Study Finds Patient Navigation Program Increases Lung Cancer Screening Rates in Urban Setting

Annual lung cancer screening for at-risk patients can help catch signs of the disease early and is recommended by the United States Preventive Services Task Force (USPSTF) to decrease the risk of lung cancer–related deaths, but uptake of screening has been low. A study conducted at an urban community health center found that a lung cancer screening navigation program increased awareness of screening and increased screening rates.

“Lung cancer is the leading cause of cancer death in the US in both men and women; causing 25% of all cancer death,” the authors wrote. “Annual lung cancer screening with a low-dose CT (LDCT) in high-risk individuals (aged 50-80 with a >20 pack-year smoking history) decreases [lung cancer] deaths by 20% and is recommended by USPSTF.”

Among eligible patients, disparities due to patient or provider barriers, as well as systemic racial or ethnic and socioeconomic factors have created even wider gaps in underserved populations, the authors noted. The study assessed the efficacy of a lung cancer screening navigation program across 4 sites in a large community health center in an ethnically diverse and socioeconomically underserved population in Rhode Island.

A bilingual, English- and Spanish-speaking patient navigator was integrated beginning January 2022 to assess screening process awareness among patients and providers, systemic barriers to screening, and provide navigational support throughout the screening process. The navigator also administered questionnaire to assess care barriers and patient demographics.

The retrospective analysis assessed the population of patients eligible for screening at the health center between January 2022 and December 2022. A total of 360 patients who were seen at the health center were eligible for LDCT screening, 149 (41.4%) of whom agreed to undergo LDCT after counseling and shared decision making, and 101 (28%) of those patients underwent LDCT. Notably, the rate in the state of Rhode Island overall is 13%. Of the eligible patients, 153 completed the questionnaire.

Of patients who completed the survey, half were female, 40% were Hispanic or Latinx, 40% were non-Hispanic or Latinx, and 22% of patients declined to respond. Most patients were White (61%), 10% were Black, and 28% did not respond. Many patients (34%) did not speak English, and many resided in cities with the lower per-capita incomes in Rhode Island.

Knowledge appeared to be the most substantial barrier to screening in this population, with 46% of patients reporting that they were unaware of the lung cancer screening process. Additionally, 44% of patients were unaware that screening was covered by health insurance, and 58% did not remember being told about lung cancer screening at their primary care provider.

Results of the LDCT results that were available for analysis showed that 84% of scans were Lung RADS-1 and 16% were in the Lung RADS-4 category.

The authors concluded that there are unique barriers to lung cancer screening in the assessed population, and that patient navigation was a useful tool to increase awareness and boost screening rates.

“While access to LCS remains an issue, patient awareness of the lung cancer screening process was the major barrier. A patient navigation program is critical to the success of LCS in a community, by providing education to patients and providers and the necessary logistical support needed in the LDCT process,” the authors wrote. “With a community-based navigational program, we demonstrate a significant increase in lung cancer screening rates in our population to 28% as compared to the state LCS rate of 13%.”

Reference

Khan H, Ramphal K, Motia M, et al. Disparities in lung cancer screening in a diverse urban population and the impact of a community-based navigational program. J Clin Oncol. 2023;41(suppl 16):6555. doi:10.1200/JCO.2023.41.16_suppl.6555