOPE — Holistic Oncology Patient Equity — The initiative started last year based on a desire to reach patients like Mansfield proactively, before social barriers get in the way of treatment. A recent study in the Journal of Radiation Oncology showed that cancer patients in rural areas are less likely to show up for radiotherapy and have poorer overall survival compared to their urban counterparts. In addition, research published in 2015 found a link between missed radiation and chemotherapy appointments and unmet socioeconomic and supportive care needs, particularly those related to housing, among black and Hispanic cancer patients.

The initiative involves a team of four nurse navigators and five community health workers, who act as liaisons between patients and clinical staff, administering patient surveys, often before their first appointment. From there, navigators and workers look to non-profit organizations, government programs or charities to meet patients’ needs. That might mean directing them to a nearby food pantry, helping them find a cheap garage apartment, or wrangling a free wheelchair ramp.

The workers speak English, Vietnamese and Spanish and share a direct phone number with the patient, bypassing cumbersome phone systems when emergencies arise.

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Hospitals and oncology providers don’t always do a full needs assessment, said Susan Sabo-Wagner, managing director of clinical strategy at Oncology Consultants. Previously, the practice, which opened in Houston about 40 years ago and operates 12 facilities in the area, didn’t look at social barriers until a patient missed an appointment. By then, some patients had simply stopped answering the phone, she said.

“We call them ‘Lost to follow-up,’ where we don’t hear from them again because too many things have happened,” she said. “They just don’t show up at appointments at all and don’t tell us, and maybe they’re considered non-compliant, which isn’t necessarily a fair summary of what they are.”

A broader trend

The HOPE initiative coincides with a wider push to improve equality and care coordination for cancer.

The Centers for Medicare and Medicaid Services last year announced the Enhancing Oncology Model, a voluntary six-year program that pays certain providers to lower the cost of care, perform social needs screenings and collect patient equity data, among other services. Oncology Consultants has been preliminarily accepted into the program, Sabo-Wagner said, noting that the patient screening initiative began before the CMS announcement.