Race can affect decision about lung cancer treatment

November 07, 2005

Race may play a role in whether a patient accepts surgical treatment for lung cancer. A study in the November issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), found that blacks with lung cancer declined surgery at a higher rate than whites, leading researchers to believe that blacks may be misinformed about the effects of lung cancer surgery.

"Surgery for early stage non-small cell lung cancer is standard treatment and is likely curative. Yet, fewer blacks than whites undergo surgery for the disease, leading to a higher mortality rate among blacks with lung cancer," said Bruno DiGiovine MD, FCCP, Henry Ford Health System, Detroit, MI. "Identifying and addressing the underlying reason for this discrepancy in surgical rates may, ultimately, lead to greater rates of surgical acceptance and decreased mortality rates among blacks with lung cancer."

Researchers from Henry Ford Health System speculated that the discrepancy in lung cancer surgical rates between blacks and whites may be a result of racial bias by the physician, a high rate of comorbidities among blacks, or a low rate of surgical acceptance among blacks. To assess these possible reasons, researchers compared the rates at which blacks and whites were offered and accepted surgery for stages I and II non-small cell lung cancer. Of the 97 blacks and 184 whites in the study, 74 percent of whites underwent surgical resection, compared with 58 percent of blacks. Within the two groups, 79 percent of whites was offered surgery, compared with 70 percent of blacks. Of those patients offered surgical resection, blacks were over three times more likely to decline surgery, with 18 percent of blacks and 5 percent of whites declining surgery.

"Knowing blacks decline surgery at a higher rate than whites is the first step to decreasing lung cancer mortality among this population. We must now identify why so many blacks decline lung cancer surgery," said Dr. DiGiovine. "Prior research has shown that blacks may be misinformed about the risks of surgery, as they are more likely than whites to believe that lung cancer will spread if exposed to air during operation. This misinformation may contribute to the low rate of lung cancer surgery acceptance among blacks, however, more research is needed in this area."

Age was found to be an independent marker for patients who were more likely to decline surgery. There was no difference in sex, marital status, tumor histology, or comorbidities between the two groups. In addition, greater than 90 percent of all patients had insurance, and all patients had access to health care through the Henry Ford Health System. However, blacks were of a lower socioeconomic status and were more likely to present with a higher stage of cancer.

"Although cure rates are often disappointing, new treatments can extend survival and improve quality of life for patients with this disease," said W. Michael Alberts, MD, FCCP, President of the American College of Chest Physicians. "It is important for physicians to educate and advise their patients about lung cancer treatment options so that patients can make informed decisions about their course of treatment."
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CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at www.chestjournal.org. ACCP represents 16,500 members who provide clinical respiratory, sleep, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at www.chestnet.org.

American College of Chest Physicians

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