Asian Americans who are diagnosed with non-small cell lung cancer (NSCLC) face real challenges in getting care. A host of factors may contribute to this disparity.
Non-small cell lung cancer (NSCLC) occurs when cells in the lungs of the lining of the airways grow unusually or uncontrollably. NSCLC is the most common kind of lung cancer, making up
Though lung cancer is by far the
Deaths from lung cancer continue to drop as well, as researchers make important advancements in early diagnosis and treatment.
Asian Americans and Pacific Islanders (AAPI) represent one of the fastest growing demographics in the United States. Asian Americans are also the only groups in the United States to list cancer — not heart disease — as the leading cause of death in both
When it comes to lung cancer, some research shows disparities among certain Asian American groups.
- Lung cancer is the leading cause of cancer-related mortality for Asian men.
- Among six Asian subgroups, Vietnamese people have the
highest rateof lung cancer, while Chinese people have the highest mortality rates of lung cancer.
- Asian people are more likely to present with later-stage lung cancer compared to white people.
- Asian people are less likely than white people to receive treatment or have delays in treatment.
Smoking vs. genetics
However, Asian American women who have never smoked have a
This likely has to do with genetics. People of Asian descent have a higher risk of developing NSCLC caused by a mutation in the EGFR gene compared to other racial or ethnic groups.
Yet, many Asian Americans may not be aware of their lung cancer risk factors and often don’t get screened to catch the cancer early.
Asian Americans who are diagnosed with NSCLC face real challenges in getting care.
- infrequent medical visits
- language and cultural barriers
- lack of health insurance
- lack of knowledge of the American healthcare system
- higher prevalence of
smoking, particularly in Chinese immigrants
- low use of smoking cessation counseling and other services
First-generation immigrants are the most disadvantaged due to language and cultural barriers and health literacy compared to Asians born in the United States.
Binh Luu, a Senior Research Coordinator for the Tobacco Free Community, an array of programs within NYU Langone Health, and Yi-Ling Tan, MPH, Program Manager at the Center for the Study of Asian American Health at NYU, explained, “First-generation Asian Americans tend to face communication and language barriers when seeing providers; they are more comfortable when seeing a physician who speaks their language.”
First-generation Asian Americans also “tend to see providers as authority figures and do not question their judgment or ask any questions.” Luu and Tan told Healthline, “As children of first-generation Asian Americans, we or other family members are often the ones who provide language support and patient advocacy at the doctor’s office.”
Second and third-generation Asian Americans, on the other hand, tend to have English-speaking ability, higher health literacy, and are better equipped to do their own research online.
Research also suggests that compared with other races, Asian Americans are more likely to be diagnosed with lung cancer at a distant stage of disease. They also may be less likely to be willing to undergo surgery to treat their cancer.
Luu and Tan wrote: “As a group, Asian Americans experience cancer health disparities throughout the entire cancer continuum, ranging from prevention, screening, diagnosis, treatment, to survivorship. Among Asian subgroups, for example, Chinese Americans report the lowest levels of health literacy, and over half of Chinese New Yorkers possess limited English proficiency, which impacts an individual’s health outcomes.”
For lung cancer specifically, these barriers include:
- a misconception that only heavy smokers should be screened for lung cancer
- lack of knowledge about expanded eligibility and insurance coverage for lung cancer screening
According to a survey conducted by the Association of Community Care Centers, AAPI with lung cancer feel they need better education and understanding of treatment options.
This is where communication with healthcare professionals is essential.
To improve the outlook, doctors will need to better tailor efforts to facilitate healthcare, biomarker screenings, and help with smoking cessation in Asian Americans.
But even with interpreters present, Luu and Tan warned that “it can be difficult for providers to fully convey a complex diagnosis.”
And, “even after treatment completion, Asian American cancer survivors have poorer mental health and quality of life compared to non-Hispanic whites.
“There is a need for better language access as well as culturally and linguistically tailored materials,” Luu and Tan told Healthline.
“The healthcare team should also recognize the role of the family when working with Asian American patients and prioritize the integration of family-centered care into healthcare delivery. Community health workers (CHWs) have also been shown to play a very important role in improving health access, outcomes and improving communication.”
Healthcare professionals can help by:
- educating Asian Americans about their increased risk of EGFR mutations
- emphasizing the need for lung cancer biomarker screening even for those who’ve never smoked
- providing support for quitting smoking, such as language-sensitive quitting smoking lines and nicotine patches
- recommending mental health support services after screening
- using a family-centered and authority-led approach to communication
NYU’s Center for the Study of Asian American Health (CSAAH) has also created a bilingual English and Chinese website to raise awareness about the importance of lung cancer screening and who should get it.
Despite advances in early detection and treatment for NSCLC, many Asian Americans may not be aware of their lung cancer risk factors and often don’t get screened. Asian Americans are more likely to be diagnosed with lung cancer at a distant stage of disease.
Doctors can help by emphasizing smoking cessation and lung cancer screening for this population in shared decision-making conversations.
Luu and Tan offered the following advice: “Lung cancer screening saves lives. We need to get that message out into the community and promote awareness of the eligibility criteria for lung cancer screening.”