title: Disparities in perceived unmet need for supportive services among patients with lung cancer in the Cancer Care Outcomes Research and Surveillance Consortium.
abstract: BACKGROUND
  The authors investigated the prevalence, determinants of, and disparities in any perceived unmet need for 8 supportive services (home nurse, support group, psychological services, social worker, physical/occupational rehabilitation, pain management, spiritual counseling, and smoking cessation) by race/ethnicity and nativity and how it is associated with perceived quality of care among US patients with lung cancer.
  
  
  METHODS
  Data from a multiregional, multihealth system representative cohort of 4334 newly diagnosed patients were analyzed. Binomial logistic regression models adjusted for patient clustering.
  
  
  RESULTS
  Patients with any perceived unmet need (9% overall) included 7% of white-US-born (USB), 9% of white-foreign-born (FB), 13% of black-USB, 8% of Latino-USB, 24% of Latino-FB, 4% of Asian/Pacific Islander (API)-USB, 14% of API-FB, and 11% of "other" patients (P < .001). Even after controlling for demographic and socioeconomic factors, health system and health care access, and need, black-USB, Latino-FB, and Asian-FB patients were more likely to perceive an unmet need than white-USB patients by 5.1, 10.9, and 5.6 percentage points, respectively (all P < .05). Being younger, female, never married, uninsured, a current smoker, or under surrogate care or having comorbidity, anxiety/depression, or a cost/insurance barrier to getting tests/treatments were associated with any unmet need. Patients with any unmet need were more likely to rate care as less-than-"excellent" by 13 percentage points than patients with no unmet need (P < .001).
  
  
  CONCLUSIONS
  Significant disparities in unmet supportive service need by race/ethnicity and nativity highlight immigrants with lung cancer as being particularly underserved. Eliminating disparities in access to needed supportive services is essential for delivering patient-centered, equitable cancer care.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Dolly A
authors.initials: DA
authors.lastname: John
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lathan
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
mesh_terms: D015331:Cohort Studies; D062665:Epidemiological Monitoring; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy*; D008297:Male; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology
keywords: health care disparities; immigrants; lung cancer; patient-centered care; supportive care; underserved populations