Early diagnosis and timely treatment are crucial for a favorable outcome. However, evidence indicates that certain populations are not receiving these essential services.
African Americans are 16% less likely to be identified with lung cancer early, 19% less likely to undergo surgical therapy, and 7% more likely to receive no treatment, according to the American Lung Association’s State of Lung Cancer 2020 study. Latinos, Asian Americans, and Native Americans also encounter inequities in screening and treatment.
Dr. Umit Tapan, a thoracic oncologist at Boston Medical Center and assistant professor of medicine at Boston University School of Medicine, observed via his research that Black patients with late-stage small cell lung cancer were less likely than white patients to get chemotherapy.
Why do members of minority groups not receive equal screening and treatment for lung cancer? Dr. Tapan tells SurvivorNet, “There are numerous reasons that contribute to racial inequality.” The most important element is access to health care.
Availability to Healthcare
People who do not routinely visit a primary care physician may be unaware that they are at risk for lung cancer or may not have the necessary screening tests to detect it early. A lack of health insurance is one of the main obstacles to receiving medical care. Historically, Blacks and Hispanics have had greater rates of uninsurance than whites.
Lack of Faith in the Medical System
Dr. Samuel Cykert, professor in the division of general medicine and clinical epidemiology at the UNC School of Medicine, asserts, “There is a long history of black exploitation in the medical system.”
Before the Civil War, medical tests were conducted on slaves. The Public Health Service performed a syphilis study on a group of Black males in Tuskegee, Alabama, without their knowledge or agreement from 1932 to 1972. These terrible injustices have left the African-American community with permanent scars.
Participation Deficit in Studies
Clinical trial outcomes inform screening and treatment decisions made by physicians. However, these studies are renowned for lacking diversity.
The current advice to screen persons aged 55 to 80 with a 30-pack-year smoking history annually with low-dose CT scans was derived from the National Lung Screening Trial, which found that low-dose CT screening lowered the risk of dying from lung cancer.
African-Americans make up approximately 13% of the U.S. population, however just 4% of participants in that survey were Black. African-American smokers are typically diagnosed at a younger age than white smokers, and they have a higher risk of acquiring lung cancer after fewer pack years of smoking. As a result, only roughly one-third of African-American patients who are eligible for screening receive it.
“Patients will not receive an early lung cancer diagnosis if they are not provided screening or are unaware of lung cancer screening,” explains Dr. Tapan. The lung cancer is more life-threatening when it is diagnosed late.
Dr. Cykert discovered in a 2010 study that non-Black physicians were less likely to conduct surgery or prescribe chemotherapy for Black patients. “There was a risk aversion against treating persons who were different from themselves,” he explains. “The physicians stated, ‘I find it more difficult to communicate with Black patients’ and ‘Black patients are less likely to be compliant'”
There are numerous misconceptions regarding patients of color among medical practitioners. According to studies, doctors view members of minority groups to be less clever, less educated, and more likely to refuse treatment. This is merely the physician’s view, not true fact, Dr. Tapan asserts. This indicates that a physician bias is present.
How Can We Minimize Disparities?
Dr. Tapan tells SurvivorNet that the most important method to level the playing field for patients is to provide everyone with equal access to health care, regardless of their insurance or socioeconomic position. Next, physicians must acknowledge their own biases and attempt to overcome them through training.
According to him, oncologists should also urge more varied participation in clinical trials. We must encourage the participation of underrepresented minorities in clinical trials since we base our treatment decisions on the results of these studies.
“If you want to make progress on inequities, you need improved communication, real-time openness, and accountability,” explains Dr. Cykert.
He evaluated an intervention to eliminate racial disparities in early-stage lung cancer therapy.
To promote openness, Dr. Cykert and his team developed a system that generated an alert in a patient’s electronic health record if an appointment was missed. Then, trained nurse navigators intervened and re-engaged the patient by removing any obstacles to receiving care. In addition, a qualified oncologist assisted in bringing the patient back for treatment.
Due to this action, 96 percent of both black and white patients obtained the necessary medical attention. “With this system, we not only enhanced care for black patients, but also for white patients,” Dr. Cykert explains. He claims that constructing this type of system is not prohibitively expensive nor time-consuming. “The computerized medical record already exists. The navigators have arrived.”
Both experts agree that it is essential to assist members of minority groups in becoming more involved in their own care. This may need community outreach, such as spreading the word about quitting smoking and lung cancer screening at barbershops and churches.
Dr. Tapan states, “I believe it is crucial that we increase awareness of this condition.”
He cites a Martin Luther King, Jr. quote: “Of all the forms of inequity, healthcare injustice is the most startling and terrible.” This quotation is from 1966. I hope we have made some progress in this area over the previous 54 years, but I believe more has to be done.”
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