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NEWS & VIEWS |
Almost 40% of patients with lung disease believe that surgery can make cancer spread by exposing the tumor to air, according a newly published survey. This myth was more common among African Americans than Whites, and researchers suggest it may contribute to lower lung cancer surgery and survival rates for African Americans.
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Lead author Mitchell Margolis, MD wrote that "...widespread acceptance of the study belief could undermine the best chance for cure of early-stage lung cancer." The study is published in the Annals of Internal Medicine (2003;139:558–563).
Margolis designed the survey because his patients at the Philadelphia Veterans Affairs Medical Center often mentioned the false belief, and several African American patients refused to see a surgeon on that basis. A total of 626 patients with lung cancer or other pulmonary diseases took the survey at clinics around Philadelphia, in Los Angeles, and in Charleston, South Carolina.
Overall 38% believed air exposure during surgery would cause a tumor to spread. By race, 61% of African Americans and 29% of White respondents agreed with this belief. In univariate analysis, this belief was also associated with lower income and education levels, but in multivariate analysis, race was the only factor significantly associated with this concern about surgery.
Nineteen percent of African Americans and 5% of Whites said they would refuse lung surgery based on the myth. Some 14% of African Americans and 5% of Whites would stick to their belief even if their doctors told them it was false.
Few people remembered where they first heard of the notion that surgery causes lung cancer to spread; some named "the gossip mill." What many people did remember were unfavorable medical outcomes for loved ones with cancer.
"The reality is that people come in very late in the disease and a few months later they die," explained Harold Freeman, MD, of North General Hospital in New York City and an expert on racial disparities in cancer.
"People who believe myths have a life experience that supports their beliefs," he continued, "and if people’s relatives and friends are being operated on and dying, that’s a strong personal experience."
Margolis speculates that past experiences with poor surgical or perioperative care could play a role, as well as "the legacy of racial discrimination against African Americans, mistrust and disenfranchisement from the current health care system."
Overall, the outlook for surviving localized lung cancer has improved somewhat, largely due to better surgical techniques. The five-year survival rate for White patients at this stage is 49%. But African Americans don’t do as well; only 43% survive five years or longer after diagnosis.
In his journal article, Margolis cites a recent study of elderly patients with localized lung cancer (based on the linked SEER-Medicare database) that found a 13% lower rate of surgery and an 8% lower five-year survival rate for African Americans compared with Whites.
Freeman says doctors and patients must both make changes so false beliefs don’t prevent patients from pursuing the best treatment. "The key to this is that we have to ask physicians to be very sensitive and understanding and open about the myths or beliefs that people share with us," he said.
"There are reasons for patient’s beliefs," said Freeman.
"Doctors have to take more time and try to bring some logic to the issue without insulting the dignity of the person," he continued. "If all cancers touched by air did spread quickly, you could logically assume that all people whose cancers are treated with surgery would die. And that’s clearly not the case."
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