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Loretta Erhunmwunsee is a surgeon-scientist at City of Hope Medical Center in Duarte, California. She splits her time between surgically treating patients with thoracic malignancies and researching health inequity. These interests come together in her effort to build evidence that structural inequities lead to thoracic oncologic disparities.
Dr. Erhunmwunsee attended Emory University for her undergraduate education before completing her medical education at Harvard Medical School. She went on to complete a general and thoracic surgical residency at Duke University and has been developing her research and surgical practice at City of Hope since her graduation.
CTSNet spoke with Dr. Erhunmwunsee about the intersection between scientific research and clinical practice, the future of thoracic surgery, and her important role in bringing it to fruition. Read on for the full interview, which has been edited for length and clarity.
CTSNet: What is the biggest advance you have seen in thoracic surgery recently?
Dr. Erhunmwunsee: Recently, there has been a significant advance within the precision medicine, tumor mutational analysis, and treatment space. Even early-stage patients are being treated differently now because of new targeted and immunotherapies, thus the thoracic surgical field is changing tremendously.
CTSNet: What is the biggest challenge facing thoracic surgery right now?
Dr. Erhunmwunsee: A major challenge remains that individuals from racial and ethnic minority groups continue to undergo surgery at lower rates, which negatively impacts their survival. Additionally, our clinical trials that lead to improved outcomes within the precision medicine space often do not include the patients who have the highest burden of disease—i.e., racial/ethnic minorities and those of lower socioeconomic status. For both reasons, thoracic surgical disparities persist or even worsen.
CTSNet: Can you talk a little bit about your research in health disparities?
Dr. Erhunmwunsee: Our work looks to understand how adverse social determinants of health and structural inequities (like racism) lead to race-based disparities in lung cancer outcomes. We are investigating, for instance, how residential segregation may impact lung cancer risk and tumor biology. We also are using artificial intelligence to improve our understanding of how adverse social determinants may be used to predict adherence to lung cancer screening in historically excluded groups.
CTSNet: How does your research complement or influence your approach to patient care?
Dr. Erhunmwunsee: Our research clarifies that environmental and social context strongly impact the health of patients. Therefore, incorporating these factors into our treatment plans is necessary if we are to achieve both excellent outcomes and health equity.
CTSNet: Can you give an example of what using social determinants in treatment plans might look like?
Dr. Erhunmwunsee: Yes. Each patient’s social determinants of health and barriers to care should be understood. Just as important as a patient’s medication list and vital signs are their environmental, economic, educational, and social contexts. We must ascertain, record, and correlate this information with outcomes. Secondly, when determinants are discovered that will negatively impact an individual’s outcomes, care, or compliance, these barriers should be targeted with the help of social work, supportive care, and/or local and regional social networks. For example, a severely food insecure patient who has early stage, resectable lung cancer would benefit not just from being scheduled for resection but also from being connected to opportunities that narrow the food insecurity gaps. This might include food pantries or social networks that support these efforts. The patient whose adverse social determinant is targeted will have better outcomes than the one whose tumor is simply resected.
CTSNet: What can other surgeons who are interested in and concerned with inequities in cardiothoracic surgery do to ensure they approach patient care more equitably?
Dr. Erhunmwunsee: We must know whether there are race or ethnicity-based disparities within our practice and/or departments. There needs to be an assessment of whether there are disparities in access to our centers, differences in surgical rates, or disparities in outcomes (e.g., survival, recurrence, late-stage diagnosis, etc.) based on race and ethnicity. This data should be highlighted and evaluated from a social determinant and structural inequity lens, and interventions should be used to target specific gaps. For instance, if a certain demographic group has a lower rate of undergoing lung cancer surgical resection, then navigation could be utilized to help support the group through the process. Additionally, knowing that adverse social determinants and structural inequities may be far more of a threat than—or may compound the hazards of—patients’ thoracic issues, we must partner with our social work, supportive care, and community benefits teams to address them.
