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. 2014 Oct 15;120(20):3178-91.
doi: 10.1002/cncr.28801. Epub 2014 Jul 1.

Disparities in perceived unmet need for supportive services among patients with lung cancer in the Cancer Care Outcomes Research and Surveillance Consortium

Dolly A John  1 , Ichiro Kawachi, Christopher S Lathan, John Z Ayanian
Affiliations

Disparities in perceived unmet need for supportive services among patients with lung cancer in the Cancer Care Outcomes Research and Surveillance Consortium

Dolly A John et al. Cancer. .

Abstract

Background: The authors investigated the prevalence, determinants of, and disparities in any perceived unmet need for 8 supportive services (home nurse, support group, psychological services, social worker, physical/occupational rehabilitation, pain management, spiritual counseling, and smoking cessation) by race/ethnicity and nativity and how it is associated with perceived quality of care among US patients with lung cancer.

Methods: Data from a multiregional, multihealth system representative cohort of 4334 newly diagnosed patients were analyzed. Binomial logistic regression models adjusted for patient clustering.

Results: Patients with any perceived unmet need (9% overall) included 7% of white-US-born (USB), 9% of white-foreign-born (FB), 13% of black-USB, 8% of Latino-USB, 24% of Latino-FB, 4% of Asian/Pacific Islander (API)-USB, 14% of API-FB, and 11% of "other" patients (P < .001). Even after controlling for demographic and socioeconomic factors, health system and health care access, and need, black-USB, Latino-FB, and Asian-FB patients were more likely to perceive an unmet need than white-USB patients by 5.1, 10.9, and 5.6 percentage points, respectively (all P < .05). Being younger, female, never married, uninsured, a current smoker, or under surrogate care or having comorbidity, anxiety/depression, or a cost/insurance barrier to getting tests/treatments were associated with any unmet need. Patients with any unmet need were more likely to rate care as less-than-"excellent" by 13 percentage points than patients with no unmet need (P < .001).

Conclusions: Significant disparities in unmet supportive service need by race/ethnicity and nativity highlight immigrants with lung cancer as being particularly underserved. Eliminating disparities in access to needed supportive services is essential for delivering patient-centered, equitable cancer care.

Keywords: health care disparities; immigrants; lung cancer; patient-centered care; supportive care; underserved populations.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

The authors made no disclosures apart from the funding sources.

Figures

Figure 1
Figure 1
Prevalence (shown as percent) of perceived unmet need for supportive services among US patients with lung cancer in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium is shown by race/ethnicity-nativity and socioeconomic status. Supportive services studied included home nurse, support group, psychological services, social worker, physical/occupational rehabilitation, pain management, spiritual counseling, and smoking cessation. Income refers to annual household income. Wealth was assessed as time able to sustain living at one’s current address and standard of living upon loss of all household income. Differences across categories are statistically significant at P <.001 for all variables except education. GED indicates General Educational Development.
Figure 2
Figure 2
Type of need for US patients with lung cancer perceiving any unmet need for supportive services in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium is shown by race/ethnicity-nativity. Percentages do not add to 100% because patients could report multiple unmet service needs. Results for Asian/Pacific Islander–US-born (API-USB) patients are not reported due to small samples (< 10 patients) in these categories.
Figure 3
Figure 3
Difference in the model-adjusted average predicted probabilities of any perceived unmet need for supportive services for patients in each racial/ethnic-nativity group and white–US-born (USB) patients with lung cancer in the Cancer Care Outcomes Research and Surveillance Consortium is shown. The difference was calculated using average marginal effects or risk differences from logistic regression models with robust standard errors adjusted for patient clustering and holding model covariates constant. For example, on average, a Latino–foreign-born (FB) patient’s probability of having any perceived unmet need is 10.9 percentage points higher than for an otherwise similar white-USB patient holding constant demographics, socioeconomic status, health care access and health system, and need. Supportive services studied included home nurse, support group, psychological services, social worker, physical/occupational rehabilitation, pain management, spiritual counseling, and smoking cessation.
Figure 4
Figure 4
Odds ratios with 95% confidence intervals are shown for factors associated with perceived unmet need for supportive services among US patients with lung cancer in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium. Supportive services studied included home nurse, support group, psychological services, social worker, physical/occupational rehabilitation, pain management, spiritual counseling, and smoking cessation. Reference categories are shown in parentheses. Reference category for health insurance-primary doctor was insured for 12 months with a primary doctor. USB indicates US-born; FB, foreign-born; HMO, health maintenance organization; CRN, Cancer Research Network.
Figure 5
Figure 5
Model-adjusted average predicted probability of perceiving less-than-excellent quality of care is shown for patients with lung cancer in the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium with and without any unmet need for supportive services. The probability was computed using predictive margins from a logistic regression model with robust standard errors adjusted for patient clustering and holding constant model covariates (demographic factors, socioeconomic status, health care access and health system, need, and perceived discrimination in care). Supportive services studied included home nurse, support group, psychological services, social worker, physical/occupational rehabilitation, pain management, spiritual counseling, and smoking cessation.
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