Racial differences in treatment priorities highlight opportunity to strengthen shared decision-making in lung cancer care

A new national survey finds that patients and physicians of different racial and ethnic backgrounds weigh lung cancer treatment priorities differently — particularly when it comes to side effects, financial concerns and quality-of-life tradeoffs. The cross-sectional study, published in November 2025 in the journal Current Medical Research and Opinion, suggests that tailoring shared decision-making to cultural and personal values may help improve the treatment experience and patient-centered care for people with non-small cell lung cancer (NSCLC).

Lung cancer remains the second most diagnosed cancer in the United States and the leading cause of cancer-related death. Even though the lung cancer mortality rate has declined in recent decades, longstanding racial disparities persist. Black patients are more often diagnosed at later stages, receive guideline-recommended treatment less often and have poorer outcomes than White patients. Black, Asian, and Hispanic patients also continue to be underrepresented in lung cancer clinical trials.

Treatment choices for lung cancer are complex, requiring healthcare providers to weigh many factors, including the patient’s age, stage of disease and other illnesses the patient has. Past research suggests that incorporating patients’ preferences can improve satisfaction and that shared decision-making helps clarify goals and strengthen communication. The collaborative approach to care may lead to better outcomes, particularly for marginalized groups.

To explore how these dynamics play out in practice, researchers set out to better understand how patients and physicians approach NSCLC treatment decisions across different racial and ethnic groups.

The new study was led by Lisa Dwyer Orr, M.P.H., director of scientific affairs population health research at Johnson & Johnson Innovative Medicine. Orr and colleagues used two online cross-sectional surveys conducted from March to May 2023 to gather perspectives from patients with NSCLC and physicians who treat the disease in the United States. Participants were recruited from large online health and professional networks, with targeted enrollment to ensure diverse racial and ethnic representation. Responses from 157 patients and a separate cohort of physicians were analyzed using descriptive statistics.

Patients across all racial and ethnic groups reported that extending life was the top treatment priority, but other preferences varied. Hispanic patients placed greater weight on treatment side effects compared with Black, Asian, and White patients. At the same time, larger proportions of Asian (63%) and White (73%) respondents said they prioritized quality over quantity of life, compared with 43% of Black and 40% of Hispanic patients.

Perceptions of side effects

Physicians of all backgrounds ranked expected overall survival, progression-free survival and duration of response as their top three decision drivers. Yet perceptions of side effects varied. Black physicians rated side effect concerns as less important than other groups, giving them an average score of 6.6 on a 1-to-10 scale (where 1 indicated highest concern). Other physician groups rated side effects at 5.3 or lower, indicating greater concern overall. Although all groups ranked treatment cost as a lower priority, more than 80% of Black and Hispanic physicians said that patients’ financial situation or out-of-pocket costs was influential in their treatment recommendations.

Most respondents said they wanted to share treatment decisions with their physician or make the final decision themselves. However, when asked about their real-life experience, only 22% of Black patients reported having a role in shared treatment decisions, followed by 37% of Asian, 38% of White and 50% of Hispanic respondents.

“The study demonstrated that while no two patients are the same, most patients prefer to be involved in their treatment decisions,” said Orr, lead author of the study. “Patients across diverse backgrounds reported ‘extending their life’ as the most important factor in determining their treatment. This was reinforced by the physician cohorts, which similarly prioritized overall survival, progression-free survival and expected duration of response.”

Orr and her co-authors wrote that earlier barriers to care may contribute to later-stage diagnoses among minoritized patients. They reported that, in their study, Asian, Black and Hispanic patients were more often referred because of symptom burden at diagnosis, a pattern they noted may contribute to dissimilar diagnostic pathways.

They also noted that the study design, which incorporated literature review, qualitative interviews and expert input, helped capture a broad view of how patients and physicians approach treatment decisions. Still, they acknowledged several limitations, including reliance on self-reported data, small subgroup sizes and a sample that may not reflect patients outside primarily urban and Southern U.S. regions.

The research team concluded that recognizing how cultural values, risk tolerance and communication preferences shape treatment goals may help strengthen shared decision-making for groups that have historically experienced unequal care.