Disparities in the Diagnosis and Treatment of Lung Cancer among People with Disabilities

Abstract

Introduction: Potential disparities in the diagnosis, treatment, and survival of patients with lung cancer with and without disabilities have rarely been investigated. Methods:We conducted a retrospective cohort study with a data set linking the Korean National Health Service database, disability registration data, and Korean Central Cancer Registry data. A total of 13,591 people with disabilities in whom lung cancer had been diagnosed and 43,809 age-and sex-matched control subjects in whom lung cancer had been diagnosed were included.Results: Unknown stage was more common in people with severe disabilities (13.1% versus 10.3%), especially those with a communication (14.2%) or mental/cognitive disability (15.7%). People with disabilities were less likely to undergo a surgical procedure (adjusted OR [aOR] ¼ 0.82, 95% confidence interval [CI]: 0.77-0.86), chemotherapy (aOR ¼ 0.80, 95% CI: 0.77-0.84), or radiotherapy (aOR ¼ 0.92, 95% CI: 0.88-0.96). This higher likelihood was more evident for people with severe communication impairment (aORs of 0.46 for surgery and 0.64 for chemotherapy) and severe brain/mental impairment (aORs 0.39 for surgery, 0.47 for chemotherapy, and 0.49 for radiotherapy). Patients with disabilities had a slightly higher overall mortality than did people with no disability (adjusted hazard ratio ¼ 1.08, 95% CI: 1.06-1.11), especially in the group with a severe disability (a hazard ratio ¼ 1.20, 95% CI: 1.16-1.24). Conclusions:Patients with lung cancer and disabilities, especially severe ones, underwent less staging work-up and treatment even though their treatment outcomes were only slightly worse than those of people without a disability. Although some degree of disparity might be attributed to reasonable clinical judgement, unequal clinical care for people with communication and brain/mental disabilities suggests unjustifiable disability-related barriers that need to be addressed.

Disparities in the Diagnosis and Treatment of Gastric Cancer in Relation to Disabilities

“…We found that the stage of disease was more likely to be marked “unknown” among people with disabilities. Like a previous study on disparities in lung cancer ( 24 ), this trend was more evident in the severe disability group and among those with mental impairments. GC staging may be “unknown” because patients did not receive proper staging tests to establish an appropriate treatment plan, which means that they probably gave up subsequent treatment ( 35 ).…”

“…Our study showed that people with disabilities were more likely to receive no cancer treatment and were less likely to undergo surgery or chemotherapy, especially when their disability is severe. Our findings imply that people with disabilities may be discouraged from receiving cancer treatment by their healthcare providers or family members, who may undervalue the benefits of treatment and overemphasize complications in patients with disabilities ( 24 , 25 , 27 ). Furthermore, receiving less treatment was more evident in people with communication and mental impairments.…”

“…In addition, they often have lower education and income levels ( 20 – 23 ). Thus, they may be diagnosed at a later stage of disease or have an unknown disease status, receive inappropriate or no standard treatment, and have worse survival ( 24 – 27 ).…”

“…Therefore, it is important to identify the potential disparities of the cancer diagnosis and treatment between patients with disabilities and those without ( 24 – 27 ). In the United States, a previous study using the Surveillance, Epidemiology, and End Results–Medicare/Social Security Disability Insurance (SSDI) databases examined the potential disparities in the cancer diagnosis and treatment ( 26 ).…”

Disability among lung cancer patients and its predictors: a cross-sectional study in a tertiary care centre at Kolkata, India

“…1 Despite of its deadliest nature, early diagnosis and treatment can better the survival of the sufferer. 2 People from socio-economically backward section face the worst situation related to prognosis due to poor awareness, lack of accessibility to health services and costly treatment. They are often diagnosed at late stage resulting in poor survival and increased chance of disability.…”