Gilberto Lopes, MD
Higher cancer death rates, less frequency of cancer screening, and increased rates of advanced cancer diagnoses in select demographics are a fraction of the health disparities occurring throughout oncology—and the lung cancer space is no exception, explains Gilberto Lopes, MD.
Specifically, in lung cancer treatment, the advent of immunotherapy and targeted approaches do not necessarily carry over to patients of low socioeconomic status and/or of developing countries, as they may not have access to care, says Lopes, who is the medical director for International Programs at Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine. Additionally, such patient groups have lower participation in clinical trials.
With relation to race, for example, African-American male and female patients in the United States have the highest incidence and death rates for both colorectal and lung cancers, according to data from the National Cancer Institute.1
In Brazil, the most common cancers in men, in descending order, are those of the prostate, lungs and airway, colon and rectum, stomach, and oral cavity.2
In females of Brazil, the most common cancers are those of the breast, colon and rectum, cervix, lungs and airway, and thyroid. Additionally, in Brazil, although there was a reported decline in lung cancer mortality among men in the state capitals in 2015, there was an increase in smaller cities.
However, solutions are forming to bridge the disparity gaps and differences in care, Lopes says.
In an interview with OncLive
prior to the 5th Annual Miami Lung Cancer Conference on March 10, 2018, Lopes shed light on the global disparities occurring in lung cancer care and some of the steps that are being taken to better serve patients with the available and emerging therapeutic approaches.
OncLive: Your talk at this meeting is focusing on global oncology and lung cancer, specifically on disparities and solutions. What are some of the disparities we have observed in recent years? Has anything really changed?
With the advent of molecularly targeted agents and immunotherapy, which have improved survival and quality of life for certain lung cancers but come with an increased cost, there are growing differences in the way patients who have no insurance or who are treated in low-resource settings do when compared with those treated in academic centers in the United States. In countries outside of North America and Western Europe, access is an even greater issue and a small minority of patients receive targeted agents and immunotherapy.
What are the causes for some of the disparities in treatment? What demographics have a more difficult time getting treatment?
Most importantly, lack of insurance adversely affects patients, but minority patients in the United States also have lower access to care and molecular testing and have much lower rates of participation in clinical trials. Moreover, patients in rural areas also struggle with access to healthcare systems and Medicaid patients tend to do worse than patients who have Medicare or private health insurance. Finally, patients with larger copays for intravenous or oral medications are less compliant and, therefore, also have worse outcomes.
What solutions do we have to bridge these gaps?
In low-resource settings, we need to increase access to health care, smoking cessation, screening low-dose CT scans, surgery, chemotherapy, radiation, molecular testing and targeted therapy, immunotherapies and clinical trials are of paramount importance to bridge these gaps. At Sylvester Comprehensive Cancer Center at the University of Miami, we are working on a number of initiatives to strengthen cancer registries, prevention and treatment networks in Latin America and the Caribbean. In the United States, we need to make sure that all patients have access to healthcare. A diverse workforce will also go a long way to help improve care for patients who come from minority groups.
Are these disparities specific to lung cancer, or do you find that this happens across tumor types?
Many of the disparities I mentioned are shared across the cancer spectrum and policies designed to address them would be far-reaching. Lack of access to molecular testing and immunotherapies, however, affects patients with lung cancer more than it might affect patients with other types of malignancies.
What are the key messages that you hope the community oncologists in attendance take home from your presentation?
That with increasing costs, patients often can’t bear their copays and it is important that health systems take that into consideration when treating patients.
- National Cancer Institute. Cancer health disparities. Published March 11, 2008. cancer.gov/about-nci/organization/crchd/cancer-health-disparities-fact-sheet. Accessed March 7, 2018.
- de Souza JA, Hunt B, Asirwa FC, Adebamowo C, Lopes G. Global health equity: cancer care outcome disparities in high-, middle-, and low-income countries. J Clin Oncol. 2016;34(1):6-13. doi: 10.1200/JCO.2015.62.2860.