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Sun. Jul 14th, 2024

Lung cancer screening rates remain low in the US, especially in the South

By Vaseline Jun10,2024

Fewer than one in five people eligible for lung cancer screening report being up to date with screening in 2022, although patient navigation added to usual care could be a way to increase these numbers, two studies show studies published in JAMA Internal Medicine.

Among nearly 26,000 respondents in a nationwide cross-sectional study, the overall prevalence of current lung cancer screening was 18.1%, but this varied from country to country (ranging from 9.7% to 31%), with relatively lower rates in southern states that have done so. high mortality from lung cancer, noted Priti Bandi, PhD, of the American Cancer Society, and colleagues.

“The largest differences in (current lung cancer screening) were dependent on access to health care factors and among US states,” they wrote. “Therefore, improving access to health care for low-income people through expanding Medicaid and increasing screening capacity may be associated with increased uptake and reduced disparities.”

In a pragmatic randomized trial conducted within the Boston Health Care for the Homeless Program, 43.4% of participants who received assistance from a patient navigator, compared with 9.2% of those who received usual care, had completed lung cancer screening with a completed low-dose CT at age 6. months after randomization (P<0.001), representing a 4.7-fold difference, Travis P. Baggett, MD, MPH, of Massachusetts General Hospital in Boston, and colleagues reported.

“These findings complement results from non-experimental studies in other homeless health care settings and add to a growing body of work demonstrating the impact of patient navigation for cancer screening in vulnerable populations,” Baggett and team noted.

In an accompanying editorial, Ilana B. Richman, MD, MHS, and Cary P. Gross, MD, both of the Yale School of Medicine in New Haven, Connecticut, wrote that the two studies “prompt us to reflect on which successful implementation of lung cancer screening in the US looks like.”

“A definition of success in implementing lung cancer screening might be that all eligible patients are identified, offered screening, have the opportunity to weigh the risks and benefits while carefully considering their own values, and not face structural barriers to screening and follow-up. ,” they wrote. “A multi-pronged approach that addresses structural and patient-level barriers to screening while facilitating and supporting high-quality shared decision-making needs can help us move closer to this ideal.”

The cross-sectional study included 25,958 individuals eligible for screening who responded to the 2022 Behavioral Risk Factor Surveillance System (BRFSS) population-based, nationwide, state-representative survey. The median age was 62 years (64.4% were 60 years and older) and 54.4% were male. The majority were white (78.4%), 8.1% were black, and 6.7% were Hispanic.

Of respondents, 61.5% were current smokers, 53% had a high school education or less, 89.5% lived in urban counties, 36.3% had private insurance, 32.4% had Medicare, and 14.5% had Medicaid. Approximately 81% reported one or more comorbidities, of whom 35.6% reported three or more comorbidities.

The prevalence of modern lung cancer screening increased with age, with a rate of 6.7% in the 50-54 age group and 27.1% in the 70-79 age group, as did the number of comorbidities (no comorbidities: 8, 7%; three comorbidities: 24.6%). Nearly 4% of those without insurance and 5.1% of those without usual care were up to date with lung cancer screening, but state-level Medicaid expansions (adjusted prevalence ratio (APR) 2.68, 95% CI 1.30- 5.53) and higher screening capacity levels (high versus low: APR 1.93, 95% CI 1.36-2.75) were associated with a higher prevalence of current lung cancer screening.

Bandi and colleagues also found that there was wide variation in the prevalence of current lung cancer screening across the US, with the highest prevalence in Rhode Island (31%) and the lowest in Wyoming (9.7%).

Fifteen of the seventeen states in the South were classified as having a high or moderate lung cancer burden, but only two states had a prevalence of modern lung cancer screening significantly above the national average. On the other hand, all nine northeastern states had a low or average lung cancer burden, with the prevalence of modern lung cancer screening in seven of those states significantly above the national average.

In the parallel-group pragmatic randomized trial, conducted from November 2020 through March 2023, Baggett and colleagues enrolled 260 participants from the Boston Health Care for the Homeless Program, a federally qualified program that provides customized, multidisciplinary care to nearly 10,000 people. homeless-experienced patients annually. The mean age was 60.5 years, 70.8% were male, 36.9% were black, and 36.9% were white.

To be eligible, participants had to have a lifetime history of homelessness and be a primary care provider within the program, be proficient in English, and meet pre-2022 Medicare coverage criteria for lung cancer screening (ages 55-77, a package of 30 packages). years of smoking history, and smoking in the past 15 years).

Of the participants, 50.8% reported fair or poor health, 29.1% screened positive for a mental disorder, 24% for an alcohol use disorder, and 27.8% for a drug use disorder. Most (85%) were current smokers, and the entire cohort had smoked an average of 48.1 pack-years.

Participants were randomized 2:1 to usual care, with or without patient navigation. Following a “theory-based, patient-centered protocol,” the navigator provided lung cancer education, facilitated shared decision-making visits with primary care physicians, assisted participants in making and attending appointments, arranged follow-up testing when necessary, and provided smoking cessation support for current smokers.

In a time-to-event analysis, participants in the patient navigation arm were more likely to undergo lung cancer screening than participants in the usual care arm.

  • author('full_name')

    Mike Bassett is a staff writer focusing on oncology and hematology. He is based in Massachusetts.

Revelations

The randomized study was supported by a grant from the American Cancer Society and by the Massachusetts General Hospital Research Scholars Program.

Bandi and colleagues had no disclosures.

Baggett reported receiving royalties from UpToDate. A co-author reported receiving a grant from Achieve Life Sciences and personal fees from Achieve Life Sciences and UpToDate.

Richman reported no disclosures. Gross reported grants from the National Comprehensive Cancer Network Foundation (funds provided by AstraZeneca) and Genentech, as well as funding from Johnson & Johnson to help devise and implement new approaches to sharing clinical trial data. Gross is also Associate Editor of JAMA Internal Medicine.

Primary source

JAMA Internal Medicine

Source reference: Bandi P, et al. “Lung cancer screening in the US, 2022” JAMA Intern Med 2024; DOI: 10.1001/jamainintermed.2024.1655.

Secondary source

JAMA Internal Medicine

Source Reference: Baggett TP, et al. “Patient Navigation for Lung Cancer Screening in a Homeless Healthcare Program: A Randomized Clinical Trial” JAMA Intern Med 2024; DOI: 10.1001/jamainintermed.2024.1662.

Additional resource

JAMA Internal Medicine

Source reference: Richman IB, Gross CP “Progress in the Adoption of Lung Cancer Screening” JAMA Intern Med 2024; DOI: 10.1001/jamainintermed.2024.1673.

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