Dr. Narjust Florez on the Psychosocial Needs of Young Patients With Lung Cancer

Narjust Florez, MD, FASCO, a thoracic medical oncologist at the Dana-Farber Cancer Institute and Harvard Cancer Center, speaks about lung cancer in younger adults and the unique psychosocial needs of these patients. Dr. Florez presented a poster on the topic during the 2024 American Society of Clinical Oncology Annual Meeting.

It was important to conduct and present research on psychosocial needs of young patients with lung cancer, because patients who are diagnosed with lung cancer at age 50 and younger are “often an excluded and forgotten population,” Dr. Florez said.

“We don’t associate young patients with lung cancer, leading to delays in diagnosis,” she said.

In addition, most young patients with lung cancer tend to have genomic mutations, which means that targeted therapies are often part of the treatment plan.

“That brings an additional layer of financial toxicity, as targeted therapies are very expensive and often have very high co-pays, and many of the young patients don’t qualify for the drug assistance program because they are above the poverty line,” she said.

Beyond the high co-pays of these therapies, it’s important to recognize that the health care system has not been designed for young patients with lung cancer, Dr. Florez said.

She provided a few key examples, such as chemotherapy infusion schedules that typically dictate that a patient must receive the infusion between 8 am and 5 pm, which can add to financial toxicity for young patients who need to take the time off from work. This makes it important for clinics and institutions to consider adding later times or weekends, she said.

Dr. Florez also discussed the social implications of a lung cancer diagnosis.

“Additionally, when you’re diagnosed with lung cancer at [a young] age, you’re completely isolated,” she said. “You don’t know anybody who has been diagnosed with lung cancer.”

There are also critical mental health considerations for these patients.

“Young patients with lung cancer have the highest incidence of depression and anxiety, and often these patients are labeled as anxious, as [if it is] a choice,” Dr. Florez said. “But when you are 40 years old, and you know you have limited time on earth, it’s appropriate anxiety.… How would you feel if you’re told you have 2 years to live and you haven’t even had children yet?”

Dr. Florez said there are “3 big issues” in the psychosocial needs of young patients with lung cancer.

“First, high levels of anxiety and depression. Second, high levels of financial toxicity because they have to keep their job to keep their insurance. They don’t have lifelong savings. They don’t have a 401(k) they can withdraw money from,” she said. “And third, who cares for the caregiver?”

On this last point, Dr. Florez explained that people aged 30 to 50 years old are often caregivers for their parents and their children.

“But when they get sick, who cares for the caregiver? There are no systems in place. They suffer in silence because they’re supposed to tough it up,” Dr. Florez said. “We need to understand that young patients with lung cancer have the highest needs and that we need to be there for them.”

Dr. Florez also emphasized that it’s important to “adapt to the communication preference that patients have” and understand that many younger patients with lung cancer prefer written communication through texts or emails rather than calls.

She concluded by noting that the research presented at the 2024 American Society of Clinical Oncology Annual Meeting is a preliminary analysis, but there will be more to come.

“We’re going to continue to study this and hopefully next year I’m back with you to show the final results of the study,” Dr. Florez said.