CHICAGO - Providing social support for lung cancer screening (LCS) to individuals at risk of the disease shows promise as an effective way to increase uptake, according to study results shared at the RSNA meeting on December 2.
"Community-based programs promoting cancer screening uptake have demonstrated increased screening engagement compared to clinic-based programs in reaching disadvantaged individuals," presenter Farouk Dako, MD, of the University of Pennsylvania in Philadelphia, told session attendees.
Lung cancer screening using low-dose CT has been shown to reduce mortality from the disease, but despite the expansion of the pool of eligible individuals in 2021, uptake remains low, especially among low-income people, racial and ethnic minorities, and those with negative baseline exams, Dako noted. Community-based programs promoting lung cancer screening have been shown to be effective, but "suffer from lack of robust funding and limited data demonstrating impact on a population level," he said.
He cited previous work he conducted with colleagues in 2017 that found the following barriers to lung cancer screening uptake: a patient belief that it costs too much; inability to get time off from work to attend a screening appointment; forgetting scheduled appointments; and a lack of awareness about the purpose of the appointment.
"[Our 2017] results demonstrated there was poor knowledge about LCS," he said. "Barriers to LCS adherence include education [about the exam], health system navigation, and negative provider interactions."
Dako and colleagues set out to develop and assess a community support program for LCS by "creating goodwill and establishing relationships" -- in part by offering groceries via a food drive and free vaccinations for COVID during the pandemic. The program was a collaboration between Penn Medicine, Temple Health, and Jefferson Health. Its training curriculum for community health workers included adapting existing lung cancer screening material from the American College of Radiology (ACR) and the LUNGevity Foundation; outlining the risks and benefits of LCS; cost and payment options for the exam; level of radiation exposure; treatment options; and smoking cessation options. The lung cancer screening support program offered free rideshares, education about LCS (written at a sixth-grade level), and navigation through the screening process.
Dako's team conducted a study to evaluate whether the program was indeed successful in increasing LCS uptake. A community health worker reached out to patients eligible for the exam in an interventional group (West Philadelphia, 191 people) and a control group (Southwest Philadelphia, 52 people) to offer the program's services. After six months, the team compared LCS adherence rate between the two groups.
Of individuals in the intervention group, 14% participated in the support program; they were more likely to be African American and female, Dako reported. But of these 14%, 88% attended a lung cancer screening appointment compared to 68% of individuals in the intervention group that did not elect to participate in the support program. Of those who participated in the support program, 69% opted to take a rideshare.
The takeaway? A community-supported LCS program improves patient adherence, Dako concluded.
"Providing patients with education on lung cancer screening can demystify the process," he said.
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