Racial and Ethnic Differences Shape NSCLC Treatment Decision-Making in the US
Key Clinical Summary
- Cross-sectional US surveys of 160 patients and 100 oncologists revealed significant racial and ethnic differences in non–small cell lung cancer (NSCLC) treatment priorities and shared decision-making preferences.
- Patients across groups prioritized life extension, but Asian and White patients emphasized quality of life, while Hispanic patients showed heightened concern about treatment side effects.
- Black and Hispanic physicians placed greater emphasis on patient financial burden, despite cost ranking low in treatment attribute priorities overall.
A new US-based study, drawing from 2 cross-sectional online surveys conducted in 2023, examined how patients with non–small cell lung cancer (NSCLC) and oncologists from different racial and ethnic backgrounds approach treatment decision-making. Findings published by investigators using data from the Inspire health community and M3 Global Research highlight substantial variation in treatment priorities, cultural considerations, and shared decision-making roles across groups.
Study Findings
Across 160 patient respondents—Asian (n = 30), Black (n = 37), Hispanic (n = 30), and White (n = 60)—extending life ranked as the most important treatment attribute. Quality of life was the second-highest priority for Asian (mean rank 3.8) and White (3.1) patients but was third for Black (5.0) and Hispanic (4.5) patients. Hispanic patients assigned more importance to avoiding side effects (4.4) than Asian, Black, or White patients (5.5–5.6).
Referral patterns also varied, with fewer White patients (60%) being referred to a specialist compared with Asian (86%), Black (87%), and Hispanic (94%) patients. Hispanic (60%) and White (60%) patients more frequently sought second opinions than Asian (40%) and Black (30%) respondents.
Cultural competence emerged as a key variable: 63% of Asian, 73% of Black, and 83% of Hispanic patients rated clinician understanding of their cultural background as somewhat or very important, compared with only 19% of White patients.
Among the 100 oncologists surveyed, expected overall survival, progression-free survival, and duration of response comprised the top-ranked treatment attributes across all racial and ethnic groups. But Black physicians expressed less concern regarding treatment side effects (mean 6.6) than Asian (5.0), Hispanic (5.3), or White (5.1) colleagues. More than 80% of Black and over 90% of Hispanic physicians indicated patient out-of-pocket costs or financial status strongly influenced treatment recommendations—compared with 32% of Asian and 72% of White physicians.
Shared decision-making preferences diverged as well. Asian patients expressed the highest preference for shared decision-making (50%), yet Hispanic patients most often reported experiencing it (50%). Physicians across minoritized groups perceived lower patient desire for involvement as the disease stage advanced.
Clinical Implications
These findings underscore the need for nuanced, culturally responsive approaches to NSCLC care. Differences in values—such as prioritization of quality of life, sensitivity to side effects, or emphasis on cultural concordance—should inform patient counseling and therapeutic planning. The study also highlights discrepancies between desired and actual participation in shared decision-making, suggesting opportunities to strengthen clinician–patient communication.
For oncologists, awareness of how financial toxicity differentially impacts patient populations is crucial. The heightened attention among Black and Hispanic physicians to cost considerations may reflect lived experience or practice setting differences that warrant broader system-level attention.
Conclusion
This study reveals meaningful racial and ethnic differences in NSCLC treatment priorities, cultural expectations, and shared decision-making dynamics. Incorporating these insights into clinical practice may improve patient-centered care and enhance treatment satisfaction, particularly for minoritized populations. Future research should evaluate how these preference patterns influence real-world outcomes.
Reference
Dwyer Orr L, Vadagam P, Vanderpoel J, et al. Differences in treatment decision-making for non-small cell lung cancer among patients and physicians, by race and ethnicity. Curr Med Res and Opin. 2025;41(10):1921–1931. doi:10.1080/03007995.2025.2584492
