Racial Differences Pertaining to a Belief about Lung Cancer Surgery: Results of a Multicenter Survey

7 October 2003 | Volume 139 Issue 7 | Pages 558-563

Background: Patients at the Philadelphia Veterans Affairs Medical Center frequently voice concern that air exposure during lung cancer surgery might cause tumor spread. Several African-American patients asserted that this belief was common in the African-American community.

Objective: To assess the prevalence of the belief that air exposure during lung cancer surgery might cause tumor spread and gauge the influence of this belief on the willingness of African-American and white patients to have lung cancer surgery.

Design: Prospective questionnaire survey.

Setting: Philadelphia Veterans Affairs Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania; Los Angeles Veterans Affairs Medical Center, Los Angeles, California; and Medical University of South Carolina, Charleston, South Carolina.

Patients: 626 consecutive patients in pulmonary and lung cancer clinics.

Measurements: None.

Results: 38% of patients (61% of whom were African American and 29% of whom were white) stated that they believe air exposure at surgery causes tumor spread. The most significant predictor of belief was African-American race (odds ratio, 3.5 [95% CI, 1.9 to 6.5]), even after controlling for other relevant variables in a multivariable analysis. Nineteen percent of African Americans stated that this belief was a reason for opposing surgery, and 14% would not accept their physicians' assertion that the belief is false. These rates were also statistically significantly higher among African-American than white patients.

Conclusions: Belief in accelerated tumor spread at surgery is prevalent among general pulmonary outpatients and lung cancer clinic patients facing lung surgery, particularly among African-American patients. Our findings may pertain to key racial disparities in lung cancer surgery and survival rates and suggest that culturally sensitive physician training or outreach programs directed at disparate beliefs and attitudes may help to address racial discrepancies in health care outcomes.

Editors' Notes Context Some people believe that exposing the lungs to air during surgery for lung cancer causes tumor spread. Contribution Of 626 outpatients seen in 5 pulmonary and lung cancer clinics in different parts of the United States, 38% believed that air exposure causes tumor spread. African Americans espoused the belief more often than did white people. Nineteen percent of African Americans said that it was a reason to decline surgery if they had a tumor. Cautions These findings may help explain some apparent disparities in lung cancer care, but they don't elucidate underlying reasons for differences in beliefs and don't directly link beliefs to actions. –The Editors

 

Author and Article Information

From the University of Pennsylvania and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Medical University of South Carolina, Charleston, South Carolina; and Los Angeles Veterans Affairs Medical Center, Los Angeles, California.

Presented in part at the national meeting of the American Thoracic Society, Toronto, Ontario, Canada, 6–10 May 2000.

Acknowledgments: The authors thank Rachel Bagelman, BS; Luis Seijo, MD; Kate Lindell, MSN, RN; Judy Shea, PhD; Christy Gaughan, MS; and Sandy Masiak, BS, for assistance with data collection and analysis. They also thank Katrina Armstrong, MD, and Ellyn Micco, BS, for helpful suggestions and Brian Strom, MD, MPH, and David Asch, MD, for a critical review of the manuscript.

Grant Support: In part by a locally initiated project grant from the Veterans Affairs Health Services Research and Development Service.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Mitchell L. Margolis, MD, Pulmonary Section, Philadelphia Veterans Affairs Medical Center, Room 8A112, University and Woodland Avenues, Philadelphia, PA 19104.

Current Author Addresses: Dr. Margolis: Pulmonary Section, Philadelphia Veterans Affairs Medical Center, Room 8A112, University and Woodland Avenues, Philadelphia, PA 19104.

Dr. Christie: Pulmonary, Critical Care, and Allergy Section, Department of Biostatistics and Epidemiology, University of Pennsylvania, 719 Blockley Hall, Philadelphia, PA 19104.

Dr. Silvestri: Pulmonary and Critical Care Medicine, Allergy, and Clinical Immunology, 96 Jonathan Lucas Street, Suite 812 CSB, PO Box 250623, Charleston, SC 29425.

Dr. Kaiser: Department of Surgery, University of Pennsylvania, 6 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104.

Dr. Santiago: Pulmonary and Critical Care Section, West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Boulevard, Los Angeles, CA 90073.

Dr. Hansen-Flaschen: Pulmonary, Critical Care, and Allergy Section, University of Pennsylvania, 8th Floor, Maloney Building, 3400 Spruce Street, Philadelphia, PA 19104.

Author Contributions: Conception and design: M.L. Margolis, J.D. Christie, G.A. Silvestri, J. Hansen-Flaschen.

Analysis and interpretation of the data: M.L. Margolis, J.D. Christie, G.A. Silvestri.

Drafting of the article: M.L. Margolis, J.D. Christie, G.A. Silvestri.

Critical revision of the article for important intellectual content: M.L. Margolis, J.D. Christie, G.A. Silvestri, L. Kaiser, J. Hansen-Flaschen.

Final approval of the article: M.L. Margolis, J.D. Christie, G.A. Silvestri, L. Kaiser, S. Santiago, J. Hansen-Flaschen.

Provision of study materials or patients: M.L. Margolis, G.A. Silvestri, L. Kaiser, S. Santiago, J. Hansen-Flaschen.

Statistical expertise: M.L. Margolis, J.D. Christie, S. Santiago.

Obtaining of funding: M.L. Margolis.

Administrative, technical, or logistic support: M.L. Margolis, L. Kaiser, J. Hansen-Flaschen.

Collection and assembly of data: M.L. Margolis, G.A. Silvestri.