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Lung Cancer |

Association of Fatalistic Beliefs and Insurance Status in Patients With Newly Diagnosed Lung Cancer

Miranda Tan*, MD; Juan Wisnivesky, MD; Grace Mhango, MPH; Steven Keller, MD; John Schicchi, MD; Andrew Berman, MD
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New Jersey Medical School, UMDNJ, Newark, NJ


Chest. 2012;142(4_MeetingAbstracts):642A. doi:10.1378/chest.1389429
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Abstract

SESSION TYPE: Lung Cancer Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Disparities in insurance status have been associated with lung cancer outcomes. Uninsured and Medicaid-insured individuals diagnosed with lung cancer have a higher mortality and are less likely to undergo curative procedures than patients with Medicare or private insurance. Fatalistic beliefs can potentially affect cancer treatment decisions. We hypothesized that persons who are under-insured will be more likely to have fatalistic beliefs and this may explain poor outcomes.

METHODS: We provided a questionnaire to patients newly diagnosed with lung cancer at four medical centers in New York City. Patients were surveyed on socio-demographic factors, including insurance status. To assess fatalistic beliefs, patients were asked if they agreed with statements such as, “everything that happens is part of God’s plan.” Patients were excluded if they did not list insurance status or if they had more than one type of health insurance. We assessed associations using chi-squared tests.

RESULTS: 257 patients listed a single type of health insurance: 61% had private insurance, 24% had Medicare, and 14% had Medicaid or no insurance. These three groups differed significantly in income (p<0.001), employment status (p<0.001), and race and ethnicity (p=0.007), with more blacks and Hispanics in the Medicaid or no insurance group. There was a significant unadjusted association with insurance status and the belief that “everything that happens is part of God’s plan” (p=0.041), with 75% of Medicaid or uninsured patients agreeing with this response, compared to 52% with Medicare and 52% with private insurance.

CONCLUSIONS: Uninsured and Medicaid insured patients were more likely than those with Medicare or private insurance to accept that “everything is part of God’s plan,” when diagnosed with lung cancer. However, since insurance groups were not similar, this association may also be explained by socioeconomic status or racial and ethnic disparities. Further research in this area is needed with greater representation of under-insured patients.

CLINICAL IMPLICATIONS: Under-insured patients with lung cancer hold fatalistic beliefs that may influence care and outcomes.

DISCLOSURE: Juan Wisnivesky: Grant monies (from sources other than industry): PI on Am Cancer Soc Grant, Grant monies (from sources other than industry): GlaxoSmithKline, Other: Research Board: EHE International, Consultant fee, speaker bureau, advisory committee, etc.: Lecture: Novartis Pharmaceutical

Andrew Berman: Grant monies (from sources other than industry): Subcontract from AM Cancer Soc

The following authors have nothing to disclose: Miranda Tan, Grace Mhango, Steven Keller, John Schicchi

No Product/Research Disclosure Information

New Jersey Medical School, UMDNJ, Newark, NJ

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