Health Equity for Communities Research Award

Lung cancer continues to be the leading cause of cancer death in the United States. Prevention of lung cancer through smoking cessation, and early detection of lung cancer in high-risk patients through CT-based lung cancer screening, are our most important tools to reduce the impact of this deadly disease. The lesbian, gay, bisexual, trans and queer (LGBTQ) community face several health disparities, including a higher rate of lung cancer due to increased rates of tobacco use in this group. In this study, we propose to partner with an urban LGBTQ community center to create and evaluate a tailored lung cancer screening and smoking cessation navigation program to specifically address the needs of this community. By directly partnering with stakeholders and community members, we plan to develop a sustainable program that will assist LGBTQ community members with both screening and cessation which can then be disseminated to improve the health of LGBTQ patients across the country.

Stigma, or feelings of guilt and shame about having lung cancer, including feeling blamed for causing one’s illness, is very common, with 95% of lung cancer patients reporting lung cancer stigma. This has been shown to lead people with lung cancer, a growing, in-need, and underserved group, to not reach out for appropriate screening, hide their diagnosis, not disclose their smoking status, not engage with smoking cessation services if needed, and not follow through on treatment recommendations.

Adding existing and intersectional stigma experienced because of race, ethnicity, and sexual and gender minority status in addition to lung cancer stigma exacerbates these issues at each key stage of interaction with our healthcare system across the care continuum. Disparities in survival rates by race, ethnicity, sexual orientation, and income are stark, and are largely created by stigma. Of course, lack of follow-through on screening and treatment recommendations, including smoking cessation, decreases treatment effectiveness and increases the likelihood of treatment complications, recurrences, and secondary cancers. Lung cancer stigma and intersectional stigma related to minoritized group status therefore leads to increased morbidity and mortality, and health disparities, compromising the five-year survival rate.

Luckily, in addition to multilevel research including healthcare provider training and systems change, which is key and can be slow, mindfulness interventions have been shown to decrease stigma and the negative impacts of stigma, and are easy to use, especially for underserved groups with low treatment access. They are thus extremely promising for driving health equity in lung cancer care across the care continuum by increasing engagement with and follow through on treatment recommendations at each stage of the cancer continuum. However, these interventions have never been tested to decrease lung cancer stigma.

In this study, using an innovative design, we aim to test and identify the key components of a brief, easily disseminable, online mindfulness intervention. We will examine the reach, acceptability, and feasibility to underserved intersectional groups that might face even more stigma, and experience extreme health disparities, including Black, Latinx, LGBTQ+ individuals, and low SES groups. We aim to increase the five-year survival rate of cancer in these groups.