What Unseen Barriers Can Delay Lung Cancer Care?

Deandre White:

So, Dr. Florez, as our healthcare system evolves with new insurance rules, changes in cancer center capacity, telehealth growth and shifting referral pathways, many patients with lung cancer encounter barriers that they didn’t even expect. So for patients with fast-moving cancers like extensive stage small cell lung cancer, these delays can feel even more urgent for them. So, what are some of the unseen barriers that newly diagnosed patients with lung cancer might not be aware of, and how can they proactively navigate these challenges early in their journey?

Dr. Narjust Florez:

I think something that the pandemic brought that was good with the incorporation of telemedicine. But the bad thing is that we forgot that not everybody has the same technology literacy or limitations, right? So, Zoom calls for somebody of our age are easy. We’re in a Zoom call right now.

But for somebody who never had a Zoom call, a retired veteran, that could be a barrier that’s often unseen. For example, I used to be at the Mayo Clinic, so I used to have a lot of patients that were rural patients. Access to cell phones and access to, like, data. It’s something that we take for granted in large cities. Not everybody has phone service. I remember having a patient, I had to call the farm next door for the person to go and get him, and he would come and talk. So that’s something that we forget. 

Another barrier is, what is the influence of cultural beliefs in the healthcare system and open communication? We need to understand how their cultural beliefs affect their journey. And how is that a barrier? Because sometimes the family will say, oh, the doctors are only going to give you poison.

You should try moringa, which is something very common in South America that people use. So, barriers can be this pressure that patients feel with all this information that’s coming also now with social media, now with family members, the WhatsApp chats. That’s a lot, like…or you should try this, you should do this, you should do that. That is a barrier because it’s overload of information. We’re already dealing with a lot.

Another thing that we forget is financial toxicity. Not only the drug’s price, but around 68 percent of cancer centers in the United States charge for parking. It’s $40. And if you have to be there every week. We talk about the food in the hospital being expensive, right? We talk about gas. Financial toxicity is a barrier that we only focus on, oh, the drug, the copay, no, out-of-pocket expenses. 

Buying a wig is expensive if you want a good wig, right? Breast implants after breast surgery. Pain medications. Special clothes. That is financial toxicity. And one thing that we don’t talk about is time toxicity. The time that you’re spending in the cancer center is a time that is toxic. Why? You are in the waiting room. And you see people that look very sick. That internalizes it. You’re like, ooh, I can be like that. Also, our healthcare system is not known for being fast, so I had appointments with my father yesterday. We left my house at 5:45 in the morning.

And we came back at 2 PM. All that time is, if you’re on hourly wages, like, if your hourly pay…oh, that’s time that you have to take as a sick time or PTO, so that time toxicity, or a healthcare system that takes a long time.

Not only in the United States, everywhere, it’s a barrier. Time, like, if you have children, your own children. Time is the most precious thing that our patients have, and if you’re a woman, you have a lot of societyl obligations that we do, as doctors need to understand. Women carry a large burden because they’re expected to do a million things when they’re also a patient with cancer.