Kei Suzuki1, Abby Zhang2
1Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA, USA; 2JTD Editorial Office, AME Publishing Company
Correspondence to: Abby Zhang. JTD Editorial Office, AME Publishing Company. Email: jtd@amepc.org.
Editor’s note
Journal of Thoracic Disease (JTD) has published a number of special series in recent years, receiving overwhelming responses from academic readers around the world. Our success cannot be achieved without the contribution of our distinguished guest editors. This year JTD launched a new column, “Interviews with Guest Editors”, to better present our guest editors and to further promote the special series. We also hope to express our heartfelt gratitude for their tremendous effort and to further uncover the stories behind the special series.
The special series “Socioeconomic Disparities in the Treatment of Thoracic Malignancies”(1) led by Dr. Kei Suzuki (Figure 1) and Dr. Virginia R. Litle from the Boston University School of Medicine has attracted many readers since its publication. This special series aimed to provide current reviews of the literature on healthcare disparities in the management and treatment of those with thoracic malignancies. At this moment, we are honored to have an interview with Dr. Suzuki to share his scientific career experience and insights on this special series.
Figure 1 Dr. Kei Suzuki.
Expert introduction
Dr. Kei Suzuki is a thoracic surgeon at Inova and the Director of Thoracic Surgery Research at the Schar Cancer Institute. His main research interest is in lung cancer, and more specifically, improving the screening rate and yield as well as determining the most appropriate treatment for early-stage cancer patients in terms of deciding the extent of resection and identifying those at high risk for recurrence. One of the main approaches in achieving these goals is to develop a more precise, personalized risk stratification. This includes better assessment of one’s risk for developing lung cancer in the screening setting and determining the aggressiveness of lung cancer beyond the TNM staging in the early-stage patients. The landscape in lung cancer treatment is quickly evolving, and he believes it is critical that they continue to look for better ways to individualize care. Another goal in improving lung cancer care is mitigating disparity. In addition to raising awareness in this realm, he also believes the key is identifying specific barriers that are intervenable. In the recent special series, their hope was to highlight the current issues in healthcare disparity as it pertains to thoracic malignancies.
Interview
JTD: As a reputable expert in thoracic surgery, what drove you to focus on this field in the first place?
Dr. Suzuki: It’s a combination of couple factors. First, I’ve always had an interest in the biology of cancer, and I believe in lung cancer there is a need for significant improvement in the way we understand and manage the disease. It’s a field that constantly offers intellectual intrigue. Second, I enjoy the technical aspect of thoracic surgery, and as a surgeon, the technical appeal is important. Third, I think a significant portion of your career choice is influenced by whom you identify as mentors, and I have been fortunate to have a handful in the field of thoracic surgery.
JTD: Why are some vulnerable people at greater risk for lung cancer but less likely to be screened? Is it mainly because of objective reasons or subjective reasons? (2)
Dr. Suzuki: I think we know this is a multi-factorial issue that includes barriers at each level – at the provider (bias, lack of knowledge, or lack of time for shared decision making), patient (fear/stigma, lack of knowledge), and system (access). Each hospital may have a combination of different factors. I believe the key is identifying what barriers exist for each hospital system and patient population, and strategically intervening to overcome those specific barriers.
JTD: As the high cost of treatments is highlighted, what can hospitals or medical institutes do to reduce costs in healthcare without sacrificing patient satisfaction?
Dr. Suzuki: While this ultimately has to happen at the policy level, effort has to start at the local level. As healthcare workers and systems, we need to raise awareness that will lead to policy changes. It is the responsibility of each healthcare system to identify the various barriers and raise awareness through outreach and publishing the work as well as planning interventions to mitigate the disparity.
JTD: What can be done to efficiently alleviate the healthcare disparities and safeguard high-quality care? Could you make a brief introduction to us?
Dr. Suzuki: Again, it is upon each of us to raise awareness which hopefully leads to changes at the policy level, ensuring screening and the subsequent care are covered by insurance. Recent work also highlights the improvement in cancer screening with paid-sick-leave mandates. I do believe the lack of paid sick-leave is a major patient factor that contributes significantly to the vulnerable population not receiving the cancer screening they need.
JTD: Is the topic of this special series associated with any of your recent research projects? Would you please share some significant researches you are working on?
Dr. Suzuki: We have various research to attack the disparity issue in lung cancer screening, with the ultimate goal of mitigating disparity and increasing both the uptake and the yield of screening. In terms of improving the uptake, we have done work to demonstrate the granular details of the barriers at the hospital level, highlighting that redlining is associated with decreased screening uptake. Identifying specific areas/populations in need may allow us to strategize how to plan our future efforts. This may come in the form of offering better clinic time for the targeted area/population or efforts such as mobile screening, in which we would come to the patients. Mobile screening has been done previously but perhaps can be improved with better technology.
As for improving the screening yield, we are investigating the role of molecular information obtained from normal airways to better assess lung cancer risk. As a part of this effort, we are investigating whether there exists a racial difference in lung cancer risk at the genetic level. Personalizing lung cancer risk will hopefully result in better cancer detection by screening CT as well as convincing patients to receive screening.
JTD: If given an opportunity to update this special series, what would you like to moderate, add or emphasize to provide a more comprehensive series?
Dr. Suzuki: In the current issue, we highlighted the current issues in socioeconomic disparity. An ideal update as a follow-up would be an issue highlighting what specific efforts have taken place and noting what efforts have had the most success in mitigating the disparity.
Reference
- Socioeconomic Disparities in the Treatment of Thoracic Malignancies. Available online: https://jtd.amegroups.com/post/view/socioeconomic-disparities-in-the-treatment-of-thoracic-malignancies
- Suzuki K, Litle VR. Healthcare disparities in thoracic malignancies. J Thorac Dis 2021;13(6):3741-3744.