Advances in precision medicine have led to the development of effective targeted therapies for a variety of cancers, including protocols for patients with non-small cell lung cancer (NSCLC). But not all patients with this type of cancer undergo the testing and care that could improve survival rates and mitigate the adverse effects that accompany traditional cancer treatments such as chemotherapy and radiation.
With interest in gauging the possible barriers that social determinants of health might create, the researchers conducted a narrative review of relevant retrospective studies published in the United States between 2016 and 2020. Data from 11 studies that met the inclusion criteria, which included medical records and/or insurance claims, were analyzed. Their findings were published in Oncology Nursing Forum.
They found socioeconomic and health insurance status were major factors. Precision medicine testing was more common among individuals with higher incomes and private insurance in 6 of the analyzed studies. The evidence showed that treatment was more common among people with private insurance, as well.
Race also played a role. People of Asian descent were offered molecular testing and targeted therapy more often than people of other racial backgrounds, and Black people were offered testing and targeted therapy less often. Some of the studies analyzed also suggested that people living in urban areas who had better access to these services were thus more likely to be offered testing and treatment.
“This review confirms that health disparities must be acknowledged when considering precision medicine initiatives in the realm of molecular testing and targeted therapeutic treatment for individuals with NSCLC in the United States,” the researchers said.
The researchers noted that their work does have some implications for the nursing profession. The nursing profession stresses the importance of considering various social determinants of health. Nurses can be instrumental in conveying the complex details of testing and treatment to patients, and they can also lend their voices to the effort to ensure that care is delivered equitably in the future.
“Gaining awareness of the inequities in the provision of precision medicine initiatives is the first step toward mitigation,” the researchers concluded.
The study did have a few limitations. First, only some of the studies were comprehensive about social determinants of health. Second, this review examined retrospective studies that analyzed medical and billing records, which left out the perspectives of individual patients. And finally, this review was limited by a lack of detail in the discussions regarding medical insurance.
Curtin M, Somayaji D, Dickerson SS. Precision medicine testing and disparities in healthcare for individuals with non-small cell lung cancer: a narrative review. Oncol Nurs Forum. 2022;49(3):257-272. doi:10.1188/22.onf.257-272