How can you help the people you can’t see? For most people the answer is: You can’t. Matty Triplette’s approach is different: Get a flashlight if you have to. Find a way to see them.
Matty Triplette, MD, MPH, a pulmonologist at Fred Hutchinson Cancer Center in Seattle, knows the importance of lung cancer screening in populations with heavy tobacco exposure. As the Medical Director of the Hutch’s Lung Cancer Screening Program and the tobacco cessation program, he also knows that when lung cancer is caught early, patients have a good chance of being treated successfully or even being cured.
However, patients at high-risk for lung cancer have been slow to embrace lung cancer screening, with only 5% of those eligible for annual screenings (aged 50-80 years with heavy tobacco exposure) actually getting screened routinely in the United States.
Several studies have aimed to identify the reasons for this slow uptake of lung cancer screening and they have identified a range of potential issues the community faces, such as lack of awareness, lung cancer stigma, lack of screening facilities, difficulty sticking to an annual screening schedule, and more. But what most researchers can agree on is that when you identify the specific needs of a community and help them overcome these obstacles, the percentage of eligible patients getting routine lung cancer screening increases significantly.
One group that has been largely overlooked in the lung cancer space is the LGBTQIA2S+ community. LUNGevity spoke with Dr. Triplette to understand what is known about this diverse community and how the Health Equity for Communities Research Award from LUNGevity in 2021 is helping to build bridges and understand the needs of underserved communities in Washington state and beyond.
LUNGevity Foundation: Why has the LGBTQIA2S+ community been overlooked in the lung cancer space?
Dr. Matthew Triplette: Historically, clinicians and cancer centers have not routinely collected Sexual Orientation and Gender Identity (SOGI) data on their patients. So, we really don't have a lot of data to know what is going on. If we can go to a cancer registry, a system designed to collect data about people with cancer, and find the information we need about a community, we can work to create effective intervention programs.
Our healthcare systems collect data on age, race and ethnicity, location, and more. But because we do not collect SOGI data, we do not know how many LGBTQIA2S+ community members we are leaving behind when we are creating lung cancer screening programs.
LF: What data is available for the LGBTQIA2S+ community and what does it tell us about their risk of lung cancer?
MT: The majority of LGBTQIA2S+ research focuses on behavioral health, such as sexual transmitted infection (STI) prevention. When we look at this behavioral health data, we see higher rates of tobacco use in people who identify as LGBTQIA2S+ compared to the general population. We also see tobacco companies continuing to market tobacco products to the LGBTQIA2S+ community through targeted advertising. We already know that tobacco use is the number one risk factor for lung cancer and it accounts for the majority of lung cancer cases in the US. So, that tells us lung cancer is likely to be a larger problem for the LGBTQIA2S+ community than for other groups.
LF: What was unique about the first part of your LUNGevity-funded research project?
MT: I’d been focused on lung cancer screening and smoking cessation for a long time, but the key to the success of this project was something entirely new for me. While I am a member of the LGBTQIA2S+ community, and that positionality certainly drove my interest, I had to build bridges into the LGBTQIA2S+ communities in Seattle and try to partner with those community-serving organizations to help improve lung cancer screening rates and foster an interest in smoking cessation.
Most research grants don’t give you time to build relationships. That’s a big part of why it was exciting to work with LUNGevity Foundation. They have the vision and creativity to see the potential and push beyond the usual.
I got the time and support to meet with the community-based organizations that serve the LGBTQIA2S+ people in our King County area. We found three organizations that want to partner for the duration of the project and beyond.
LF: Tell us more about your research project.
MT: Once we built the partnerships across King County, we conducted surveys, focus groups and individual interviews with people who identified as LGBTQIA2S+ and who were eligible for lung cancer screening or smoking cessation programs to understand their experiences. This helped us to understand the barriers they faced.
The third and final part of our project involved a small clinical trial. We hired and trained a navigator to work with community members as they made decisions about lung cancer screening. The navigator helps members with everything from scheduling appointments to explaining test results. Our navigator is also a trained tobacco treatment specialist, so he is able to provide ongoing smoking cessation support, which is such a key component of lung cancer prevention.
Our goal was to enroll 40 participants into this trial and then follow the patients over time. I’m pleased to say we’ve already exceeded our enrollment goal—enrolling our 41st participant last week.
LF: Was there anything unexpected that has come out of this work so far?
MT: The long-term sustainable partnerships that developed from that initial work building relationships within the community has been amazing.
For example, as we learned more about the organizations in the area, we discovered a group called Gen Pride—which is focused on queer elders (folks over the age of 50). They are an ideal organization for us to partner with because people between the ages of 50 and 80 (with heavy tobacco use) are eligible for lung cancer screening.
When we were starting the study, Gen Pride was starting a new community living facility in Seattle called Pride Place, an affordable housing solution for older queer folks which also has an open community space on the ground floor. Because of our partnership, we’re able to meet there for community lunches (my team helps serve!), recruit people into the trial, and offer tobacco cessation education and resources. It’s a wonderful bidirectional partnership that was only possible because of this award from LUNGevity.
LF: What are the next steps for your research?
MT: Our goal for this research project is to build a strong navigation program and data to back it up. We’ll determine the effectiveness of the navigation intervention and talk to patients to understand what was good and what could be improved. Then, we can refine the navigation program further. I’ve been working with my cancer center to ensure this work continues even after my research project is complete.
I’ve also had conversations with national leaders outside of King County who are interested in doing a larger study that will help bring this type of navigation to cancer centers across the country.
LF: How can nonprofit organizations, like LUNGevity, help overcome challenges facing the broader lung cancer community?
MT: The government, through the National Institutes of Health, is the largest source of research funding and individual foundations can’t compete with that. But what they can do is carve out niches that they know are really important, where investment matters and in areas that the government is less likely to support.
That is exactly what this community-based research award from LUNGevity did. It allowed some flexibility and discussion. It allowed me to build community relationships. LUNGevity works closely and creatively with researchers—that is what makes this award so valuable to the whole scientific landscape. To me, this personalization can make every dollar much more valuable than the other dollars spent at the government level.
LF: How has this award impacted your career?
MT: So much has happened since I got the LUNGevity award.
The LUNGevity grant allowed me to cut my teeth and show that I could build these community relationships and partner to build sustainable interventions. I got my first large federal (R01) grant to improve lung cancer screening in another underserved group—rural communities. This was part of the White House-National Cancer Institute Cancer Moonshot program. I was among the first 11 scientists to receive that award, and work we’ve done with the LUNGevity grant certainly contributed to that.
LF: What does the future hold for you?
MT: As a scientist, we often focus on hard data as the primary outcome of a research award. And we do have great data from the LUNGevity award. But, I’m most excited about the skills I’ve learned particularly in building and sustaining community relationships. If you talk to me in 10 years, I guarantee that ripples from these partnerships are going to have a huge impact on the next steps I take with my scientific projects.
My career and my ability to create meaningful change in underserved communities have been directly shaped and bolstered by this LUNGevity research award. I’m so grateful for this opportunity and to be able to develop tailored approaches to increase the use of lung cancer screening and smoking cessation in marginalized communities.
Visit the LGBTQIA2S+ Resource Center for resources, facts and figures, and official reports.