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Lung cancer patients don't get equal symptom care

By Kerry Grens

NEW YORK (Reuters Health) - Lung cancer patients at public hospitals, which serve a greater proportion of poor and disadvantaged people, are less likely to receive adequate treatment for pain and other symptoms than patients treated at a cancer center, according to a new study.

Patients at public hospitals were nine times more likely than the cancer center patients to come in with more-severe symptoms to begin with.

"I think it's been noted...for the last couple of decades" that cancer "is less well managed in what we consider underserved patients," said Dr. Charles Cleeland from MD Anderson Cancer Center in Houston, who led the study.

Underserved patients tend to be poor, single, unemployed, non-white, and receiving public assistance health insurance. They also tend to have low levels of formal education.

Previous work, Cleeland said, had only analyzed patients' symptom treatment at a specific point in time. His study, published in the Journal of Clinical Oncology, monitored patients for more than two months.

Eighty patients were receiving treatment for their lung cancer at one of three public hospitals - two in Houston and one in Miami. Another 101 were receiving care at MD Anderson Cancer Center.

Roughly one-third of the MD Anderson patients and two-thirds of the public hospital patients had very severe symptoms before they started on chemotherapy for their cancer. These included pain, fatigue, nausea, vomiting, distress, and problems with appetite and memory.

Over the weeks, patients who started out with less severe symptoms found some relief over time -- but that was generally not the case for those with more severe symptoms to begin with.

"Even though these patients are experiencing symptoms, they are not being corrected," Cleeland told Reuters Health, "and they tended to be treated at public hospitals."

The reasons for the differences between the types of hospitals are "very complex," Cleeland said. "I don't think it's the intention of those caring for those folks."

Rather, patients' access to resources within the hospital and beyond it could explain why underserved patients tended to experience worsening symptoms.

Cleeland said patients at public hospitals might be less likely to get referrals to specialists for behavioral health services or for the treatment of bone pain.

Additionally, the patients at a cancer clinic might be more able to afford specialty care when it's offered.

The patients in the study did receive equal treatment for the cancer itself.

Sixty-two out of every 100,000 adults in the United States are diagnosed with lung cancer each year.

Previous studies have uncovered disparities among lung cancer patients for treatment and survival as well.

African Americans and patients of lower socioeconomic status are less likely to survive lung cancer (see Reuters Health report, February 1, 2011).

And an earlier study led by Dr. Samuel Cykert, a professor of medicine at the University of North Carolina, found that African Americans are more likely than whites to forego surgery for early stage lung cancer - the best treatment for the disease.

"There were probably unintended biases in physicians," Cykert suggested. "When they looked at a sick patient who had less resources in a really difficult situation, they would be less apt to recommend surgery than to someone in a similar situation who had good resources."

The same hesitancy to treat a cancer aggressively might extend to symptom treatment as well, Cykert told Reuters Health.

"Being passive is bad," said Cykert, who was not involved in the current study. "You have to say, 'I have this symptom and I need help.' And you have to say it over and over. Advocating for oneself is very important."

Cleeland said providers need to prioritize the treatment of symptoms, and not just the cancer.

"These people are pretty close to the end of their lives and this (study) is characterizing their experience during that time. I think we need to strategize about how to help them," he said.

SOURCE: http://bit.ly/mpZAWo Journal of Clinical Oncology, online June 20, 2011.

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