MetroHealth
Ismini Kourouni and Yasir Tarabichi, the MetroHealth doctors that spearheaded the four-year study.
When it comes to lung cancer, why do different races and ethnicities suffer unequally?
Yasir Tarabichi, a pulmonology doctor at MetroHealth, tackled this inquiry head-on in a four-year analysis of hundreds of lung cancer patients, the results of which were published in the medical journal Clinical Lung Cancer this month.
The study, aided by a rapid outpatient diagnostic program (RODP) that combs digital medical records, found that individualizing approaches to high-risk patients nearly doubled the chances said person would show up on-time for a CT scan or tissue sampling. And, Tarabichi is most excited to report, the AI-enhanced strategy nearly leveled the response between white and minority patients.
"We found that the biggest improvement was in the racial, ethnic minority individual," Tarabichi told Scene. "That means, well, everybody got better."
With what would become an eight-person team of nurses and lung specialists, Tarabichi began examining the medical records and paths of 909 patients, 54 percent of whom were Black and Hispanic persons, on average, in their early sixties. It was 2017, and Tarabichi was perusing health records of patients' CT scans, wondering why there were such vast delays in followups and surgical biopsies.
"Patients were being referred to specialists, but not a lot of them were following through," Tarabichi told Scene. "So, when I saw that, the answer was, 'We need to start catching these people—when somebody gets referred, we are not letting go.'"
Tarabichi's concern was justified. Lung cancer is a leading cause of cancerous death globally, and statistically worse for Black men, according to the American Lung Association. What makes it so deadly, Tarabichi said, is that patients aren't usually aware of the cancerous nodules in their lung until the disease reaches a nearly untreatable state. "It's why it's the silent killer," he said.
Believing that societal inequities played a greater part in higher mortality rates for Black and Hispanic lung cancer patients, Tarabichi designed a program that would comb health records looking for specific signifiers: Is this person a smoker? Did they have a worrisome CT scan? Are they known to delay seeing a specialist?
By 2018, Tarabichi bought on Katherine Dutton, a coordinator in MetroHealth’s Division of Pulmonary Medicine, to call specific high-risk patients who needed necessary scans on-time, or prodding to schedule biopsies.
In two years, with Dutton's help, he and Ismini Kourouni, a co-author and director of Thoracic Diagnostics, would compare the response times of the original 909 patients with 913 patients tracked by RODP.
"In the past, somebody would have to manually click every patient's health record, and figure out where they are in the process," Tarabichi said. "The software just made that easier." (MetroHealth serves roughly 300,000 patients, their website says.)
Whether it be ongoing denial, fear of a terminal prognosis, lack of insurance, or just work or car difficulties, the variables were hard to pinpoint across the intervening years of the study, Tarabichi said. But being able to know to call a Lyft for a patient without a car—which has happened in the past—is key when time is of the essence.
After the article's publication on March 3, Tarabichi said he's working with Kourouni to make RODP easier to adapt in other healthcare systems, which he said should be pretty feasible.
And then, in some years, lung cancer stats could change.
"This is not an insurmountable problem, that health disparities don't have to persist," he said. "You don't just shrug them off. You study the underlying reasons, you develop mechanisms and you can actually make a difference."
