Abstract
Purpose
To investigate if race impacts receipt of follow-up care in lung cancer survivors, we conducted a cross-sectional study in lung cancer survivors recruited through the New Jersey State Cancer Registry (NJSCR).
Methods
Between May 2019 and December 2019, survivors of early-stage NSCLC were identified and recruited from the NJSCR. Eligible participants were asked to complete a paper survey questionnaire and medical record release form sent to them by mail.
Results
Of the 112 survivors included in the analysis, 78 (70%) were non-Hispanic (NH) Whites and 34 (30%) were NH Blacks. Mean age was 67 years, 61% were female, and 92% had cancer in remission. A total of 82% of participants reported receiving a surveillance scan (CT or PET) within 1 year of completing the study survey. More NH White survivors received a scan within a year compared to NH Black survivors (89% vs 70%; p = 0.02). More NH White survivors (94%) reported that they were informed of the need for follow-up care by their provider compared to NH Blacks (71%; p = 0.002). Only 57% survivors reported receiving a treatment summary. Significant barriers to care were out-of-pocket costs (24%), non-coverage of test (12.5%), and lack of insurance (10%).
Conclusions
Significant disparity was identified between NH Blacks and NH Whites in receipt of surveillance scans, as well as in receiving information about need for follow-up care. Low income, lack of insurance, and other financial concerns were identified as significant barriers to follow-up care.
Implications for Cancer Survivors
Future interventions to increase survivorship care should target specific unmet needs identified in each survivor population.
Similar content being viewed by others
References
Pepek JM, Chino JP, Marks LB, D’Amico TA, Yoo DS, Onaitis MW, Ready NE, Hubbs JL, Boyd J, Kelsey CR. How well does the new lung cancer staging system predict for local/regional recurrence after surgery?: a comparison of the TNM 6 and 7 systems. J Thorac Oncol. 2011;6(4):757–61. https://doi.org/10.1097/JTO.0b013e31821038c0.
Hamaji M, Allen MS, Cassivi SD, Deschamps C, Nichols FC, Wigle DA, Shen KR. Surgical treatment of metachronous second primary lung cancer after complete resection of non-small cell lung cancer. J Thorac Cardiovasc Surg. 2013;145(3):683–90. https://doi.org/10.1016/j.jtcvs.2012.12.051. discussion 90-1.
Surapaneni R, Singh P, Rajagopalan K, Hageboutros A. Stage I lung cancer survivorship: risk of second malignancies and need for individualized care plan. J Thorac Oncol. 2012;7(8):1252–6. https://doi.org/10.1097/JTO.0b013e3182582a79.
Vansteenkiste J, Crino L, Dooms C, Douillard JY, Faivre-Finn C, Lim E, et al. 2nd ESMO Consensus Conference on Lung Cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up. Ann Oncol. 2014;25(8):1462–74. https://doi.org/10.1093/annonc/mdu089.
SEER*Stat Database: incidence - SEER 18 Regs Research Data + Hurricane Katrina impacted Louisiana cases, Nov 2014 Sub (1973–2011 varying), National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch. [Internet]. Available from: www.seer.cancer.gov. Accessed January 2018.
Bach PB, Cramer LD, Warren JL, Begg CB. Racial differences in the treatment of early-stage lung cancer. N Engl J Med. 1999;341(16):1198–205. https://doi.org/10.1056/NEJM199910143411606.
Merritt RE, Abdel-Rasoul M, D’Souza DM, Kneuertz PJ. Racial disparities in overall survival and surgical treatment for early stage lung cancer by facility type. Clin Lung Cancer. 2021;22(5):e691–8. https://doi.org/10.1016/j.cllc.2021.01.007.
Wu X, Wang Y, Lin X, Wang Z, Xu J, Lv W, Hu J. Racial and ethnic disparities in lung adenocarcinoma survival: a competing-risk model. Clin Lung Cancer. 2020;21(3):e171–81. https://doi.org/10.1016/j.cllc.2019.10.015.
Mulligan CR, Meram AD, Proctor CD, Wu H, Zhu K, Marrogi AJ. Unlimited access to care: effect on racial disparity and prognostic factors in lung cancer. Cancer Epidemiol Biomarkers Prev. 2006;15(1):25–31. https://doi.org/10.1158/1055-9965.EPI-05-0537.
Blackstock AW, Herndon JE 2nd, Paskett ED, Perry MC, Graziano SL, Muscato JJ, Kosty MP, Akerley WL, Holland J, Fleishman S, Green MR. Outcomes among African-American/non-African-American patients with advanced non-small-cell lung carcinoma: report from the Cancer and Leukemia Group B. J Natl Cancer Inst. 2002;94(4):284–90. https://doi.org/10.1093/jnci/94.4.284.
Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27(17):2758–65. https://doi.org/10.1200/JCO.2008.20.8983.
Thomas JW, Penchansky R. Relating satisfaction with access to utilization of services. Med Care. 1984;22(6):553–68.
Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care. 1981;19(2):127–40.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29. https://doi.org/10.3322/caac.21254.
Jemal A, Thun MJ, Ries LA, Howe HL, Weir HK, Center MM, Ward E, Wu XC, Eheman C, Anderson R, Ajani UA, Kohler B, Edwards BK. Annual report to the nation on the status of cancer, 1975–2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst. 2008;100(23):1672–94. https://doi.org/10.1093/jnci/djn389.
Sanchez de Cos Escuin J, Rodriguez Lopez DP, Utrabo Delgado I, Gallego Dominguez R, Sojo Gonzalez MA, Hernandez Valle M. Disease recurrence and second tumors in long-term survivors of lung cancer. Arch Bronconeumol. 2016;52(4):183–8. https://doi.org/10.1016/j.arbres.2015.07.013.
Westeel V, Choma D, Clement F, Woronoff-Lemsi MC, Pugin JF, Dubiez A, Depierre A. Relevance of an intensive postoperative follow-up after surgery for non-small cell lung cancer. Ann Thorac Surg. 2000;70(4):1185–90.
Backhus LM, Farjah F, Zeliadt SB, Varghese TK, Cheng A, Kessler L, Au DH, Flum DR. Predictors of imaging surveillance for surgically treated early-stage lung cancer. Ann Thorac Surg. 2014;98(6):1944–51. https://doi.org/10.1016/j.athoracsur.2014.06.067. discussion 51-2.
Krebs P, Coups EJ, Feinstein MB, Burkhalter JE, Steingart RM, Logue A, Park BJ, Ostroff JS. Health behaviors of early-stage non-small cell lung cancer survivors. J Cancer Surviv. 2012;6(1):37–44. https://doi.org/10.1007/s11764-011-0191-9.
Advani PS, Ying J, Theriault R, Melhem-Bertrand A, Moulder S, Bedrosian I, Tereffe W, Black S, Pini TM, Brewster AM. Ethnic disparities in adherence to breast cancer survivorship surveillance care. Cancer. 2014;120(6):894–900. https://doi.org/10.1002/cncr.28490.
King CJ, Chen J, Dagher RK, Holt CL, Thomas SB. Decomposing differences in medical care access among cancer survivors by race and ethnicity. Am J Med Qual. 2015;30(5):459–69. https://doi.org/10.1177/1062860614537676.
Burg MA, Adorno G, Lopez ED, Loerzel V, Stein K, Wallace C, Sharma DK. Current unmet needs of cancer survivors: analysis of open-ended responses to the American Cancer Society Study of Cancer Survivors II. Cancer. 2015;121(4):623–30. https://doi.org/10.1002/cncr.28951.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Malhotra, J., Paddock, L.E., Lin, Y. et al. Racial disparities in follow-up care of early-stage lung cancer survivors. J Cancer Surviv 17, 1259–1265 (2023). https://doi.org/10.1007/s11764-022-01184-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11764-022-01184-1