title: Evaluating beliefs associated with late-stage lung cancer presentation in minorities.
abstract: BACKGROUND
  Minority patients in the United States present with later stages of lung cancer and have poorer outcomes. Cultural factors, such as beliefs regarding lung cancer and discrimination experiences, may underlie this disparity.
  
  
  METHODS
  Patients with a new diagnosis of lung cancer were recruited from four medical centers in New York City. A survey, using validated items, was conducted on the minority (black and Hispanic) and nonminority patients about their beliefs regarding lung cancer, fatalism, and medical mistrust. Univariate and logistic regression analyses were used to compare beliefs among minorities and nonminorities and to assess the association of these factors with late-stage (III and IV) presentation.
  
  
  RESULTS
  Of the 357 lung cancer patients, 40% were black or Hispanic. Minorities were more likely to be diagnosed with advanced-stage lung cancer (53% versus 38%, p = 0.01). Although beliefs about lung cancer etiology, symptoms, and treatment were similar between groups (p > 0.05), fatalistic views and medical mistrust were more common among minorities and among late-stage lung cancer patients (p < 0.05, for all comparisons). Adjusting for age, sex, education, and insurance, minorities had increased odds of advanced-stage lung cancer (odds ratio: 1.79; 95% confidence interval, 1.04-3.08). After controlling for fatalism and medical mistrust, the association between minority status and advanced stage at diagnosis was attenuated and no longer statistically significant (odds ratio: 1.56; 95% confidence interval, 0.84-2.87).
  
  
  CONCLUSIONS
  Fatalism and medical mistrust are more common among minorities and may partially explain the disparities in cancer stage at diagnosis. Addressing these factors may contribute to reducing disparities in lung cancer diagnosis and outcomes.
authors.affiliation: Doris Duke Clinical Research Fellow, UMDNJ-Robert Wood Johnson Medical School, Camden, New Jersey, USA.
authors.forename: Cara
authors.initials: C
authors.lastname: Bergamo
authors.forename: Jenny J
authors.initials: JJ
authors.lastname: Lin
authors.forename: Cardinale
authors.initials: C
authors.lastname: Smith
authors.forename: Linda
authors.initials: L
authors.lastname: Lurslurchachai
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.forename: Charles A
authors.initials: CA
authors.lastname: Powell
authors.forename: Andrew
authors.initials: A
authors.lastname: Berman
authors.forename: John S
authors.initials: JS
authors.lastname: Schicchi
authors.forename: Steven M
authors.initials: SM
authors.lastname: Keller
authors.forename: Howard
authors.initials: H
authors.lastname: Leventhal
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000368:Aged; D016001:Confidence Intervals; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000473:pathology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009519:New York City; D016017:Odds Ratio; D035502:Trust / Q000523:psychology; D044465:White People / Q000523:psychology*