Medical College of Wisconsin Cancer Center, Froedtert and Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
Department of Radiation Oncology, Washington University School of Medicine, 4511 Forest Park Ave, St. Louis, MO, 63108, USA.
Cancer Metastasis Rev. 2024 Dec;43(4):1217-1231. doi: 10.1007/s10555-024-10187-6. Epub 2024 May 16.
Inequitable access to care continues to hinder improvements in diagnosis and treatment of lung cancer. This review describes healthcare disparities in the changing landscape of non-small cell lung cancer (NSCLC) in the United States, focusing on racial, ethnic, sex-based, and socioeconomic trends. Furthermore, strategies to address disparities, overcome challenges, and improve patient outcomes are proposed. Barriers exist across lung cancer screening, diagnosis, and treatment regimens, varying by sex, age, race and ethnicity, geography, and socioeconomic status. Incidence and mortality rates of lung cancer are higher among Black men than White men, and incidences in young women are substantially greater than in young men. Disparities may be attributed to geographic differences in screening access, with correlating higher incidence and mortality rates in rural versus urban areas. Lower socioeconomic status is also linked to lower survival rates. Several strategies could help reduce disparities and improve outcomes. Current guidelines could improve screening eligibility by incorporating sex, race, and socioeconomic status variables. Patient and clinician education on screening guidelines and patient-level barriers to care are key, and biomarker testing is critical since ~ 70% of patients with NSCLC have an actionable biomarker. Timely diagnosis, staging, and comprehensive biomarker testing, including cell-free DNA liquid biopsy, may provide valuable treatment guidance for patients with NSCLC. Efforts to improve lung cancer screening and biomarker testing access, decrease bias, and improve education about screening and testing are needed to reduce healthcare disparities in NSCLC.
医疗保健的不平等获取继续阻碍着肺癌诊断和治疗的改善。本综述描述了美国非小细胞肺癌 (NSCLC) 不断变化的格局中存在的医疗保健差异，重点关注种族、民族、性别和社会经济方面的趋势。此外，还提出了一些策略来解决差异、克服挑战并改善患者的预后。在肺癌筛查、诊断和治疗方案中存在各种障碍，这些障碍因性别、年龄、种族和民族、地理位置和社会经济地位而异。肺癌的发病率和死亡率在黑人男性中高于白人男性，而年轻女性的发病率明显高于年轻男性。差异可能归因于筛查获取方面的地理差异，农村地区的发病率和死亡率与城市地区相比更高。较低的社会经济地位也与较低的生存率相关。几种策略可能有助于减少差异并改善结果。目前的指南可以通过纳入性别、种族和社会经济地位等变量来改善筛查资格。对筛查指南和患者护理障碍的患者和临床医生教育是关键，生物标志物检测也很关键，因为 NSCLC 患者中有~70%具有可操作的生物标志物。及时的诊断、分期和全面的生物标志物检测，包括游离 DNA 液体活检，可为 NSCLC 患者提供有价值的治疗指导。需要努力改善肺癌筛查和生物标志物检测的获取途径、减少偏见以及提高对筛查和检测的认识，以减少 NSCLC 中的医疗保健差异。
