Racial and Ethnic Differences in Beliefs About Lung Cancer Care

Jonnalagadda, Sirisha; Lin, Jenny; Nelson, Judith E.; Powell, Charles A.; Salazar-Schicchi, John; Berman, Andrew; Keller, Steven M.; Smith, Cardinale B.; Lurslurchachai, Linda; Halm, Ethan A.; Leventhal, Howard; Wisnivesky, Juan P.

doi:10.1378/chest.12-0330

Cited by 57 publications

(73 citation statements)

References 42 publications

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“…Prior research has shown that minority patients may hold beliefs different from those of nonminorities related to risk perception, fatalism, and fear of cancer diagnosis (13)(14)(15)(16). In particular, we found that blacks and Hispanics were more likely to hold fatalistic beliefs and that blacks were more likely to believe that surgery could cause lung cancer to spread (16).…”

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Cultural Factors Associated with Racial Disparities in Lung Cancer Care

Lin

Mhango

Wall³

et al. 2014

Annals ATS

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Rationale: Minority patients with lung cancer are less likely to receive stage-appropriate treatment. Along with access to care and provider-related factors, cultural factors such as patients' lung cancer beliefs, fatalism, and medical mistrust may help explain this disparity.Objectives: To determine cultural factors associated with disparities in lung cancer treatment. Methods:Patients with newly diagnosed lung cancer were recruited from four medical centers in New York City from 2008 to 2011. Using validated tools, we surveyed participants about their beliefs regarding lung cancer, fatalism, and medical mistrust. We compared rates of stage-appropriate treatment among blacks, Hispanics, and nonminority patients. Multiple regression analyses and structural equation modeling were used to assess whether cultural factors are associated with and/or mediate disparities in care. Measurements and Main Results:Of the 352 patients with lung cancer in the study, 21% were black and 20% were Hispanic.Blacks were less likely to receive stage-appropriate treatment (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.27-0.93) compared with whites, even after adjusting for age, sex, marital status, insurance, income, comorbidities, and performance status. No differences in treatment rates were observed among Hispanics (OR, 1.05; 95% CI, 0.53-2.07). Structural equation modeling showed that cultural factors (negative surgical beliefs, fatalism, and medical mistrust) partially mediated the relationship between black race and lower rates of stage-appropriate treatment (total effect: 20.43, indirect effect: 20.13; 30% of total effect explained by cultural factors).Conclusions: Negative surgical beliefs, fatalism, and mistrust are more prevalent among minorities and appear to explain almost one-third of the observed disparities in lung cancer treatment among black patients. Interventions targeting cultural factors may help reduce undertreatment of minorities.

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“…In particular, we found that blacks and Hispanics were more likely to hold fatalistic beliefs and that blacks were more likely to believe that surgery could cause lung cancer to spread (16).…”

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confidence: 84%

Cultural Factors Associated with Racial Disparities in Lung Cancer Care

Lin

Mhango

Wall³

et al. 2014

Annals ATS

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“…Factors contributing to the disparities in lung cancer include inequities in access to health care, differing perceptions regarding early detection, smoking cessation and treatment, and variation in susceptibilities to the effects of cigarette smoke (6,7). Conversely, the incidence rates for lung cancer among Hispanic men are much lower, and OS is better than in non-Hispanic whites.…”

Section: Disparitiesmentioning

confidence: 99%

Update in Lung Cancer and Mesothelioma 2012

Powell

Halmos

Nana‐Sinkam

2013

Am J Respir Crit Care Med

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Lung cancer remains the number one cause of cancer-related death in the United States among both men and women. It is estimated that in 2013, there will be more than 200,000 new diagnoses of lung cancer and nearly 160,000 deaths (1). Despite the discovery and application of targeted therapies, the overall survival (OS) remains poor, with an overall 5-year survival approximating 16%. In addition, there are a growing number of cases among former smokers and never smokers. However, based on research advances in 2012, there is enthusiasm that improvements in early detection, coupled with tobacco cessation and the application of novel genetic and genomics technologies, will lead to improved outcomes. EPIDEMIOLOGYAlthough more than 85% of patients diagnosed with lung cancer will have smoked at some point in their lives, only 15 to 20% of smokers will develop lung cancer, thus suggesting the involvement of additional risk factors. Studies examining the roles of various exposures, including asbestos, welding, arsenic, and concomitant lung diseases, such as chronic obstructive pulmonary disease (COPD), tuberculosis, and pneumonia, as risk factors independent of tobacco consumption are ongoing (2, 3). A recent large epidemiological study in more than 2,000 incident cases of lung cancer cases and control subjects identified a 36% increase in lung cancer risk among welders and flame cutters. Interestingly, welding fumes were an independent risk factor for lung cancer (4). DisparitiesA recent examination of multiple registries confirmed that African Americans have the highest incidence of lung cancer (73/100,000) (5) and have a decreased OS and lower rates of surgical resection. Factors contributing to the disparities in lung cancer include inequities in access to health care, differing perceptions regarding early detection, smoking cessation and treatment, and variation in susceptibilities to the effects of cigarette smoke (6, 7). Conversely, the incidence rates for lung cancer among Hispanic men are much lower, and OS is better than in non-Hispanic whites. The explanations for these differences include a combination of decreased smoking rates among Hispanics, potential genetic variants (8), and histological distribution. Saeed and colleagues conducted a systematic analysis of the SEER database and determined that Hispanics had a higher rate of less aggressive histological subtypes of lung cancer (adenocarcinoma in situ and lepidic predominant adenocarcinoma) (9). Investigation of these areas should help to narrow the lung cancer outcomes gap that exists between ethnic groups.

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“…Beliefs about care differed in a study with 335 lung cancer patients in relation to their ethnic backgrounds [110], as did symptom burden in another study involving 980 patients with pulmonary carcinoma [111]. In a recent study, MARTIN et al [112] highlighted significant differences in terms of various therapeutic aspects across ethnic groups in 5044 patients with lung or colorectal carcinoma.…”

Section: Cultural Dimensionmentioning

confidence: 99%

The lung cancer patient, the pneumologist and palliative care: a developing alliance

Blum

Schönfeld

2014

Eur Respir J

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Considerable evidence is now available on the value of palliative care for lung cancer patients in all stages and at all times during the course of the disease. However, pneumologists and their institutions seem to be widely in arrears with the implementation of palliative care concepts and the development of integrated structures.This review focuses on the available evidence and experience of various frequently unmet needs of lung cancer patients, especially psychological, social, spiritual and cultural ones. A PubMed search for evidence on these aspects of palliative care as well as on barriers to the implementation, on outcome parameters and effectiveness, and on structure and process quality was performed with a special focus on lung cancer patients.As a consequence, this review particularly draws pneumologists' attention to improving their skills in communication with the patients, their relatives and among themselves, and to establish team structures with more far-reaching competences and continuity than existing multilateral cooperations and conferences can provide. Ideally, any process of structural and procedural improvement should be accompanied by scientific evaluation and measures for quality optimisation. @ERSpublications Pneumologists should get more widely involved in palliative care for lung cancer patients

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Racial and Ethnic Differences in Beliefs About Lung Cancer Care

Cited by 57 publications

References 42 publications

Cultural Factors Associated with Racial Disparities in Lung Cancer Care

Cultural Factors Associated with Racial Disparities in Lung Cancer Care

Update in Lung Cancer and Mesothelioma 2012

The lung cancer patient, the pneumologist and palliative care: a developing alliance

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