Coral Olazagasti, MD discusses disparities in lung cancer screening rates between Hispanic and non-Hispanic White survivors of head and neck cancer.  

Dr Olazagasti on Disparities in Lung Cancer Screening Rates for Hispanic Head and Neck Cancer Survivors

Coral Olazagasti, MD, thoracic oncologist, professor, medicine, The University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, discusses factors that may contribute to disparities in lung cancer screening rates between Hispanic and non-Hispanic White survivors of head and neck cancer.

Head and neck cancer survivors have 3-times the risk of developing lung cancer compared with patients without a prior history of the disease, Olazagasti reports. This increased risk necessitates robust lung cancer screening protocols, particularly in vulnerable populations. However, there are significant disparities in lung cancer screening for the Hispanic population, she says.

Prior studies have shown that Hispanics are less likely to meet eligibility criteria for lung cancer screening compared with non-Hispanic patients, Olazagasti reports. Within different screening criteria, Hispanics are less likely to meet the United States Preventive Services Task Force criteria than the National Comprehensive Cancer Network criteria, she says. This discrepancy is attributed to differences in smoking histories and pack-year histories, as the studies that designed the lung cancer screening criteria predominantly enrolled white participants, Olazagasti explains.

Moreover, Hispanic patients who do meet these are still less likely to undergo screening, Olazagasti adds. This could be attributed biases from healthcare providers, who might perceive Hispanics as non-compliant, or due to barriers in access to care, such as a lack of insurance and access to private transportation, Olazagasti says. These barriers prevent effective lung cancer screening in this high-risk population, she emphasizes.

To address this significant inequity, the GUIAR study was designed to evaluate the impact of a culturally tailored educational intervention on lung cancer screening uptake among Hispanic head and neck cancer survivors, Olazagasti details. This trial assessed awareness and disposition toward lung cancer screening among Hispanic head and neck cancer survivors. Secondary aims included identifying barriers to lung cancer screening, developing and testing a tailored lung cancer screening program, and comparing lung cancer screening uptake rates between the two arms at baseline and after one year. By implementing culturally tailored educational interventions, the study aims to improve awareness and increase screening uptake, thereby reducing lung cancer mortality rates in this high-risk group.

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Coral Olazagasti, MD, discusses disparities in lung cancer screening rates between Hispanic and non-Hispanic White survivors of head and neck cancer.
 

Dr Olazagasti on Culturally Tailored Lung Cancer Screening for Hispanic Head and Neck Cancer Survivors

Coral Olazagasti, MD, thoracic oncologist, professor, medicine, The University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, discusses the development of a tailored lung cancer screening program for Hispanic head and neck cancer survivors. This initiative addresses disparities in lung cancer outcomes and screening rates in this population.

The GUIAR study aims to evaluate the impact of a culturally tailored educational intervention on lung cancer screening uptake among Hispanic head and neck cancer survivors. Participants are pre-screened for eligibility and enrolled in the University of Miami’s lung cancer screening program. The study has 2 components: a survey to assess awareness and perceptions of lung cancer screening, and a randomized trial comparing the tailored educational intervention to standard care, Olazagasti explains.

The survey component assesses awareness of lung cancer screening, risk perceptions of lung cancer, and attitudes toward screening among head and neck cancer survivors, Olazagasti reports. The randomized trial will involve 125 participants, with 62 undergoing annual 60-minute sessions with a nurse navigator who will provide education in the participant’s native language about lung cancer risk factors, the patient’s lung cancer screening eligibility, and the screening process. Those in the intervention arm will also receive culturally tailored educational materials and participate in semi-structured interviews to explore cultural beliefs and barriers to lung cancer screening, she notes.

The primary aim of this trial is to assess awareness and disposition toward lung cancer screening among Hispanic head and neck cancer survivors, Olazagasti states. Secondary aims include identifying barriers to lung cancer screening, developing and testing a tailored lung cancer screening program, and comparing lung cancer screening uptake rates between the 2 arms at baseline and after 1 year.

Descriptive statistics will summarize demographic and clinical characteristics and survey responses, Olazagasti explains. Key outcomes will seek to include the proportion of patients who are aware of lung cancer screening recommendations and the proportion of those willing to pursue screening, as well as factors related to this awareness. Qualitative data from interviews will be analyzed using a modified grounded theory approach with NVivo10 Software. For the randomized study, McNemar’s test will compare lung cancer screening uptake rates within each arm from baseline to year 1, and Fisher’s exact test will compare rates between the arms, she adds.

Overall, Olazagasti emphasizes this trial’s aim to address the significant gap in lung cancer screening uptake among Hispanic head and neck cancer survivors by developing a culturally tailored educational intervention. The goal is to improve early detection and outcomes in this high-risk population by determining whether culturally tailored education can yield higher lung cancer screening uptake rates compared with standard care, she concludes.

Coral Olazagasti, MD discusses a tailored lung cancer screening program for Hispanic head and neck cancer survivors. 

Dr Olazagasti on a Case-Based Discussion of ALK-Mutated NSCLC Treatment

Coral Olazagasti, MD, assistant professor, Clinical Medical Oncology, Department of Medicine, Division of Medical Oncology, Sylvester Cancer Center, University of Miami Miller School of Medicine, discusses her participation in a case-based discussion at the 

 Winter Lung Cancer Conference®, and the importance of having conversations such as these.

During the event, Olazagasti presented a case study of a patient with non–small cell lung cancer (NSCLC) harboring an 

 alteration. The patient initially had an unconventional clinical presentation that appeared to be primary thyroid disease but was ultimately diagnosed as lung adenocarcinoma, she details. PET/CT scans revealed FDG avid lymph nodes in the neck, cheek and abdomen that signaled a potential malignancy, along with diffuse FDG uptake in the thyroid gland, peribronchial thickening. The patient's immunoprofile favored the lung as the origin of disease.

After undergoing next-generation sequencing, the patient was identified as harboring an 

 mutation and treated with 600 mg of alectinib (Alecensa) every 12 hours. The patient initially achieved a complete response on initial PET scan, but later began experiencing cervical lymph nodes. A follow-up scan demonstrated signs of disease recurrence, and the patient was switched to lorlatinib (Lorbrena). Carboplatin/pemetrexed was then added to this regimen, and improvements in response were observed. The patient is currently on maintenance pemetrexed and lorlatinib.

The presentation prompted a thorough discussion among colleagues, where varying perspectives were evaluated and different treatment options were explored, Olazagasti says. The interactive nature of the case presentation allowed for a collaborative exchange of ideas and insights from the audience, she adds. Colleagues provided valuable feedback and suggestions, including key considerations if the patient's disease transformed into a squamous cell presentation, and the importance of repeating biopsies or adjusting treatment accordingly, Olazagasti details.

The experience underscored the dynamic and nuanced nature of medicine, where clear guidelines may not always apply to atypical presentations, Olazagasti continues. Engaging in discussions with peers and considering alternative viewpoints ensures comprehensive patient care and enables clinicians to adapt their approach based on individual patient needs, she emphasizes.

Ultimately, the case presentation served as a reminder of the importance of interdisciplinary collaboration and ongoing learning in delivering optimal patient care, Olazagasti says. By continuously seeking feedback and staying informed about the latest studies and trials, clinicians can ensure that they are providing the best possible treatment options for their patients, Olazagasti concludes.

Coral Olazagasti, MD, discusses her participation in a case-based discussion at the 21st Annual Winter Lung Cancer Conference®.

Outbreaks of coronavirus disease 2019 (COVID-19) are on the rise in Latin America, with more than 4 million confirmed cases. In response to this health crisis, elective medical procedures, including cancer screening and care, as well as treatment for conditions beyond the virus, have been held.

Procedures that may not be considered elective are also being postponed, and patients are now being diagnosed with more advanced cancer, which in many cases are at incurable stages. For 2018, the International Agency for Research on Cancer (IARC) estimated 1.4 million new cancer cases in Latin America with more than 600,000 cancer deaths. It is projected that by 2040, cancer cases will increase by 91.4% in Central and South America.

 Unfortunately, during the COVID-19 pandemic, diagnostic procedures, research activities, and treatment plans have been disrupted; the clinical implications of these changes are still unknown.

Despite the measures implemented by some Latin American governments, the number of cases continues to climb. Some presumed reasons for this include lapses in social distancing implementation, in addition to crowded living conditions in urban areas. To date, 2.35 million confirmed cases of COVID-19 infections have been confirmed in Brazil, with over 85,000 deaths.

 Similarly, 378,000 positive cases have been reported in Mexico with over 42,000 deaths, and over 234,000 cases in Colombia with reports of 7,975 deaths. Notably, experts warn that the peak hasn’t been reached yet in that region.

As of May 2020, Central and South America were considered to be the new epicenter of the COVID-19 pandemic. Clinics and medical offices have been forced to close, raising concerns that healthcare systems could collapse, as has already happened in countries such as Ecuador. In March 2020, many European governments suspended breast, cervical, and colon cancer screening programs.

 In the United States, cancer screening programs were considered to be low priority.

 Although these practice changes are reasonable in light of this crisis, the negative impact could directly affect mortality in patients with cancer. Among Latinos, the cancer screening rate is already low, and COVID-19 may significantly worsen this situation.

In a national population-based modelling study done in the United Kingdom, investigators used linked National Health Service cancer registrations and hospital administrative datasets to estimate how the COVID-19 pandemic has delayed the diagnosis of cancer during lockdown measures. Compared with pre-pandemic figures, the authors estimate an 8% to 10% increase in the number of deaths due to breast cancer. It is estimated that for colorectal cancer, the number will increase from 1,445 to 1,563 additional deaths, and for lung cancer, additional deaths will jump from 1,235 to 1,372, a 4.8% to 5.3% percentage increase, respectively.

We have seen the severity of the impact of the pandemic on the United States. Despite clear data demonstrating the higher impact of COVID-19 in the Latino community, the effects of this virus in patients with cancer who live in Latin American countries is not well reported. Our study will focus on the effects of COVID-19 in oncology practices in Latin America. Data from the United Kingdom suggested that new cancer referrals decreased significantly due to concerns of contracting COVID-19; surgeries were delayed for more than 3 months across all stages of cancer and new chemotherapy practices were adopted by oncologists to avoid disruptions in cancer care.

 Our goal is to determine the extent of which the COVID-19 pandemic is affecting the care of patients with cancer in Latin America.

Understanding how the care of patients with cancer in Latin America has adapted during these unprecedented times, and the specific challenges experienced by providers caring for these patients, is essential to understand current limitations and disruptions in resource-limited healthcare systems. This survey will serve as an opportunity for hematologists/oncologists to share their perspectives on how COVID-19 has affected their communities.

 will take 10 minutes to answer and will be anonymous. These insights will hopefully guide future emergency preparedness plans on how to best deliver cancer care during a pandemic in low-income countries, and avoid cancer deaths due to lack of screening, surgeries, or availability of chemotherapy.

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Richards, M, Anderson, M, Carter, P, et al. The impact of the COVID-19 pandemic on cancer care. 

. 2020;1:565-567. doi:10.1038/s43018-020-0074-y 

Latin America and the Caribbean facts sheet. World Health Organization. March 2020. Accessed August 4, 2020. https://bit.ly/2ENQLB3. 

Andreoni M. Coronavirus in Brazil: what you need to know. New York Times. August 3, 2020. Accessed August 4, 2020. https://nyti.ms/3fu0s4m.

Resuming bowel cancer screening post-COVID-19. 

. 2020;5(8):711. doi:10.1016/S2468-1253(20)30200-4

Gorin SS, Heck JE. Cancer screening among Latino subgroups in the United States. 

. 2005;40(5):515-526. doi:10.1016/j.ypmed.2004.09.031

Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. 

 Published online on July 20, 2020. doi:10.1016/S1470-2045(20)30388-0

Sud, A, Jones ME, Broggio J, et al. Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic. 

 2020;31(8):1065-1074. doi:10.1016/j,annonc.2020.05.009

Articles

Outbreaks of coronavirus disease 2019 are on the rise in Latin America, with more than 4 million confirmed cases. In response to this health crisis, elective medical procedures, including cancer screening and care, as well as treatment for conditions beyond the virus, have been held.

Coral Olazagasti, MD

Articles

Dr Olazagasti on Disparities in Lung Cancer Screening Rates for Hispanic Head and Neck Cancer Survivors

Dr Olazagasti on Culturally Tailored Lung Cancer Screening for Hispanic Head and Neck Cancer Survivors

Dr Olazagasti on a Case-Based Discussion of ALK-Mutated NSCLC Treatment

Survey Aims to Identify COVID-19–Related Health Care Challenges in Latin America