Q&A: Uncovering research opportunities for health disparities in lung nodule management

Lung nodule evaluations are crucial when working proactively against lung cancer, but some patients face disparities in managing them, according to a research statement published in American Journal of Respiratory and Critical Care.

Black individuals, Latino individuals and individuals with mental health conditions make up some of these patients, Katrina Steiling, MD, MSc, lead author, assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine and pulmonary/critical care physician at Boston Medical Center, told Healio.

Despite knowledge of these patient groups facing disparities, there is a lack of research on how to help them. To bring attention to the unknowns in health disparities in lung nodule management, Steiling and a team of researchers came together to find gaps in research on the topic. After reviewing the evidence, they proposed several research opportunities that would assess interventions to alleviate disparities.

Healio spoke with Steiling to learn more about how these disparities impact health-related outcomes, the knowledge gaps found and how clinicians can care for patients with this new insight.

Healio: What patient groups suffer with health disparities in lung nodule management and what causes these disparities in follow-up appointments and treatment?

Steiling: Several patient groups experience health disparities in lung nodule management, including individuals who are Black or Latino/a, those who have mental health conditions or substance use disorders and people with lower income. Health disparities in lung nodule management may also affect other patient groups, but further research is needed in this area.

The causes of health disparities in lung nodule management are multifactorial. Our committee identified three key focus areas where management delays might occur and where interventions can be targeted. Patient-level factors that might contribute to disparities include social determinants of health. Clinician-level factors include patient-clinician communication. System-level factors include barriers to accessing or affording health care, and barriers to monitoring adherence to follow-up.

Healio: What impact do these disparities have on outcomes related to their health?

Steiling: Disparities in lung nodule management may have important implications for disparities in lung cancer, but further studies are needed in this area. About 1 in 20 individuals with lung nodules will be diagnosed with lung cancer. Because lung cancer survival is linked to stage at diagnosis, it would make sense that improving disparities in lung nodule management would also improve lung cancer disparities. However, research in this area is lacking.

Healio: How can these health disparities be alleviated?

Steiling: Our subcommittee identified several areas for further study to work toward alleviating health disparities in lung nodule management. The research areas prioritized highest by the committee included studies aimed at better defining disparities in lung nodule management, evaluating how social determinants of health influence disparities in lung nodule evaluation, improving patient-clinician communication, and evaluating the effectiveness of interventions such as patient navigators.

Healio: In the statement, you and your colleagues identified several knowledge gaps related to lung nodule management. Could you outline them and discuss how studying each will lead to a more informed understanding of lung nodule management.

Steiling: There is a lack of data to guide interventions to improve health disparities in lung nodule management. By identifying specific gaps in knowledge, research studies can then be designed to determine which interventions might be most effective at addressing the disparities. The committee identified a lack of studies about the specific disparities in lung nodule management and the mechanisms underlying these, and further research in this area is needed. Because it is unclear how social determinants of health or language barriers contribute to disparities in lung nodule management, evaluating the effectiveness of appointment-level reminders and various communication strategies is an important research priority. The effect of patient navigation on disparities in lung nodule evaluation is unknown, and research studies to evaluate the impact of this intervention are important. Additionally, research studies evaluating the effectiveness of strategies to allocate resources, such as patient navigation or transportation assistance, to individuals at highest risk for nonadherence should be prioritized. Finally, there is a lack of data on how best to track and manage incidental lung nodules, and research to identify the optimal approach is needed.

Healio: With knowledge of the gaps in patient-level, clinician-level and health system-level interventions, what are your recommendations for clinicians on how to better care for patients who present with lung nodules?

Steiling: Management of lung nodules is complex, and there are several potential areas in a patient’s journey from initial nodule detection through diagnostic resolution where care can be disrupted. It is important for clinicians to consider how social determinants of health may impact a patient’s follow-up for an incidental lung nodule, and advocate for system-level changes that improve access to care.

For more information:

Katrina Steiling, MD, MSc, can be reached at steiling@bu.edu.

References:

• Researchers develop priorities for interventions to address health disparities in lung nodule management. https://www.bumc.bu.edu/busm/2023/03/15/researchers-develop-priorities-for-interventions-to-address-health-disparities-in-lung-nodule-management/. Published March 15, 2023. Accessed March 17, 2023.
• Steiling K, et al. Am J Respir Crit Care Med. 2023;doi:10.1164/rccm.202212-2216ST.