Patient Beliefs about Lung Cancer Surgery

What is the problem and what is known about it so far?

In the United States, lung cancer is the second most common cancer occurring in both men and women. Lung cancer occurs when abnormal cells in the lung divide without control. Sometimes the cancer cells quickly invade nearby tissue and spread through the blood and lymph system to other parts of the body. Doctors sometimes recommend surgery to remove lung tumors before they spread or to see whether the cancer has already spread to lymph nodes in the chest. In fact, surgery is the treatment of choice for most early tumors.

Doctors have heard that some patients worry that if lung cancer is exposed to air during surgery, the cancer will spread. African Americans have surgery for early lung cancer less often than do white people. They also have lower survival rates. No scientific evidence shows that air exposure affects lung cancer spread. However, if this belief is common among African Americans, it may explain why they have surgery less often than do white people.

Why did the researchers do this particular study?

To find out whether African Americans believe that air exposure affects spread of lung cancer more often than do white people and whether this belief affects treatment choices.

Who was studied?

626 patients from 5 different clinics specializing in lung diseases and lung tumors. Some patients had lung cancer and other patients had risk factors for lung cancer. 67% listed race or ethnicity as Caucasian or white and 27% listed race as African American or black.

How was the study done?

Researchers asked patients to fill out an anonymous survey as they checked in for clinic appointments. Patients answered 6 questions on their beliefs about lung cancer. One question asked whether the patient had heard that lung cancer spreads if it is exposed to air during surgery. Other questions asked whether the patient thought this was true and whether it was a reason not to have surgery if the patient had a tumor. Another question asked, “If your doctor told you this belief was false, would you believe him or her?” Researchers compared how African Americans and white people answered the questions.

What did the researchers find?

Thirty-eight percent believed that exposure to air during lung surgery causes cancer to spread. More African Americans (61%) than white people (29%) thought this was true. Nineteen percent of African Americans and only 5% of white people were opposed to having surgery on the basis of the belief. Fourteen percent of African Americans and 5% of white people said they wouldn't believe their doctor if told the belief was false.

What were the limitations of the study?

Many patients weren't facing the possibility of surgery; answers might differ in patients with lung cancer and who are actually facing surgery. Most patients' doctors were white, and all of the clinics were in urban, coastal areas. Patients who live in other areas or are cared for by doctors of their own race or ethnicity may have different beliefs and opinions.

What are the implications of the study?

Many patients may believe that exposing lung cancer to air during surgery causes cancer to spread. The belief, which seems to be particularly common among African Americans, might adversely affect treatment choices.