Disparities in perceived unmet need for supportive services among patients with lung cancer in the Cancer Care Outcomes Research and Surveillance Consortium

Abstract

BACKGROUND The authors investigated the prevalence, determinants of, and disparities in any perceived unmet need for 8 supportive services (home nurse, support group, psychological services, social worker, physical/occupational rehabilitation, pain management, spiritual counseling, and smoking cessation) by race/ethnicity and nativity and how it is associated with perceived quality of care among US patients with lung cancer. METHODS Data from a multiregional, multihealth system representative cohort of 4334 newly diagnosed patients were analyzed. Binomial logistic regression models adjusted for patient clustering. RESULTS Patients with any perceived unmet need (9% overall) included 7% of white–US‐born (USB), 9% of white–foreign‐born (FB), 13% of black‐USB, 8% of Latino‐USB, 24% of Latino‐FB, 4% of Asian/Pacific Islander (API)‐USB, 14% of API‐FB, and 11% of “other” patients (P < .001). Even after controlling for demographic and socioeconomic factors, health system and health care access, and need, black‐USB, Latino‐FB, and Asian‐FB patients were more likely to perceive an unmet need than white‐USB patients by 5.1, 10.9, and 5.6 percentage points, respectively (all P<.05). Being younger, female, never married, uninsured, a current smoker, or under surrogate care or having comorbidity, anxiety/depression, or a cost/insurance barrier to getting tests/treatments were associated with any unmet need. Patients with any unmet need were more likely to rate care as less‐than‐“excellent” by 13 percentage points than patients with no unmet need (P<.001). CONCLUSIONS Significant disparities in unmet supportive service need by race/ethnicity and nativity highlight immigrants with lung cancer as being particularly underserved. Eliminating disparities in access to needed supportive services is essential for delivering patient‐centered, equitable cancer care. Cancer 2014;120:3178–3191. © 2014 American Cancer Society.