Personalized Care Plans Must Consider Social Disparities

Targeted agents have rapidly evolved to personalize the treatment of lung cancer. And now, a patient’s genetics and tumor biology play a key role in determining an individualized care plan. But what about the person’s race or socioeconomic status?

When it comes to personalizing medicine, these things must be taken into consideration, too, said Loretta Erhunmwunsee, M.D., thoracic surgeon and professor of surgery at City of Hope.

“As we push the envelope to make care for patients with lung cancer better, we need also to understand that we have to work hard to allow vulnerable patients not to be left behind,” she said in an interview with OncLive, a sister publication of CURE.

Racial and socioeconomic status disparities can affect all types of lung cancer treatment — including surgery, chemotherapy and radiation. However, researchers may not be aware of this, since many of these groups are underrepresented in lung cancer clinical trials.

Genomic differences can vary from one race to another, which in turn, may enable these disparities to occur. Erhunmwunsee explained that EGFR mutations might be very different in African-American men compared to Asian men. Meanwhile a MET mutation is certainly different, she added.

Hispanic and Latino patients demonstrate higher risks for lung cancer, and they appear to be less likely to receive treatment. Yet, it seems that this patient population has a more favorable genetic profile, or “the Hispanic paradox,” as Erhunmwunsee called it.

Data shows that Hispanic and Latino patients are frequently diagnosed with adenocarcinoma or minimally invasive adenocarcinoma, which leads to longer survival. Another difference within this population is that there is a much higher percentage of women — who tend to live longer – diagnosed with lung cancer compared to African American, Caucasian and other racial groups.

“The point is that genetic and genomic differences impact those racial and socioeconomic status differences — as does access and tobacco use – so there are a lot of things that impact some of these differences we see,” Erhunmwunsee said.

Although racial genomic differences can be determined once a patient comes in for treatment, there are certain groups that, unfortunately, are less likely to even make it into the door of a doctor’s office.

“Certain groups, especially disadvantaged groups, are less likely to get treatment; they are also the same folks who are less likely to survive,” Erhunmwunsee said.

People of poor socioeconomic background, as well as patients who are Hispanic, are less likely to get treatment, Erhunmwunsee found. But once patients who are poor or a minority do enter the health care system to be treated for lung cancer, it is crucial that physicians and the care team see the whole patient — not just his or her disease.

“It is part of our responsibility to understand that if you know a patient has more risk factors for death, you will acknowledge those risk factors,” Erhunmwunsee said.

Patients who are facing these hurdles should know that they are not alone. There are many financial lifelines that can help patients pay for treatment. Individuals can also be referred, by their physicians, to social workers who can help coordinate care and overcome barriers.

“The point is, simply, our medical oncologists, surgical oncologists and radiation oncologists need to understand that different patients have different hurdles,” Erhunmwunsee said.