Commonly-held belief contributes to patients' rejection of recommended lung cancer surgery

October 06, 2003

NOTE: This release has been modified since its original posting.

PHILADELPHIA - Nearly 40 percent of patients believe that the exposure of lung cancer to air at the time of surgery promotes the spread of the cancer, according to a study published in today's Annals of Internal Medicine. Based on this commonly-held belief - which is not supported by empirical evidence - a significant number of patients might reject lung-cancer surgery, even if their physician recommended it.

"This belief is very prevalent, especially among African-Americans, and it may be used by many to avoid recommended surgical intervention," noted Mitchell L. Margolis, MD, director of the pulmonary clinic at the Philadelphia Veterans Affairs (VA) Medical Center and lead author of the study. "Our findings may be helpful in suggesting appropriate action by physicians to address this belief," he added.

Margolis and his research team surveyed 626 pulmonary and lung-cancer outpatients at five VA and non-VA sites in three urban settings - Los Angeles, CA; Philadelphia, PA; and Charleston, SC. Forty-five percent of all patients acknowledged having heard of the belief that exposure to air during surgery causes tumor spread; and 37 percent said they believed it to be true.

The most significant predictor of belief was race - with 61 percent of African-American respondents stating they thought the belief was true, versus 29 percent of Caucasians. Of the African-Americans, 19 percent said they would base opposition to surgery on the belief, and 14 percent would not accept their physician's assertion that the belief was false.

"It is unclear why this conviction is more common among African-American patients, but the net effect is that this belief may be over-weighted in a decision-making process to forego necessary surgery, which may contribute to racial disparities in healthcare outcomes," said Margolis, who is also associate professor of medicine at the University of Pennsylvania School of Medicine and researcher with the VA's Center for Health Equity Research and Promotion.

Lung cancer is more prevalent and deadly in the African American community than among Caucasians, and data indicate that much of the difference in survival rates can be attributed to differences in the treatment of early-stage disease.

Most patients could not identify the original source for their belief that exposure to air during surgery causes tumor spread (some patients indicated they learned about it "from the gossip mill"), and researchers could only speculate as to how the belief had taken hold and become somewhat accepted. "There is no scientific evidence that tumors spread on contact with air when the chest is opened surgically," said Margolis.

"Accelerated residual tumor growth after surgical resection seems to be distinctly uncommon clinically, and widespread acceptance of the study belief could undermine the best chance for cure of early-stage lung cancer."

"Clearly, our study suggests that physicians need to better understand the role of this belief in the decision-making process of some patients, and then communicate sensitively and accurately with patients about the issue. In that way, we may help remove an obstacle to care that disproportionately disadvantages the African-American community," added Margolis.

Other members of the research team included Jason D. Christie, MD, Larry Kaiser, MD, and John Hansen-Flaschen, MD, of the University of Pennsylvania School of Medicine; Silverio Santiago, MD, of the Los Angeles VA Medical Center; and Gerard A. Silvestri, MD, with the Medical University of South Carolina.

The study was funded, in part, by a grant from the Veterans Affairs Health Services Research and Development Service.

NOTE FOR REPORTERS: Study leader Mitchell L. Margolis, MD, of the Philadelphia VA Medical Center, is available for press interviews. For telephone or on-site interviews, please contact Judi Cheary at (215) 823-5807 (Office); (877) 591-9348 (Pager) or For additional assistance, please contact Jim Blue at (212) 807-3429 or

Veterans Affairs Research Communications

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