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Project RADICAL (RAcial Disparity In CAncer of the Lung) is a community-based working group. We are lung cancer survivors, care givers, advocates, researchers, and heathcare providers. We aim to achieve racial health equity in diagnosing and treating lung cancer. We raise awareness among communities, researchers, and doctors. This fundraising is for research on disparity in the treatment of metastatic lung cancer in Black communities.
Sponsored by Morhaf Al Achkar, MD, PhD
Lung Cancer Disparity
Lung cancer, the leading cause of cancer death, disproportionately affects Black Americans. The 5-year survival rate is lower in Blacks than in Whites. African Americans are less likely to receive staging. When diagnosed at earlier stages, they are less likely to receive curative treatment. African Americans are diagnosed at a higher rate with metastatic disease, when the 5-year survival is less than 6%.
Disparity in Treatment of Metastatic Lung Cancer
In recent years, molecular testing and targeted cancer therapy have become routine care for late-stage NSCLC. This innovation led to great improvements in mortality rates. Although African Americans harbor actionable oncogenic alterations similar to Whites, they receive targeted treatment less often. Suboptimal access to targeted therapies and clinical trials only worsens the existing disparity.
In addition to racism, different biological, behavioral, and societal factors have been suggested to explain the disparity in lung cancer. While we know the roots of this disparity generally and how to eliminate disparity when lung cancer is diagnosed early, little is known about the disparity for patients with metastatic lung cancer, the stage at which the majority of African Americans are diagnosed.
Objectives of the Project
We will achieve the following specific aims:
Aim 1: Explore pitfalls, suboptimal experiences, and discriminatory practices in cancer treatment and survivorship for African Americans with metastatic lung cancer and oncogenic alterations. During the Formative Qualitative Inquiry Phase (first six months), we will conduct interviews (patients and caregivers) and focus groups (healthcare providers and community advocates) in diverse African American communities. We will use the qualitative data to inform the development of the survey instrument employed in the second phase of the study.
Aim 2: Identify causes of health disparity in cancer treatment and survivorship for African Americans with metastatic lung cancer and oncogenic alterations. During the Exploratory Quantitative phase (second 6 months), we will survey a representative sample of African American patients with metastatic lung cancer on targeted therapies to identify the prevalence of pitfalls, suboptimal experiences, and discriminatory practices in patient experiences with treatment and survivorship. We will also study factors and structures associated with these patterns and pay attention to variations of gender, age, and rural vs urban settings.
We will follow a mixed-methods sequential qualitative and quantitative methodology in a community-based participatory research framework. The interviews will provide patient-level accounts of cancer treatment and survivorship experiences among those receiving targeted therapy to identify any pitfalls, suboptimal experiences, and discriminatory practices. The focus groups will provide reflections and observations to contextualize possible etiologies for the observed disparities from individuals in the community who are invested in understanding and removing these disparities. The focus groups will give provider-level and community-level perspectives.
We will triangulate participants’ perspectives in a multi-level analysis. A community advisory group will review emerging themes and define the key survey items. The quantitative survey will be informed by findings from the qualitative interviews and focus groups and will incorporate validated measurements of racism, discrimination, and other known social factors.
We believe the triangulated perspectives from 20 is sufficient to highlight diverse experiences to reach inductive saturation during analysis. This assumption is based on our previous qualitative studies and pilot study for this method. For the survey in the second phase, we will recruit 100 patients.
We aim to disseminate findings through written manuscripts in peer-reviewed journals, opinion pieces in newspapers, podcasts, community events, and conferences. Individuals from the lung cancer community and advocates from African American communities will lead the efforts of dissemination. We will partner with groups, foundations, and organizations that serve Black communities to help with these efforts.
Understanding pitfalls, suboptimal experiences, and discriminatory practices will help develop strategies that minimize their occurrence. Learning from the experiences of individuals who overcome challenges along the way will help others navigate similar situations. The ultimate goal is to close the disparity gap in lung cancer treatment.
Disclaimer: The donor will receive no benefits, tangible or intangible, from their contribution. Funds collected will be used to support Dr. Al Achkar’s research project at the University of Washington, Seattle.