Implementation and Uptake of Rural Lung Cancer Screening

doi:10.1016/j.jacr.2021.12.003

. 2022 Mar;19(3):480-487.

doi: 10.1016/j.jacr.2021.12.003. Epub 2022 Feb 7.

Implementation and Uptake of Rural Lung Cancer Screening

Affiliations

¹ Department of Internal Medicine (Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas.
² Senior Program Manager, Oncology Screening Services, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas.
³ Clinical Research Manager, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas.
⁴ Population Research Project Associate, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas.
⁵ Senior Grants and Contracts Specialist, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas.
⁶ Assistant Director of Clinical Facilities and Operations, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas.
⁷ Assistant Professor of Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.
⁸ Professor of Radiology; Vice Chair of Clinical Operations, Department of Radiology; Chief of Community Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.
⁹ Professor of Population and Data Sciences, and Family and Community Medicine; Director of Behavioral Sciences; Director of Moncrief Cancer Institute, Department of Population and Data Sciences, and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.
¹⁰ Professor of Internal Medicine (Hematology-Oncology) and Population and Data Sciences; Associate Director of Clinical Research, Department of Internal Medicine (Hematology-Oncology), Department of Population and Data Sciences; and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: David.Gerber@utsouthwestern.edu.

PMID: 35143786
PMCID: PMC8923939
DOI: 10.1016/j.jacr.2021.12.003

Implementation and Uptake of Rural Lung Cancer Screening

Tri Le et al. J Am Coll Radiol. 2022 Mar.

. 2022 Mar;19(3):480-487.

doi: 10.1016/j.jacr.2021.12.003. Epub 2022 Feb 7.

Authors

Affiliations

¹ Department of Internal Medicine (Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas.
² Senior Program Manager, Oncology Screening Services, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas.
³ Clinical Research Manager, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas.
⁴ Population Research Project Associate, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas.
⁵ Senior Grants and Contracts Specialist, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas.
⁶ Assistant Director of Clinical Facilities and Operations, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas.
⁷ Assistant Professor of Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.
⁸ Professor of Radiology; Vice Chair of Clinical Operations, Department of Radiology; Chief of Community Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.
⁹ Professor of Population and Data Sciences, and Family and Community Medicine; Director of Behavioral Sciences; Director of Moncrief Cancer Institute, Department of Population and Data Sciences, and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.
¹⁰ Professor of Internal Medicine (Hematology-Oncology) and Population and Data Sciences; Associate Director of Clinical Research, Department of Internal Medicine (Hematology-Oncology), Department of Population and Data Sciences; and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: David.Gerber@utsouthwestern.edu.

PMID: 35143786
PMCID: PMC8923939
DOI: 10.1016/j.jacr.2021.12.003

Abstract

Objective: Given the higher rates of tobacco use along with increased mortality specific to lung cancer in rural settings, low-dose CT (LDCT)-based lung cancer screening could be particularly beneficial to such populations. However, limited radiology facilities and increased geographical distance, combined with lower income and education along with reduced patient engagement, present heightened barriers to screening initiation and adherence.

Methods: In collaboration with community leaders and stakeholders, we developed and implemented a community-based lung cancer screening program, including telephone-based navigation and tobacco cessation counseling support, serving 18 North Texas counties. Funding was available to support clinical services costs where needed. We collected data on LDCT referrals, orders, and completion.

Results: To raise awareness for lung cancer screening, we leveraged our established collaborative network of more than 700 community partners. In the first year of operation, 107 medical providers referred 570 patients for lung cancer screening, of whom 488 (86%) were eligible for LDCT. The most common reasons for ineligibility were age (43%) and insufficient tobacco history (20%). Of 381 ordered LDCTs, 334 (88%) were completed. Among screened patients, 61% were current smokers and 36% had insurance coverage for the procedure. The program cost per patient was $430.

Discussion: Implementation, uptake, and completion of LDCT-based lung cancer screening is feasible in rural settings. Community outreach, health promotion, and algorithm-based navigation may support such efforts. Given low lung cancer screening rates nationally and heightened lung cancer risk in rural populations, similar programs in other regions may be particularly impactful.

Keywords: CT; Community; navigation; stakeholder; tobacco.

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Conflict of interest statement

Conflict of Interest Disclosures: The authors declare no conflict of interest.

Figures

**Figure 1.**
Lung Cancer Screening Algorithm ¹Interval scan to evaluate indeterminate CT scan at interval < 12 months until there is resolution or findings. ²Go to PET-CT and/or subsequent biopsy to occur within weeks of screening result.

**Figure 2.**
Patients referred to, eligible for, and completing low-dose computed tomography (LDCT)-based lung cancer screening.

See this image and copyright information in PMC

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References

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1. Cetin K, Ettinger DS, Hei YJ, O’Malley CD. Survival by histologic subtype in stage IV nonsmall cell lung cancer based on data from the Surveillance, Epidemiology and End Results Program. Clin Epidemiol. 2011;3:139–148. - PMC - PubMed
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[1] Shewale JB, Corsini EM, Correa AM, et al. Time trends and predictors of survival in surgically resected early-stage non-small cell lung cancer patients. J Surg Oncol. 2020. - PubMed

[2] Shewale JB, Corsini EM, Correa AM, et al. Time trends and predictors of survival in surgically resected early-stage non-small cell lung cancer patients. J Surg Oncol. 2020. - PubMed

[3] Cetin K, Ettinger DS, Hei YJ, O’Malley CD. Survival by histologic subtype in stage IV nonsmall cell lung cancer based on data from the Surveillance, Epidemiology and End Results Program. Clin Epidemiol. 2011;3:139–148. - PMC - PubMed

[4] Cetin K, Ettinger DS, Hei YJ, O’Malley CD. Survival by histologic subtype in stage IV nonsmall cell lung cancer based on data from the Surveillance, Epidemiology and End Results Program. Clin Epidemiol. 2011;3:139–148. - PMC - PubMed

[5] National Lung Screening Trial Research T, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409. - PMC - PubMed

[6] National Lung Screening Trial Research T, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409. - PMC - PubMed

[7] de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020;382(6):503–513. - PubMed

[8] de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020;382(6):503–513. - PubMed

[9] Gerber DE. Should family physicians routinely screen for lung cancer in high-risk populations? Yes: CT-based screening is complex but worthwhile. Am Fam Physician. 2014;90(2):73B–74B. - PubMed

[10] Gerber DE. Should family physicians routinely screen for lung cancer in high-risk populations? Yes: CT-based screening is complex but worthwhile. Am Fam Physician. 2014;90(2):73B–74B. - PubMed

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Implementation and Uptake of Rural Lung Cancer Screening

Affiliations

Implementation and Uptake of Rural Lung Cancer Screening

Authors

Affiliations

Abstract

Conflict of interest statement

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Grants and funding

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Abstract

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