Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Strategies in the plan

1. Increase awareness and implementation of evidence-based SDOH screening tools for all patients to identify needs and resources, including:
   • Safe housing, transportation, and neighborhoods
   • Education, job opportunities, and income
   • Nutritious foods and physical activity opportunities
   • Discrimination and violence
   • Polluted air and water
   • Language and literacy skills
2. Support the availability of patient education materials that adhere to health literacy standards, utilizing the evidence-based tools and best practices.
3. Disseminate health literacy standards and language guides to health care providers, community health workers, and health navigators.

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Strategies in the plan

1. Monitor and share updates on the use of artificial intelligence (AI) across the cancer continuum.
2. Monitor and share updates on the use of new and emerging technology across the cancer continuum.
3. Provide data (where available) to support increased utilization in decision-making and prioritization across the cancer continuum.

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Strategies in the plan

1. Promote and increase awareness and education of clinical trials for all ages, including finder tools for patients.
2. Increase awareness of non-treatment clinical trials and research for all ages, including supportive services.

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Strategies in the plan

1. Provide tools and resources to educate patients, caregivers, and providers on patient-centered decision-making, and emphasize the importance of decisions regarding cancer screening and treatment being made by the patient.
2. Collaborate to incorporate shared decision-making, including cancer screening, treatment decisions, fertility preservation, genetic testing, and advance care planning.
3. Increase awareness to address stigma associated with risk reduction, detection, treatment, and survivorship among individuals whose cancer treatment may benefit from targeted, proven, or emerging therapies.
4. Increase consumer representation, particularly among cancer patients, survivors, and caregivers, on leadership and advisory boards of organizations serving cancer patients and survivors.

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Strategies in the plan

1. Promote reliable and reputable resources (including financial advocates and navigators) for financial assistance to cancer patients and survivors and their families during and after cancer treatment (such as foundations, prescription assistance programs, and government assistance programs) and programs not directly related to treatment including assistance for co-pays, insurance premiums, and basic living expenses (rent, utilities, phone, food, childcare, transportation costs, etc.).
2. Train community based organizations and health care professionals to educate patients on self-advocacy, and to advocate on behalf of patients for reduced screening and treatment costs.
3. Share tools and resources that aid informed decision-making about public health insurance options.

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Strategies in the plan

1. Promote the implementation of evidence-based health navigator and community health worker services across the cancer care continuum.
2. Promote recognized competency-based and accessible training programs for non-clinical navigators and community health workers within the cancer care continuum.
3. Increase awareness and implementation of reimbursement for patient navigation through state and federal public insurance options.
4. Promote use of the Colorado Community Health Worker Registry by health systems, community-based organizations, and community health workers.

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Strategies in the plan

1. Increase awareness of mental health and support services for health care professionals and caregivers.
2. Provide and promote wellbeing resources based on identified needs.

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Strategies in the plan

1. Collaborate with the State Tobacco Education and Prevention Partnership to achieve shared priorities in support of the Tobacco Education, Prevention, and Cessation Strategic Plan.

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Strategies in the plan

1. Develop and implement policies and programs that protect, promote, and support breastfeeding-friendly environments.
2. Improve nutrition and physical activity environments for children younger than 18 years in early care and education settings and schools, especially those serving low-income populations.
3. Promote community-based interventions, evidence-based interventions, and policies that make the healthy choice the easy choice for physical activity and nutrition.

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Strategies in the plan

1. Increase access to worksite wellness programs that implement and communicate best practices in worksite wellness activities.
2. Connect community members to evidence-based exercise classes (e.g., Walk with Ease, National Diabetes Prevention Program, Active Living Everyday, SilverSneakers, Girls on the Run) and fitness program support in community centers, senior centers, and fitness and community wellness centers.
3. Promote and implement policy interventions in the built environment, combining new or enhanced transportation systems (e.g., pedestrian and cycling paths) with new or enhanced land use design (e.g., proximity to a store, access to a public park) to promote physical activity among residents.
4. Provide community-based interventions, evidence-based interventions, and policies that make the healthy choice the easy choice for physical activity and nutrition.

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Strategies in the plan

1. Promote the use of electronic screening and brief intervention (e-SBI) to facilitate personalized feedback about the risks and consequences of excessive drinking.
2. Educate providers and the general public on cancer risk related to alcohol use.
3. Support increasing the purchase price of alcoholic beverages.
4. Support requiring alcoholic beverage labels to include a warning related to the increased risk of cancer, such as “According to the Surgeon General, consumption of alcoholic beverages can cause cancer, including breast and colon cancers.”

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Excludes Basal and Squamous Cell Carcinoma.

Strategies in the plan

1. Educate adults and children about risk reduction for melanoma, sun safety behaviors, and reducing risk of UV exposure, including indoor UV tanning devices.
2. Develop educational materials for policymakers on the risks of indoor tanning.
3. Advocate for local governments, parks departments, workplaces, schools, preschools, and childcare centers to establish sun safety guidelines, procedures, and policies for increased sun protection and shade.

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Strategies in the plan

1. Support efforts, including those from the National Colorectal Cancer Roundtable, to standardize the collection of family history data in electronic health records to allow providers to identify individuals who meet the clinical criteria for a hereditary cancer syndrome and those who should be referred to a genetic counselor.
2. Educate providers on guidelines for collecting family history, screening tools, and referrals for comprehensive genetic testing and counseling. Evidence-based guidelines are available from national organizations, including the United States Preventive Services Task Force, the National Comprehensive Cancer Network, the American Cancer Society, the American College of Radiology, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians.
3. Educate the public on the role of family history and potential genetic testing for hereditary cancer syndromes.
4. Support implementation of family history screening tools in primary or specialty care settings to identify patients at risk for hereditary cancer.
5. Support genetic counselor workforce development.
6. Identify and share resources for genetic counseling and testing for at-risk individuals.

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Strategies in the plan

1. Educate parents and/or eligible recipients, ages 9-26, about the HPV vaccine as a cancer prevention method.
2. Explore HPV vaccination series completion in pharmacies.
3. Explore HPV vaccination education and vaccine recommendations within dental settings to protect against the types of HPV that can cause oropharyngeal cancers.
4. Promote vaccination programs and requirements in schools and health systems, and encourage participation in the Colorado Immunization Information System to track vaccine uptake within clinics.
5. Promote resources for evidence-based interventions that increase vaccine uptake, such as reminder and recall systems targeted to providers, patients, and parents/guardians within health systems and schools, provider assessment and feedback, and standing orders.

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Strategies in the plan

1. Educate medical providers on how to prevent hepatitis B and to treat hepatitis C, with special focus on primary care settings. Evidence-based guidelines are available from national organizations, including the National Comprehensive Cancer Network, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians.
2. Educate people who:
   • Have increased risk for hepatitis B and C on how to prevent it, including harm reduction strategies that empower people to take charge of their health.
   • Are eligible for hepatitis B vaccination (all people).
   • Were born between 1945 and 1965 on the importance of getting tested for hepatitis C.
   • Are living with chronic hepatitis B and C on the importance of maintaining care for their hepatitis to prevent complications such as liver cancer.
3. Promote implementation of standing orders for hepatitis B and C testing for all pregnant women during each pregnancy and for all people age 18 and older.
4. Promote access and coverage for hepatitis B and C treatment among public and private health plans, including increased access to telehealth options in rural areas of the state.
5. Promote hepatitis A and B vaccinations for people at risk of contracting hepatitis A and B.

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Strategies in the plan

1. Educate Colorado residents and policymakers about the hazards of radon exposure, and the importance of radon testing and mitigation using credentialed radon service providers who follow consensus standards of practice.
2. Educate builders, code officials, city councils, and county commissioners on the hazards of radon exposure and the importance of adopting radon-resistant new construction building codes.
3. Support environmental equity through radon education, free radon testing, and the Low-Income Radon Mitigation Assistance directed at under-resourced communities.
4. Provide radon education to the medical community, childcare facilities, and schools.

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Strategies in the plan

1. Educate health care providers on the importance of health care provider recommendations and following nationally recognized, evidence-based cancer screening guidelines, such as those from the United States Preventive Services Task Force (USPSTF), National Comprehensive Cancer Network (NCCN), American Cancer Society (ACS), and American College of Radiology (ACR).
2. Increase awareness and implementation of patient and provider-oriented evidence-based interventions to increase cancer screening, including client reminders, electronic health record (EHR) automation for provider reminders, provider assessment and feedback, and reduction of structural barriers (i.e., helping with scheduling, providing transportation, providing childcare, alternative clinic hours, etc.).
3. Promote informed, shared decision-making between providers and patients based on individual, comprehensive risk assessment profiles and current clinical guidelines, such as the benefits, risks, insurance coverage, and appropriate timing of age-related screenings, including:
   • When to begin breast cancer screening.
   • Which test option is best for cervical cancer screening.
   • Which test option is best for colorectal cancer screening.
   • Whether or not lung cancer screening is appropriate.
   • When to begin and the frequency of prostate cancer screening.
4. Educate providers, clinic staff, including those involved in billing and coding, and decision-makers to ensure that follow-up colonoscopy following a positive non-invasive test is classified as part of the complete cancer screening process and therefore covered without cost to the patient.
5. Implement workplace policies to support individuals in completing recommended cancer screenings.
   • Policies to support paid time off for hourly employees
   • On-site screenings
   • Employee education

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Strategies in the plan

1. Increase access to cancer screening services for colorectal, cervical, breast, prostate, and lung, in rural areas by implementing mobile services, traveling providers, transportation assistance, and getting the equipment needed to increase the capacity of rural facilities.
2. Partner with community-based organizations to reduce financial, cultural, structural, and geographic barriers to cancer screening. This includes supporting the recruitment and training of community health workers, patient navigators, financial navigators, social workers, Promotoras de Salud, and care coordinators to help patients overcome these barriers.
3. Increase awareness of how to enroll in public and private health insurance.
4. Provide education on insurance benefits, coverage, and enrollment, including screenings covered at no or minimal cost.
5. Implement a tobacco-use history tool in electronic medical records to alert health care professionals to eligible patients for lung cancer screening and referral to the Colorado Quitline.
6. Monitor emerging screening options for future implementation to improve detection of cancers with high mortality rates that are not detected by current screening tests.
7. Collaborate with transportation councils and organizations (e.g., nonprofits, rideshare providers, volunteers) to improve access to medical facilities.

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Strategies in the plan

1. Increase awareness of the symptoms of cancers without population-based cancer screening guidelines among health care providers and individuals, including early-age onset colorectal, ovarian, and HPV cancers.
2. Educate providers about symptoms, risk factors, early detection, genetic counseling, and genetic testing for cancers that currently lack screening tests.
3. Educate pediatric clinicians to raise awareness of the signs and symptoms of childhood cancers.
4. Increase the timely diagnosis of childhood cancers.

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Strategies in the plan

1. Identify and implement shared decision-making tools and provide educational resources for patients of all ages, families, and caregivers for treatment side effects management, and supportive care decisions, including current treatment options, genetic testing, biomarker testing, side effects, late side effects, and fertility preservation.
2. Encourage and support access to genetic counseling and testing services for individuals (especially those with a family history) in accordance with national guidelines, enabling earlier discussion of all appropriate treatment options.
3. Engage health navigators to educate patients and caregivers on the importance of timely and informed decision-making during navigation to cancer care and during cancer care.

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Strategies in the plan

1. Educate patients, caregivers, providers, and decision-makers on potential financial toxicity, or unintended financial consequences of pursuing cancer treatment regimens, including advocating for policies that could reduce the financial burden of cancer.
2. Provide education on insurance benefits, coverage, and enrollment, including diagnostic testing and treatment covered at no or minimal cost.
3. Identify and engage financial assistance programs and promote these to patients seeking diagnostic services or pursuing active treatment, including indirect costs.

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Strategies in the plan

1. Increase access to cancer diagnostic and treatment services statewide by implementing innovative strategies that utilize technology (e.g., telemedicine).
2. Collaborate with transportation councils and organizations (e.g., nonprofits, rideshare providers, volunteers) to improve access to medical facilities.
3. Engage community health workers, health navigators, social workers, Promotoras de Salud, and care coordinators to assist patients with increasing access to care.

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Strategies in the plan

1. Advocate for and increase awareness of and access to universal genetic counseling and genetic testing in accordance with national guidelines, including reducing financial barriers.
2. Advocate for and increase awareness and access to molecular and biomarker testing for patients in accordance with national guidelines, including reducing financial barriers, to identify treatment options.

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Strategies in the plan

1. Develop and implement educational initiatives to improve early recognition of cancer symptoms in the pediatric and AYA population (ages 0–39).
2. Increase awareness of treatment and supportive care services, including fertility preservation and care transitions across the cancer continuum.
3. Create centralized resources to help families navigate treatment support programs, including financial, insurance coverage, travel and lodging assistance, and caregiver services.
4. Conduct a needs assessment to identify regional barriers to accessing diagnostic and cancer treatment services.

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Strategies in the plan

1. Educate patients, caregivers, providers, employers, and school officials about maintaining a healthy lifestyle as a way to decrease the risk of cancer recurrence, side effects from treatment, additional primary cancers, and/or other comorbidities.
2. Facilitate and promote collaboration across clinical and community settings, including physical therapy, occupational therapy, social work, nutrition, physical activity, and fertility.
3. Promote and implement evidence-based complementary and alternative therapies (e.g., physical activity, yoga, or massage) as non-clinical approaches to improve quality of life for people affected by cancer.
4. Provide a mechanism to identify and promote comprehensive Colorado-specific physical well-being resources, including community-based organizations and support groups.

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Strategies in the plan

1. Educate and support people of all ages diagnosed with cancer and their families, caregivers, and health care professionals about mental, emotional, and behavioral health, including cognitive function.
2. Provide a mechanism to identify and promote comprehensive Colorado-specific resources, which may include health care and community-based organizations, and support groups.

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Strategies in the plan

1. Provide resources to the public and medical communities, including primary care providers, on national resources and guidelines such as the American Cancer Society, American College of Radiology, American Institute of Cancer Research, National Comprehensive Cancer Network, and United States Preventive Services Task Force.
2. Enhance collaboration between oncology and primary care providers on treatment side/late effects, to provide ongoing support that improves treatment outcomes, and prevents or reduces the risk of cancer recurrence and secondary cancers.
3. Collaborate with the public, organizations, and health care communities to increase awareness of the importance of advanced care planning.
4. Educate the public and medical communities about the benefits and differences of palliative and hospice/end-of-life care.

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Strategies in the plan

1. Identify and integrate data from national and state-level cancer registries, pediatric cancer centers, and survivorship programs to measure incidence, prevalence, and survivorship outcomes for individuals diagnosed with cancer between ages 0–39.
2. Develop and implement standardized data collection tools and annual surveys across pediatric and AYA oncology programs to assess long-term health outcomes beyond survival, access to survivorship care, utilization of supportive services (e.g., mental health, fertility preservation, rehabilitation), and gaps in services and care coordination.
3. Educate parents, caregivers, school officials and staff, students, and local health care providers on late side effects and support needs.
4. Work with community-based organizations and health care systems to promote policies that improve long-term support and reduce the financial and emotional stress of survivorship.

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