2019 LCRF Research Grant on Disparities in Lung Cancer
Manali Patel, MD, MPH
Stanford University
Research Project:
Reducing Disparities in Lung Cancer through Community Partnerships
Summary:
Scientific advances continue to reduce rates of new lung cancer cases and death from the disease. However, populations with low income as well as racial and ethnic minorities continue to experience high rates of lung cancer cases and lung cancer death. One potential cause for ongoing disparate outcomes from lung cancer includes inequitable receipt of evidence-based lung cancer care. Studies over the past decade repeatedly show lower receipt of stage-appropriate lung cancer care among low-income and minority populations as compared with non-Hispanic white and the more affluent. Previously, we demonstrated the role of social support in improving lung cancer survival for Hispanic populations and developed a novel approach, the CARE (Community health workers Activate, Reach, and Engage) intervention, to utilize social support to engage patients in their care and improve access to end-of-life cancer care for low-income and minority patients with advanced stages of cancer. The objective of this project is to refine, implement, and evaluate CARE with patients and caregivers in community oncology practices to increase access to evidence-based lung cancer recommendations from diagnosis until the end-of-life. The hypothesis is that this approach is feasible and acceptable in the community and can improve patients’ quality of life and reduce lung cancer outcome disparities.
Final report:
As part of Aim 1, the researcher recruited 55 stakeholders across sectors including industry, government, public and private health care and clinic systems, along with advocates and survivors. Many of these stakeholders remained extremely engaged and active in community advisory board (CAB) meetings and communications. By using a survey, it was found that >90% of CAB members believed in the sustainability of the proposed efforts and in the near term 100% of CAB members believed that disparities would be addressed by the end of the project. Interviews were conducted but they were repeated with a COVID-specific aim and suggestions were incorporated for a pilot intervention as part of Aim 2. The researcher enrolled 110 patients in a randomized trial to evaluate the feasibility and acceptability of intervention by a health care worker. Secondary outcomes included receipt of stage appropriate guideline-based care, patient satisfaction with decision from baseline to 3 months post-enrollment, patient activation, and survival. The CARE intervention was feasible and acceptable, it improved receipt of stage-appropriate guideline-based care, and improved patient activation and satisfaction with their care.
Impact:
Reducing disparities among lung cancer patients is a big challenge. This investigator was able to utilize a community advisory board to become active in communications, meetings and planning various projects. Despite setbacks from COVID-19 the researcher was able to recruit community health care workers who helped enroll over 100 patients in a study evaluating an intervention to address some of the disparities. Through these efforts communication with community partners was improved, and a reimbursement policy was established for community health workers. These efforts will allow health care to be brought to patients who are in desperate need.
More Content:
Notable Accomplishments:
Dr. Patel published a manuscript in JCO Oncology Practice in June 2022: Perspectives of Low-Income and Minority Populations With Lung Cancer: A Qualitative Evaluation of Unmet Needs.