Racial disparities in follow-up care of early-stage lung cancer survivors.

Abstract

12025 Background: Follow-up care and surveillance in lung cancer survivors is essential formanagement of treatment- and disease-related symptoms as well as for the early detection of cancer recurrence. To investigate if race impacts receipt of follow-up care in lung cancer survivors, we conducted a cross-sectional study in lung cancer survivors recruited through the New Jersey State Cancer Registry (NJSCR). Methods: Between May 2019 and December 2019, survivors of early-stage NSCLC were identified and recruited from the NJSCR. Participants were eligible if they had surgery for stage I or II NSCLC between 2014 and 2017 and, completed all treatment at least one year prior to enrollment. Eligible participants were asked to complete a paper survey questionnaire and medical record release form sent to them by mail. The survey had questions about demographics, smoking, cancer history and treatment, quality of life, follow-up care, barriers to care and informational needs. Study measures were compared between the groups using t-test or chi-square test as applicable. Results: Of the 482 survivors contacted, 23% (n = 114) mailed back the survey questionnaire. Of the 112 survivors who returned a completed survey; 78 (70%) were non-Hispanic (NH) Whites and 34 (30%) were NH Blacks. Mean age was 67 years, 61% were female, 92% had cancer in remission. 82% of participants reported receiving a surveillance scan (CT or PET) within one year of completing the study survey. More NH White survivors received a scan within a year compared to NH Black survivors (89% vs 64%; p = 0.006). Also, 88% of survivors reported that they were informed of the need for follow-up care by their provider with more NH White survivors reporting receiving this information (94%) compared to NH Blacks (71%; p = 0.002). About 57% of the survivors reported receiving a written treatment summary and 92% reported being seen by a physician within the past year; no racial differences in these measures were noted.There was also no racial difference in receipt of age-appropriate cancer screening; 66% and 80% reported receiving regular colon and breast cancer screening, respectively. A significantly higher percentage of NH Blacks reported currently smoking compared to NH Whites (16% vs 12%). The most significant barriers to care for both populations were concern for out-of-pocket costs (26% NH Whites, 19% NH Blacks), non-coverage of test (14% NH Whites, 10% NH Blacks) and lack of insurance (8% NH Whites, 16% NH Blacks). Conclusions: Significant racial disparity was identified between NH Blacks and NH Whites in receipt of surveillance scans, guidance about follow-up care and smoking cessation. The most significant barriers to follow-up care was lack of insurance in NH Blacks and financial concerns about cost and coverage of tests in NH Whites. Future interventions to increase survivorship care should target these specific needs in survivor populations.