Fear of Lung Cancer Surgery

Summarized by Robert W. Griffith, MD
December 19, 2003

Introduction

It's important for physicians to be aware of cultural beliefs in different races. An interesting example of this comes from Philadelphia. Chest surgeons at the Veterans Affairs Medical Center in that city observed that patients undergoing evaluation for surgery for lung cancer had an unusual, but serious belief; they thought that lung cancer spreads if exposed to air (as during surgery). Obviously, patients holding this conviction would be far less willing to have surgery for their cancer.

The surgeons did a survey to see just which people were influenced by this belief. Here's what they found, as reported in the Annals of Internal Medicine.

What was done

A self-completed questionnaire was given to 626 consecutive patients at 5 pulmonary and lung cancer clinics in Philadelphia. Patients completed the questionnaire while they were waiting to see the doctor. The questionnaire itself had been tested in a pilot study to ensure that it was specific enough, and unbiased.

In analyzing the returned questionnaires, the frequency of the belief in question was compared between white people and African-Americans. Other factors that might influence the result, such as age, gender, educational level, household income and religious affiliation were recorded.

What was found

The patients were mostly middle-aged or elderly men (average age 60), white, and lived in the city. Almost half (45%) had heard of the belief that lung surgery could lead to the spread of cancer by air; and more than one in three (37%) believed this to be true. One in ten thought that this was a reason to void lung surgery.

For each question, there were significant differences in frequencies of response between white people and African-Americans. Thus 29% of white people versus 61% of African-Americans thought the belief to be true. And 5% of white people versus 19% of African-Americans would avoid surgery because of this belief.

Although the amount of education and household income were shown to be important in determining the frequency of this belief, racial differences remained after appropriate adjustments were made for these factors.

Why is this important?

The belief that exposure of lung cancer to air at the time of surgery promotes cancer spread is obviously quite common in this community. And this belief is about twice as common in African-Americans than in white people.

There are other reports of such racial differences in beliefs about health matters; these concern the risks of high blood pressure, mental health, syphilis, AIDs, skin cancer, prostate cancer, and breast cancer.

The reasons for these racial differences may be sought in the legacy of earlier racial discrimination against African-Americans, mistrust in the present US healthcare systems, and doubts concerning the accuracy off medical advice given by non-African-American physicians. There may be myths rooted in Afro-centric cultural, religious, and folk beliefs. More important, however, is the fact that lung cancer is more common and has a lower 5-year survival rate in black than in white people, largely because of inferior treatment opportunities.

When similar treatment for lung cancer is provided to black and white people, the outcome (survival rate) is similar, both for those having surgery and those receiving radiation. The message is clear: efforts must be made by treating physicians to dispel any such beliefs, so that people of all races seek health care as soon as symptoms occur, and that those who might be avoiding surgery for fear of cancer spread can be freed of this idea. And African-American physicians would be more powerful message carriers in areas where this belief is prominent.

Source

• Racial differences pertaining to a belief about lung cancer surgery. ML. Margolis, JD. Christie, GA. Silvestri,  et al., Ann Intern Med, 2003, vol. 139, pp. 558--563

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