Download the full paper here: The Impact of Lung Cancer in America
Health is essential to all aspects of life as it impacts the world’s capacity to develop and improve. One of the most crucial body systems that contribute to human health and survival is the respiratory system. In the United States, lung cancer is the second most common cancer diagnosis for both men and women (de Groot et al., 2018). In 2018 alone, 234,030 new cases of this fatal disease were diagnosed throughout the year; approximately 641 new cases develop every day in the U.S. (de Groot et al., 2018). Although trends per every 100,000 persons in the American population have steadily decreased since 1982, the overall case total has increased to 234,101 as of 2018 (de Groot et al., 2018). From 2010-2015, 370,477 individuals were diagnosed with lung and bronchus cancer (U.S. Cancer Statistics Working Group [U.S. CSWG], 2019). During this period, the rate of survival for patients ages 45 and below was 29.8% and continuously dropped to a 15.1% chance of survival for those 75 years old and above (U.S. CSWG, 2019). In 2018, 83,550 deaths for male lung cancer patients and 70,500 deaths for female lung cancer patients occurred, accounting for around 25% of all cancer-related fatalities that year (de Groot et al., 2018). According to de Groot et al. (2018), the national survival rate for cancer in 2018 leveled at 66.1% whereas the survival rate for lung cancer in the same year was at a mere 19.1%. As demonstrated by these numbers, lung cancer has continuously devastated the human population and will continue to do so without prevention, support, education, and intervention from the healthcare and governing systems. In order to decrease the amount of cases and deaths caused by lung cancer, national prevention efforts have become crucial to America’s wellbeing. From education to surgery, the nation’s people rely on these interventions to combat the ever-growing cases of lung cancer.
Populations at Risk
Among the thousands of individuals who have been diagnosed for lung cancer, several different groups have higher risk. According to the U.S. CSWG (2019), researchers found that approximately 80% to 90% of deaths resulting from lung cancer have been linked to smoking. Researchers at the US CSWG (2019) report that smoking increases the risk of lung cancer by 15 to 30 times when compared to the risk of nonsmokers. Additionally, smoking also affects 1 in every 4 nonsmokers in America and also leads to increased risk due to exposure (U.S. CSWG, 2019). For both nonsmokers, many environmental factors such as radon, asbestos, arsenic, and more also play a large role in increasing risk for developing lung cancer (U.S. CSWG, 2019). Moreover, lung cancer most commonly is diagnosed in individuals 65 years old and older, the average age upon diagnosis is 70 years old (American Cancer Society [ACS], 2020). In regards to gender, risks for both men and women have been relatively similar with men’s risk slightly higher than women’s risk for lung cancer. According to the ACS (2020), 1 in every 15 men and 1 in every 17 women develop lung cancer. In terms to racial background for men, Non-Hispanic Black Americans maintain the highest incidence of 87.9 per 100,00 as of 2018 (de Groot et al., 2018). The next highest incidences for lung cancer in America are Caucasians, Native Americans, Asian Americans/Pacific Islanders, and Hispanic people (de Groot et al., 2018).
Lastly, a great disparity between the individuals of differing education and socioeconomic levels prevail throughout American society. Those with lower educational levels are not likely to attempt quitting in comparison to others who achieved higher education levels also have greater access to resources such as insurance, quality, healthcare, and increased health literacy. Data presented by de Groot et al. (2018) displays that smokers comprise 32.1% of those who did not complete high school, 27.9% of smokers live below the poverty threshold, while only 9.1% of smokers are college graduates. Though cigarette smoking and low socioeconomic status correlate, data presented by de Groot et al. (2018) suggests that regardless of smoking, a prevalent relationship between lower socioeconomic status and lung cancer cases exists, pointing to other environmental contributors such as poor housing and work conditions often associated with low income populations.
Primary Prevention Strategies
Primary prevention is looking at what can be done to prevent an injury or illness from occurring in the first place (Rector, 2018, p. 19). This is important for ensuring health for individuals as it keeps them in their best condition for the longest time possible. There are several ways that primary prevention can be implemented in relation to preventing lung cancer by looking at specific risk factors that are controllable.
The leading cause of lung cancer is smoking, causing about 80-90% of terminal cases in the United States (Centers for Disease Control [CDC], 2019), therefore smoking cessation programs are an important aspect of primary prevention. There are many types of smoking cessation programs, including pharmacological treatments, support groups, and counter campaigns that providers should be aware of and able to assist patients with picking what will work best for them (Black, 2010). Focusing on cutting down on the leading cause of lung cancer would prevent lung cancer from being such a problem overall.
Cruz et al. (2015) took the idea of primary prevention one step further in their study in Cuba; thinking beyond the health of the individual themselves and applying it to a family unit as a whole. In traditional family structures with gender roles, the woman of the house has influence over the health and wellbeing of those living with her “since they are essential figures for instilling healthy behaviors, habits and lifestyles early in life that will become part of their families’ knowledge and practice for health maintenance” (Cruz et al., 2015, p. 44). The study by Cruz et al. (2015) implemented an educational program for women regarding the risk factors and behavioral changes that could be made to prevent lung cancer and found this program to be effective in increasing health literacy and lifestyle changes for both the women and their families (Cruz et al., 2015). This would suggest that educational programs should be implemented in more places, to educate people on the hazards of smoking, provide information on other risk factors of lung cancer, and especially the changes that they can make to prevent themselves and loved ones from developing this disease. The key with educational programs is ensuring their effectiveness for the area they are being used in. As Cruz et al. looked at the Cuban culture, they focused their intervention on a group that had power to change others around them. When implementing educational programs in other areas it would be vital to look at the culture of the area to ensure that those being taught have the means to make a difference in the lives of those around them rather than assuming that because teaching women worked in Cuba it is a one-size-fits-all type of solution.
Secondary Prevention Strategies
Secondary prevention focuses on detecting, and then treating, conditions as soon as possible after they begin (Rector, 2018, p. 19). The most common form of secondary prevention is screening for different health conditions. This can be a bit of a dilemma as screening for cancer often involves use of technologies that can be harmful to the human body, such as radiation, because internal structures can’t be viewed with the naked eye. In order to ensure that cancer is caught as early as possible, a set of guidelines are needed to determine who should be screened, and when. “For lung cancer screening, determining eligibility will require information regarding smoking history in addition to age; for example, current guidelines generally recommend screening patients with a smoking history of >30 pack‐years and <15 years of smoking abstinence” (Armstrong, 2016, p. 1339). This means that those who are known to be heavy smokers and at high risk for developing lung cancer should be encouraged to have regular CT screening done.
Despite focusing screening efforts on only those that are considered to be high risk, there can be enormous benefits of this preventative measure. “Screening high‐risk smokers for lung cancer with low‐dose computed tomography (CT) scans reduced lung cancer mortality by 20% in the National Lung Screening Trial (NLST)” (Armstrong, 2016, p. 1338). For those who do develop lung cancer, early screening followed by appropriate treatment can be the difference between life and death. While preventing lung cancer via primary prevention would be ideal, secondary prevention is still important for those who are already affected.
Tertiary Prevention Strategies
Tertiary prevention is preventing an existing condition from worsening or causing more damage in the body (Rector, 2018, p. 19). This means that once a person already has a condition, treating it to the best of healthcare’s ability to prevent the condition from worsening or harming other parts of the body, even possibly preventing disability. Another way to think about tertiary prevention for lung cancer is the different treatment options. For lung cancer, “depending on the severity of the disease, surgery, chemotherapy or radiotherapy are potential treatment options” (Aumann et al., 2015). Surgery involves removal or the tumor growth, and potentially healthy surrounding tissues to prevent the continued spreading of the cancer (Mayo Clinic, 2020), this is considered an invasive process. Both chemotherapy, which uses medications to kill cancerous cells, and radiation, which uses energy beams to kill cancer cells, are often used in addition to surgical treatments (Mayo Clinic, 2020). Aumann et al. found that no matter which route is decided upon for the patient, it was most important that they feel comfortable and had trust in their provider (2015). All treatment options have both advantages and disadvantages to them and full discussion with an oncologist will be needed to determine the right form of tertiary prevention for the patient.
Ethical Issues
While these preventative interventions provide the means to thoroughly treat and decrease the incidence of lung cancer, not all of these interventions are equitable among the populations at risk for this detrimental disease. One of the most at risk populations in America are the low-income, low socioeconomic status populations (de Groot et al., 2018). Considering how essential communication and language are to all three levels of prevention, it is crucial for healthcare workers to be aware of language barriers that prevent low socioeconomic individuals from receiving the care and information that they require in order to lower risk for lung cancer. Guttman (2017) highlights the ethical responsibility of healthcare professionals when performing patient education as “health communication interventions may also have unintended adverse effects on the psychological well-being of individuals or groups” (para. 5) such as utilizing complex foreign vocabulary or inadvertently perpetuating or creating stigmas. In their study Hernandez and Sparks (2020) present that the American Healthcare system lacks an “intersectional lens” when caring for patients of marginalized communities which continually perpetuates stigmas and discourages people from low income and low education individuals to seek care. Moreover, the data findings of Hernandez and Sparks (2020) demonstrate that many people in the United States primarily from low socioeconomic and minority groups refuse, delay, or are unable to receive care due to cost, lack of access to a provider and/or health care. To add to this, data from the Bureau of Labor Statistics (2018) states that only 31% of private industry workers of the lowest wage category have paid sick leave in their jobs. This coupled with data presenting a lack of affordable childcare available to low-income families by the National Women’s Law Center [NWLC] (2017) clearly exhibits the large strain of scheduling medical appointments and any extended hospital stays for low socioeconomic status families and individuals. When caring for individuals with this background, healthcare workers are ethically responsible for taking these factors and barriers into consideration as they treat this patient and offer various resources such as financial counseling with various social workers or insurance providers.
Conclusion
The issue of lung cancer is far more than just statistics and numbers. The prevalence of lung cancer in underrepresented and low socioeconomic communities is a reflection of the health disparities and social inequalities that ravage through these poor low income populations within the United States. As healthcare professionals and government agencies work together to promote health and prevention of this fatal disease, it is imperative to enact preventative care that accommodates the needs of the at risk populations such as the low socioeconomic communities in the U.S. Caring for these at risk communities requires thorough primary prevention measures to help patients avoid any preventable expenses and gain holistic understanding of the individual risks, family history, and lifestyle to better determine the need for additional interventions such as secondary prevention screenings. With greater understanding of the underlying issues surrounding the major health problems, such as lung cancer, healthcare providers and government will be able to better enforce and change health policies and systems to care for and prevent diseases in these marginalized communities.
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