Association between patient-physician relationship and overall survival among African Americans with lung cancer: the Detroit Research on Cancer Survivors study

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Background: African Americans with lung cancer experience disparities in overall survival (OS) outcomes. The association between patient-physician relationships on survival differences is not well understood. This study examined the association between patient-physician relationship and OS among African American non-small cell lung cancer (NSCLC) survivors from the Detroit Research on Cancer Survivors (ROCS) cohort. Methods: Patients with NSCLC completed baseline and yearly follow-up surveys. The baseline survey included the interpersonal process of care (IPC). Cox regression analysis was performed to evaluate variable associations with survival. Results: From the ROCS cohort, 398 NSCLC survivors were included with an average age of 63 years. Stage at diagnosis was equally represented: 33.3% local, 33.3% regional, and 33.5% distant. The majority of participants (55.4%) reported experiencing racial discrimination in their lives and 19.2% perceived that they received worse medical care due to discrimination. For IPC measures, optimal scores were explaining results (75.0%), demonstrating compassion (61.7%), and eliciting patient's concerns (56.8%). Patients who underwent surgery were more likely to report optimal scores for eliciting patient's concerns compared to those not treated with surgery (46.1% vs. 35.8%, P<0.05). An optimal score for eliciting patients' concerns showed a suggestive association with improved OS in adjusted analyses [hazard ratio (HR) 0.69, P=0.04]. Conclusions: Among African American NSCLC perceived discrimination was common, while patient-physician relationship scores were generally favorable across some domains. Optimal patient-physician relationship scores were associated with undergoing surgery and showed a suggestive association with improved OS.

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