Disparities in lung cancer care must be closed to improve patient outcomes.
With nearly 230,000 new lung cancer diagnoses projected in the United States this year, and with the disease causing more annual deaths than breast, colon and prostate cancers combined, it is critical that we address the disconnects that get in the way of the most effective patient care and treatment for lung cancer.
Although we continue to make strides in cancer research and treatment, there are new and persisting disparities that need to be addressed. These include gaps in the sharing of accessible, actionable information; inequitable outcomes based on race and ethnicity; lung cancer stigma; and the lack of research funding — all keep researchers, health care professionals and advocates from our ultimate goal of ensuring patients have the best possible outcomes.
Among the most significant breakthroughs in lung cancer in the past 15 years is biomarker testing, which led to targeted therapies for non-small cell lung cancers, including those with tumor mutations in the EGFR, ALK, ROS1, BRAF and NTRK genes. One of the many disparities in care is that comprehensive biomarker testing, although routine clinical practice in most academic centers and included in clinical guidelines, is not happening in many rural and community settings. If patients don’t receive appropriate testing, they and their oncologist will not know if they have a biomarker that might indicate a different treatment path. Even worse, some studies show that just 45% of patients who have these markers are receiving the appropriate targeted therapy. Among the many reasons that this disconnect exists: Testing results are too often inaccessible to treatment teams and to patients.
Ensuring that all oncologists and patients have immediate and understandable access to biomarker testing results and corresponding targeted therapies will help address this treatment gap. In the past, some thought this information was too complex for patients to understand. However, with much more information available online, credible lung cancer research is available at the click of a mouse, advocacy groups are educating patients and caregivers, and lung cancer social media groups delve into and share detailed information on tumor markers and corresponding treatments. Patients and their families are more educated than ever before about their disease and involved in their own treatment. They have the right to be empowered to understand their disease and treatment options.
Racial disparities, particularly among African American patients, have long existed in cancer treatment, and lung cancer is no exception. For example, according to the National Cancer Institute (NCI), black men are nearly 20% more likely to receive a lung cancer diagnosis than white men, but they are less likely to get treatment and also succumb to their disease sooner than their white counterparts.
Fortunately, studies are being done to address and reduce this disparity, including a recent clinical trial by the NCI. By reducing cracks in the electronic records system and assigning nurse navigators to resolve barriers to care while collecting data on clinical outcomes, the NCI was able to eliminate treatment disparities for black patients and improve treatment for all patients in the study. We need to continue looking for disparities in the treatment of minority and ethnic patients and learn from these types of studies how to best scale the discovered solutions.
Patients with lung cancer already find themselves at a disadvantage compared with other patients with cancer because they perceive a strong stigma around their disease. When this is coupled with disparities in the quality of care received because of their geographic location or racial demographics, there can be devastating consequences.
GO2 Foundation for Lung Cancer is helping to address these gaps in care with programs such as LungMatch, which allows any patient to request biomarker testing and then pairs them with a treatment and trial navigator to help educate them about treatment choices. In addition, the GO2 Foundation Continuum of Care Centers of Excellence tracks the amount of biomarker testing performed in community cancer centers to ensure that patients are receiving quality care, because many academic centers already have high testing rates.
Collectively, we must strive to provide high-quality, guideline-driven care for every patient, regardless of demo- graphics or geographic location. Our patient community needs and deserves the elimination of testing and treatment disparities so that we can finally make improvements in long-term survival of lung cancer.
JENNIFER C. KING, PH.D., is the senior director of science and research at the GO2 Foundation for Lung Cancer, the world’s leading organization dedicated to saving, extending and improving the lives of patients with lung cancer. King has extensive experience in oncology, precision medicine, health information technology and patient advocacy.