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J Thorac Oncol. 2018 Nov 16. pii: S1556-0864(18)33407-5. doi: 10.1016/j.jtho.2018.10.158. [Epub ahead of print]

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

Author information

1
Supportive Care Center, Department of Family Medicine, Samsung Medical Center, Seoul, Republic of Korea; Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea.
2
Department of Thoracic Surgery, Samsung Medical Center, Seoul, Republic of Korea.
3
Department of Radiation Oncology, Samsung Medical Center, Seoul, Republic of Korea.
4
Division of Hemato-Oncology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea.
5
Department of Medical Statistics, The Catholic University of Korea, Seoul, Republic of Korea.
6
Department of Public Health and Preventive Medicine, Chungbuk National University Hospital, Cheongju, Republic of Korea; College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Republic of Korea.
7
Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea.
8
College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Republic of Korea; Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea. Electronic address: jonghyock@gmail.com.
9
T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts.

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] = 0.82, 95% confidence interval [CI]: 0.77-0.86), chemotherapy (aOR = 0.80, 95% CI: 0.77-0.84), or radiotherapy (aOR = 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 = 1.08, 95% CI: 1.06-1.11), especially in the group with a severe disability (a hazard ratio = 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.

KEYWORDS:

Disability; Lung cancer; Stage; Survival; Treatment

PMID:
30453082
DOI:
10.1016/j.jtho.2018.10.158

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