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Modifiable Health System–Level Barriers Contribute to Lung Cancer Disparities

By: Julia Fiederlein
Posted: Wednesday, October 19, 2022

According to Manali I. Patel, MD, MPH, MS, of the Stanford University School of Medicine, California, and colleagues, disparities in the incidence, mortality, and quality of lung cancer care persist among minorities and populations with low income. The results of a community-based participatory research study, which were published in JCO Oncology Practice, suggest the integration of community-based peer support may improve care.

“Etiologies for disparities are multifactorial and include structural factors, such as structural racism and its associated impact on social and economic factors, and health system–level etiologies, such as inequitable evidence-based cancer care delivery,” the investigators remarked. “In the era of precision medicine, these unaddressed structural factors are expected to widen persistent lung cancer disparities gaps.”

A total of 48 patients with lung cancer from the San Francisco Peninsula and Central Coast regions of California were interviewed. The majority of this population had an annual household income of less than $35,000 U.S. dollars (95.8%); attained less than a high school education (93.7%); were male (85.4%); were Latino or Hispanic (52.1%) and White (54.2%); were married (83.2%); were living in a household with at least four members (54.1%); were employed full-time (85.3%); were insured by Medicaid (58.3%); had been diagnosed with stage IV disease (62.5%); and were receiving active cancer-directed therapies (100.0%). The semistructured interviews were recorded and transcribed, and a thematic analysis was performed.

Unmet psychosocial support needs, lack of understanding of precision medicine, undertreated symptoms, and financial concerns about cancer were identified as the major structural and process barriers in current lung cancer care. According to the participants, a trusting relationship with their cancer care team members was a facilitator for high-quality care; this suggests that proactive integration of proactive psychosocial and community-based peer support may overcome some of the identified barriers.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.


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