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Patient education may narrow racial disparity gap in lung cancer care
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CHICAGO — A multifaceted intervention designed to enhance patient communication and treatment understanding reduced surgical disparities between blacks and whites with early-stage non-small cell lung cancer, according to study results presented at International Association for the Study of Lung Cancer Multidisciplinary Symposium in Thoracic Oncology.
“For decades, it’s been known that there has been a disparity that African Americans get less curative lung cancer surgery than Caucasians,” Paul R. Walker, MD, FACP, chief of the division of hematology/oncology, and director of thoracic oncology at East Carolina University Brody School of Medicine, said during a presentation. “In the most updated SEER data in 2012, 67% of Caucasians went to curative lung cancer surgery, but only 56% of African Americans did. Our study was aimed to try to narrow this racial disparity gap.”
The researchers’ previous study — the Lung Cancer Surgery: Anatomy of the Decision — was a multi-institutional prospective cohort study of 386 patients with early-stage NSCLC.
“The hypothesis of [that] prospective study was to try to identify modifiable factors that, if addressed and changed, could narrow the racial disparity and the treatment of curative intent early lung cancer,” Walker said.
The study included a questionnaire with 106 questions that addressed demographics, patient perception of disease and treatment, certainty of diagnosis, trust of physician and other variables.
Researchers found that 75% of whites went to curative lung cancer surgery within 4 months but only 63% of blacks did, results that aligned with all other studies, Walker said.
“We also found the following potential modifiable areas: communication and understanding. If there was a negative perception of patient-physician communication, the odds ratio of going to surgery was only 0.42,” Walker said. “Most notably, if there was a negative perception of the curative intent surgery [and] that the 1-year prognosis [after] surgery was very poor, the OR was only 0.27, an absolute lower risk of 34%.”
Researchers conducted a prospective intervention to determine whether patient communication and understanding were potentially modifiable factors.
Rate of surgery at 4 months served as the primary outcome. Secondary outcomes included 1-year OS and perceptions of communication.
Researchers randomly assigned 244 patients (mean age, 65.7 years; 54% women; 36% black) to either a standard treatment approach or a specially trained cancer communication educator to determine whether the intervention technique improved patient communication and treatment understanding.
The overall surgical rate for the intervention group was 74%. The surgery rate was 74.8% among white patients, on par with the first study, Walker said. However, the surgery rate for blacks increased from 63% to 71% among black patients.
When researchers considered combined treatment of either surgery or stereotactic body radiotherapy, ablative treatment rates increased to 91.9% among whites and 94.1% among blacks.
Sixty-five percent of patients assigned the standard communication arm underwent surgery compared with 75% of patients who saw the cancer educator. Of those who saw the educator, 71% of white patients and 68% of black patients underwent surgery.
Among patients who underwent a combination of surgery and SBRT, 90% were assigned standard communication and 92.7% saw the cancer educator. The latter included 90.1% of white patients and 93.2% of black patients.
Logistic regression results showed that overall treatment improved for white and black patients, and overall and surgical treatment disparities appeared eliminated. However, age (OR = 0.951), chronic obstructive pulmonary disease (OR = 0.494) and clinical stage (OR = 1.998) remained significant predictors of treatment.
“The [cancer educator] had the greatest impact on receiving treatment,” Walker said. – by Melinda Stevens
Reference:
Walker PR, et al. Abstract OA03.02. Presented at: International Association for the Study of Lung Cancer Multidisciplinary Symposium in Thoracic Oncology; Sept. 14-16, 2017; Chicago.
Disclosure: Walker reports speaker’s bureau and advisory board roles with Biodesix and Genentech.