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肺癌护理中的公平性与机会——应对差异、挑战及未来路径

Equity and Opportunities in Lung Cancer Care-Addressing Disparities, Challenges, and Pathways Forward.

作者信息

Shehata Dena G, Pan Jennifer Megan, Pan Zhuxuan, Vigneswaran Janani, Contreras Nicolas, Rodriguez Emily, Sakowitz Sara, Magarinos Jessica, Pereira Sara, Wilder Fatima G, Watkins Ammara A

机构信息

Division of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.

Department of General Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.

出版信息

Cancers (Basel). 2025 Apr 17;17(8):1347. doi: 10.3390/cancers17081347.

Abstract

BACKGROUND

Lung cancer is the leading cause of cancer-related mortality in the United States, which disproportionately affect racial and ethnic minorities. Disparities in lung cancer screening, diagnosis, treatment, and survival outcomes are due to a complex interplay of socioeconomic factors, structural racism, and limited access to high-quality care. This review aims to examine the underlying causes of these disparities and explore potential mitigation strategies to improve lung cancer care equity.

METHODS

A review of the literature was conducted, evaluating racial and ethnic disparities in lung cancer care. Disparities in lung cancer screening, genomic testing, surgical and systemic treatment, and survival were explored. Additionally, interventional strategies such as risk-based screening, patient navigation programs, and policy reforms were examined.

RESULTS

Racial and ethnic minority patients are diagnosed at younger ages with fewer pack-years yet are less likely to qualify for screening under current guidelines. They receive lower rates of guideline-concordant treatment, including surgery, radiation, chemotherapy, and biomarker testing, and have reduced access to specialty care. Socioeconomic barriers, medical mistrust, and geographic disparities further contribute to these inequities. Targeted interventions, including mobile screening programs, financial assistance initiatives, and culturally competent care, have shown promise in improving lung cancer outcomes.

CONCLUSION

A multi-level approach, incorporating healthcare policy changes, improved screening criteria, and an enhanced community engagement strategy, is essential for achieving equitable lung cancer care, ultimately improving outcomes for racial minority populations.

摘要

背景

肺癌是美国癌症相关死亡的主要原因,对少数族裔的影响尤为严重。肺癌筛查、诊断、治疗和生存结果的差异是社会经济因素、结构性种族主义以及获得高质量医疗服务机会有限等复杂相互作用的结果。本综述旨在研究这些差异的根本原因,并探索潜在的缓解策略,以改善肺癌医疗公平性。

方法

对文献进行综述,评估肺癌医疗中的种族和族裔差异。探讨了肺癌筛查、基因检测、手术和全身治疗以及生存方面的差异。此外,还研究了基于风险的筛查、患者导航计划和政策改革等干预策略。

结果

少数族裔患者被诊断出肺癌时年龄较小,吸烟史年包数较少,但根据现行指南符合筛查条件的可能性较小。他们接受符合指南的治疗(包括手术、放疗、化疗和生物标志物检测)的比例较低,获得专科护理的机会也较少。社会经济障碍、医疗不信任和地理差异进一步加剧了这些不平等。有针对性的干预措施,包括移动筛查计划、经济援助举措和具有文化胜任力的护理,在改善肺癌治疗结果方面显示出了前景。

结论

采用多层次方法,包括医疗保健政策变革、改进筛查标准和加强社区参与策略,对于实现公平的肺癌医疗至关重要,最终可改善少数族裔人群的治疗结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cdad/12026292/0ad1589ccff3/cancers-17-01347-g001.jpg

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