Ethnicity and Lung Cancer Survival: A Test of the Hispanic Sociocultural Hypothesis - PROJECT SUMMARY/ABSTRACT
As the leading cause of cancer death, lung cancer represents the most significant cancer-related public health
challenge in the United States. Although low-dose CT-based screening holds promise for earlier detection,
currently, most lung cancer cases are not diagnosed until advanced stages (III, IV) and have 5-year survival
rates of 21% or less. In contrast to Black-White survival disparities, Hispanic patients have markedly lower
age-adjusted death rates than their non-Hispanic White (NHW) counterparts despite later stage diagnoses and
broader SES and healthcare disparities; these findings are well established and consistent with the “Hispanic
Health Paradox”, a phenomenon characterized by Hispanic advantages in objective health outcomes (e.g.,
mortality) despite significant health and socioeconomic risk factors. The leading explanatory hypothesis
concerns the role of cultural factors facilitating social integration. Social integration is among the most robust
psychosocial predictors of a range of objective health outcomes, including cancer survival. However, no
published work has directly tested this sociocultural hypothesis in relation to Hispanic resilience. Consistent
with the emerging science of resilience, we propose a multisite, two-study, mixed-methods investigation to
evaluate this sociocultural hypothesis. Study 1 is a multisite, longitudinal observational study of 672 Hispanic
and NHW individuals with advanced stage lung cancer sampled from three regions across the U.S. Interviews
using gold-standard and culturally-informed survey measures (demographics, social integration, cultural
values, acculturation) will be conducted in English and Spanish from a centralized coordinating center with a 6-
week follow-up to examine change in perceived support provision/needs. The primary outcome of survival and
secondary outcomes (e.g., treatment adherence), will be gathered from electronic medical records over mean
follow-up time of 33-months. Study 2 is a single-site, 7-day, intensive measurement investigation into the daily
units of social integration that mediate outcomes. Study 2 integrates two novel in vivo sampling methods
(Electronically Activated Recorder [EAR] and ecological momentary assessments [EMA]) using a mobile phone
platform. The current aims are to (1) investigate whether the observed Hispanic survival advantage is mediated
by ethnic differences in social integration among recently diagnosed late-stage lung cancer patients and (2) to
examine the processes/mechanisms that underlie these relationships in daily life including the role of
individual, family, network, and neighborhood-level factors. The highly experienced investigator team includes
leaders in all relevant content areas, including the Hispanic health paradox, lung cancer survivorship, social
integration, and ecological sampling methodologies. The results will contribute to better understanding of social
processes among cancer patients, inform psychosocial interventions based on social integration, and
contribute to the emerging science of health resilience as well as racial/ethnic and cultural variations in health
outcomes.
