People with Severe Disabilities are at a Disadvantage for Early Detection and Treatment of Lung Cancer

DENVER – Lung cancer patients with severe disabilities underwent less staging work-up and treatment and had slightly higher overall mortality compared to people with no disability.

Lung cancer is the most common cancer and the leading cause of cancer-related deaths worldwide. Socially disadvantaged populations such as people with low-income, ethnic minorities, and the elderly have been shown to be at a disadvantage for early detection and treatment of lung cancer. Historically, these populations have been diagnosed in late-stage disease, have received less aggressive treatments, and have not been included in clinical trials. It is unclear whether people with disabilities experience the same disparities as other disadvantaged populations.

A group of Korean investigators conducted a retrospective study using a dataset linking the Korean National Health Service (KNHS) database, disability registration data, and Korean Central Cancer Registry data to understand potential disparities in the diagnosis, treatment, and survival of lung cancer patients with and without disabilities. The study population included all subjects who were diagnosed with lung cancer from January 1, 2009 to December 31, 2013. Patients were excluded who were ?19 years of age at the time of diagnosis and/or had a history of other cancers with the exception of thyroid cancer before lung cancer diagnosis. Relative probability of receiving a specific treatment were calculated by logistic regression analysis and adjusted for age, sex, Charlson comorbidity index, income, place of residence, and cancer stage. Cox proportional hazards regression analysis was used to determine the hazard ratios for the overall and lung cancer-specific mortality for people with disabilities compared with people without disabilities.

The results of the study were published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer (IASLC). The study population consisted of 57,400 patients with lung cancer diagnosis. Of those, 13,591 had a disability and 43,809 did not and were assigned as control subjects. There was no significant difference in stage of diagnosis between lung cancer patients with and without disabilities. However, unknown stage was more common in people with severe disabilities (13.1% vs. 10.3%), especially those with communication (14.2%) or mental/cognitive disability (15.7%). People with disabilities were less likely to undergo surgery (19.8% vs. 21.9%), chemotherapy (42.3% vs. 46.1%, or radiotherapy (26.4% vs. 27.6%). The trend was more evident in people with severe disabilities with adjusted odds ratio (aOR) of 0.47 (95% CI, 0.42-0.52) for surgery, 0.57 (95% CI, 0.53-0.61) for chemotherapy, and 0.75 (95% CI, 0.70-0.81) for radiotherapy, whereas treatment disparity was not observed in people with a mild disability. Patients with disabilities had a slightly higher overall mortality compared to people with no disability with an adjusted hazard ratio (aHR) of 1.08 (95% CI, 1.06-1.11) and the severe disability group aHR of 1.20 (95% CI, 1.16-1.24). 

The authors comment that, “Lung cancer patients with disabilities, especially severe ones, underwent less staging work-up and treatment, although their treatment outcomes were only slightly worse than those of people without a disability. While some degree of disparity might be attributed to reasonable clinical judgement, unequal clinical care for people with communication and brain/mental disabilities suggests unjustifiable, disability-specific barriers which need to be addressed. It seems necessary to educate healthcare professionals, as well as the people with disabilities and their families, to not have negative perceptions about the need for equal diagnosis and treatment. Optimization of treatment protocols for patients with disabilities, provision of supportive care, and patient/caregiver education to meet the special needs of this population, as well as social and economic support, can be a strategy to reduce the disparity of treatment outcome. Further research is warranted to develop policies and guidelines to work toward equity in lung cancer diagnosis and treatment.”

Co-author Jongho Cho is a member of the IASLC.

About the IASLC
The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated solely to the study of lung cancer and other thoracic malignancies. Founded in 1974, the association's membership includes more than 6,500 lung cancer specialists across all disciplines in over 100 countries, forming a global network working together to conquer lung and thoracic cancers worldwide. The association also publishes the Journal of Thoracic Oncology, the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis and treatment of all thoracic malignancies. Visit www.iaslc.org for more information.