How Can Clinicians Combat Stigmas and Financial Barriers in Lung Cancer?

Lung cancer can occur in patients of all backgrounds, yet different stigmas and financial obstacles may complicate access to treatment among certain populations, according to Guilherme Sacchi de Camargo Correia, MD.

In a visit to Georgia Cancer Center in Augusta, Georgia, CancerNetwork® spoke with Correia, clinical assistant professor at Augusta University and thoracic and head and neck medical oncologist at Georgia Cancer Center, about current disparities and inequalities in lung cancer.

Correia touched upon how certain stigmas—particularly those related to smoking—may limit the number of patients who undergo screening and subsequent therapy for their disease. Furthermore, consultations with other departments like pulmonology and the use of novel surgical procedures like robotic bronchoscopy may incur higher costs and financial toxicity for patients.

Transcript:

Lung cancer is a very complex disease in that scenario because there’s still a lot of stigmas related to it being a disease. Lots of people think it’s a disease only for smokers, which is not true. The truth, right now, I like to say, as long as you have lungs, you can have lung cancer. We are seeing more patients who are non-smokers, but there’s still a stigma in there, which also plays a role in making access to treatment more complicated, especially in underserved populations with socioeconomic disparities. We see that a lot. We see that we underperform in terms of lung cancer screening compared with other diseases like breast cancer, colon cancer, and even cervical cancer. A colonoscopy for the colon is much more invasive than a CT scan in the lung, but we’re still sometimes seeing many states with significantly lower [screening] numbers. That’s part of the stigma. It’s a very complex care that requires a lot of resources at the beginning, especially upfront. When a patient is being diagnosed, [they are] just diagnosed with lung cancer. Usually, there are visits to us, but there are also visits to the interventional pulmonologist. They conduct a bronchoscopy; usually, that involves endobronchial ultrasound or sometimes robotic bronchoscopy. Those are expensive procedures. There might be visits to the thoracic surgeon. There might be visits to palliative care; there are specialists who will help us manage those symptoms. There might be other things that we have to do. We have to get a PET/CT scan. We have to get an MRI of the brain. We have to send those tissue biopsies in their blood into molecular studies through many platforms that we have.

All of those end up piling up and becoming more things that we have to use, which are for the best and the better treatment of the patient, because they give us very useful information. On the other hand—the other side of the coin—it adds more financial barriers. It adds to the financial toxicity, so treatments can become more expensive to patients upfront. Sometimes, there is a little bit of conflict between what we would like to do on the fast pace of scientific progress in terms of the therapies and new studies that might not be reflected right away with insurance. Sometimes, there is a little bit of conflict on that side.

[Lung cancer] becomes so frequent that we can see it in all settings. We can see it in all socioeconomic statuses. We can see it in everyone: smokers, non-smokers, men, women, young patients, and [older] patients. It becomes very challenging sometimes, especially in environments that are more rural and may have less access to doctors. It might be difficult to actually come up with that diagnosis, and when you suspect that it might be hard to have access to those tools—like I mentioned, the bronchoscopies, the PET/CT [scans], and MRI—those things end up delaying care, and it basically widens the disparity gap that you see in a lot of patients.