Lung cancer screening patient navigation for current smokers in community health centers: A randomized controlled trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 1506-1506 ◽  
Author(s):  
Sanja Percac-Lima ◽  
Jeffrey M Ashburner ◽  
Nancy Rigotti ◽  
Elyse R. Park ◽  
Yuchiao Chang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Community Health ◽  
Community Health Centers ◽  
Patient Navigation ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
Chest Ct ◽  
Health Centers ◽  
Lung Cancers

1506 Background: Annual chest computed tomography (CT) can decrease lung cancer mortality in high risk individuals. Patient navigation (PN) has been shown to improve cancer screening rates in underserved populations. We evaluated the impact of PN on lung cancer screening (LCS) in current smokers in community health centers (CHC). Methods: Current smokers aged 55-77 receiving care in five CHC affiliated with an academic medical center were randomized to intervention (n = 400) or control (n = 800) groups. In the intervention arm, patient navigators (PNs) determined eligibility for LCS, provided brief smoking cessation counseling, introduced shared decision making about LCS, scheduled appointments with the primary care provider (PCP), reminded patients about appointments and PCPs to order CTs, and helped patients attend testing and follow-up any abnormal results. Control patients received usual care. The primary outcome was the proportion of patients in each group who had any chest CT during the study period. Secondary outcomes included proportion of patients receiving lung screening CTs and the number of lung cancers diagnosed in each group. Results: Baseline patient characteristics were similar between randomized groups. From March 2016-January 2017, PNs contacted 332 (83%) of intervention patients; 76 refused further participation. Of participating patients, 130 (51%) were eligible for LCS. Exclusions included insufficient smoking history (n = 117), competing comorbidities (n = 5), moved (n = 2), and died (n = 2). In intention-to-treat analyses, 124 intervention patients (31%) had chest CT vs. 138 control patients (17.3%, p < 0.01). Lung cancer screening CTs were performed in 94 intervention patients (23.5%) vs. 69 control patients (8.6%, p < 0.01). Eight lung cancers were diagnosed in intervention patients (2%) vs. 4 in controls (0.5%). Conclusions: A patient navigation program implemented in community health centers significantly increased lung cancer screening among current smokers. PNs may help underserved low-income current smokers complete LCS and improve equity in care while decreasing lung cancer mortality. Clinical trial information: 2015P002239.

scholarly journals Patient navigation for lung cancer screening among current smokers in community health centers a randomized controlled trial

2018 ◽  
Vol 7 (3) ◽  
pp. 894-902 ◽  
Author(s):  
Sanja Percac-Lima ◽  
Jeffrey M. Ashburner ◽  
Nancy A. Rigotti ◽  
Elyse R. Park ◽  
Yuchiao Chang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Randomized Controlled Trial ◽  
Cancer Screening ◽  
Community Health ◽  
Community Health Centers ◽  
Patient Navigation ◽  
Controlled Trial ◽  
Lung Cancer Screening ◽  
Health Centers ◽  
Randomized Controlled

scholarly journals Lung Cancer Screening with Low-Dose CT in Smokers: A Systematic Review and Meta-Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1040
Author(s):  
Theresa Hunger ◽  
Eva Wanka-Pail ◽  
Gunnar Brix ◽  
Jürgen Griebel
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Meta Analysis ◽  
Smoking Behavior ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
Clinical Effectiveness ◽  
Relative Reduction ◽  
Lung Cancers

Lung cancer continues to be one of the main causes of cancer death in Europe. Low-dose computed tomography (LDCT) has shown high potential for screening of lung cancer in smokers, most recently in two European trials. The aim of this review was to assess lung cancer screening of smokers by LDCT with respect to clinical effectiveness, radiological procedures, quality of life, and changes in smoking behavior. We searched electronic databases in April 2020 for publications of randomized controlled trials (RCT) reporting on lung cancer and overall mortality, lung cancer morbidity, and harms of LDCT screening. A meta-analysis was performed to estimate effects on mortality. Forty-three publications on 10 RCTs were included. The meta-analysis of eight studies showed a statistically significant relative reduction of lung cancer mortality of 12% in the screening group (risk ratio = 0.88; 95% CI: 0.79–0.97). Between 4% and 24% of screening-LDCT scans were classified as positive, and 84–96% of them turned out to be false positive. The risk of overdiagnosis was estimated between 19% and 69% of diagnosed lung cancers. Lung cancer screening can reduce disease-specific mortality in (former) smokers when stringent requirements and quality standards for performance are met.

Implementation of a Lung Cancer Screening Program in Two Federally Qualified Health Centers

2021 ◽  
pp. 003335492097171
Author(s):  
Lesley Watson ◽  
Megan M. Cotter ◽  
Shauna Shafer ◽  
Kara Neloms ◽  
Robert A. Smith ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Pilot Project ◽  
Health Centers ◽  
Smoking History ◽  
Federally Qualified Health Centers ◽  
Cancer Society ◽  
Improved Outcomes

Using low-dose computed tomography (LDCT) to screen for lung cancer is associated with improved outcomes among eligible current and former smokers (ie, aged 55-77, at least 30-pack–year smoking history, current smoker or former smoker who quit within the past 15 years). However, the overall uptake of LDCT is low, especially in health care settings with limited personnel and financial resources. To increase access to lung cancer screening services, the American Cancer Society partnered with 2 federally qualified health centers (FQHCs) in Tennessee and West Virginia to conduct a pilot project focused on developing and refining the LDCT screening referral processes and practices. Each FQHC was required to partner with an American College of Radiology–designated lung cancer screening center in its area to ensure high-quality patient care. The pilot project was conducted in 2 phases: 6 months of capacity building (January–June 2016) followed by 2 years of implementation (July 2016–June 2018). One site created a sustainable LDCT referral program, and the other site encountered numerous barriers and failed to overcome them. This case study highlights implementation barriers and factors associated with success and improved outcomes in LDCT screening.

scholarly journals Mobile Low-Dose Computed Tomographic (LDCT) Scanning combined with Remote Reading: a feasible approach to lung cancer screening among rural population

2021 ◽  
Author(s):  
Bojiang Chen ◽  
Jun Shao ◽  
Jinghong Xian ◽  
Pengwei Ren ◽  
Wenxin Luo ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Rural Areas ◽  
Pulmonary Nodules ◽  
Lung Cancer Screening ◽  
Western China ◽  
Control Group ◽  
Local Hospital ◽  
Lung Cancers ◽  
Computed Tomographic

Abstract BackgroundLow-dose computed tomographic (LDCT) screening has been proven to be powerful in detecting lung cancers in early stage. However, it’s hard to carry out in less-developed regions in lacking of facilities and professionals. The feasibility and efficacy of mobile LDCT scanning combined with remote reading by experienced radiologists from superior hospital for lung cancer screening in deprived areas was explored in this study.MethodsA prospective cohort was conducted in rural areas of western China. Residents over 40 years old were invited for lung cancer screening by mobile LDCT scanning combined with remote image reading or local hospital-based LDCT screening. Rates of positive pulmonary nodules and detected lung cancers in the baseline were compared between the two groups.ResultsAmong 8073 candidates with preliminary response, 7251 eligibilities were assigned to the mobile LDCT with remote reading (n = 4527) and local hospital-based LDCT screening (n = 2724) for lung cancer. Basic characteristics of the subjects were almost similar in the two cohorts except that the mean age of participants in mobile group was relatively older than control (61.18 vs. 59.84 years old, P < 0.001). 1778 participants with mobile LDCT scans with remote reading (39.3%) revealed 2570 pulmonary nodules or mass, and 352 subjects in the control group (13.0%) were detected 472 ones (P < 0.001). Proportions of nodules less than 8 mm or subsolid were both more frequent in the mobile LDCT group (83.3% vs. 76.1%, 32.9% vs. 29.8%, respectively; both P < 0.05). In the baseline screening, 26 cases of lung cancer were identified in the mobile LDCT scanning with remote reading cohort, with a lung cancer detection rate of 0.57% (26/4527), which was significantly higher than control (4/2724 = 0.15%, P = 0.006). Moreover, 80.8% (21/26) of lung cancer patients detected by mobile CT with remote reading were in stage I, remarkedly higher than that of 25.0% in control (1/4, P = 0.020).ConclusionMobile LDCT combined with remote reading is probably a potential mode for lung cancer screening in rural areas.Trial registrationNo. of registration trial was ChiCTR-DDD-15007586 (http://www.chictr.org).

Successes and Challenges of Implementing a Lung Cancer Screening Program in Federally Qualified Health Centers: A Qualitative Analysis Using the Consolidated Framework for Implementation Research

2020 ◽  
Author(s):  
Caitlin G. Allen ◽  
Megan M. Cotter ◽  
Robert A. Smith ◽  
Lesley Watson
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Pilot Project ◽  
Health Centers ◽  
Implementation Barriers ◽  
Successful Program ◽  
Barriers To Implementation ◽  
Facilitators And Barriers

Abstract Background: The American Cancer Society (ACS) partnered with two federally qualified health centers (FQHCs) and American College of Radiology designated lung cancer screening facilities on a two-year pilot project to implement lung cancer screening. The project aimed to develop a referral program and care coordination practices to move patients through the screening continuum and identify critical facilitators and barriers to implementation. Methods: Evaluators conducted key informant interviews (N=46) with navigators, clinical staff, administrators from both sites, and ACS staff during annual site visits in 2017 and 2018 to capture data on implementation barriers and facilitators. Three evaluators conducted a thematic analysis using the Consolidated Framework for Implementation Research (CFIR) and assessed factors associated with effective implementation and improved screening outcomes.Results: One study site established a sustainable lung screening program, while the other encountered numerous implementation barriers which they failed to overcome. CFIR constructs highlighted critical barriers and factors associated with success and improved outcomes. Intervention Characteristics: Time spent with patients and disruption to normal workflows were challenges to implementation at both sites. Outer Setting: Both sites struggled with building patient trust and worked to gain trust by providing clear, consistent information about the screening process. One site was located in a state with Medicaid expansion that reimbursed screening but the other was not. Inner Setting: Engaged, supportive leaders who provided clear, consistent communication about implementation helped improve staff capacity, which was critical to building a successful program. Individual Characteristics: Knowledgeable, confident champions and intervention leaders were able to train, guide, and motivate staff throughout the intervention, whereas the absence of supportive leadership failed to produce staff champions and intervention leaders. Process: A slow, stepwise approach to implementation at one site allowed project champions to pilot-test the referral and reimbursement processes and resolve issues before scaling-up.Discussion: This pilot project provides insight into critical resources and steps for successful program implementation in underserved FQHC settings. Future efforts could build upon these findings by considering self-assessment and monitoring tools that incorporate CFIR constructs to help identify and address possible facilitators and barriers to implementation of LDCT.

Organizational Factors Influencing the Use of Clinical Decision Support for Improving Cancer Screening Within Community Health Centers

2016 ◽  
pp. 118-148 ◽  
Author(s):  
Timothy Jay Carney ◽  
Michael Weaver ◽  
Anna M. McDaniel ◽  
Josette Jones ◽  
David A. Haggstrom
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Decision Support ◽  
Cancer Screening ◽  
Community Health ◽  
Clinical Decision Support ◽  
Community Health Centers ◽  
Clinical Decision ◽  
Health Centers ◽  
Practice Setting

Adoption of clinical decision support (CDS) systems leads to improved clinical performance through improved clinician decision making, adherence to evidence-based guidelines, medical error reduction, and more efficient information transfer and to reduction in health care disparities in under-resourced settings. However, little information on CDS use in the community health care (CHC) setting exists. This study examines if organizational, provider, or patient level factors can successfully predict the level of CDS use in the CHC setting with regard to breast, cervical, and colorectal cancer screening. This study relied upon 37 summary measures obtained from the 2005 Cancer Health Disparities Collaborative (HDCC) national survey of 44 randomly selected community health centers. A multi-level framework was designed that employed an all-subsets linear regression to discover relationships between organizational/practice setting, provider, and patient characteristics and the outcome variable, a composite measure of community health center CDS intensity-of-use. Several organizational and provider level factors from our conceptual model were identified to be positively associated with CDS level of use in community health centers. The level of CDS use (e.g., computerized reminders, provider prompts at point-of-care) in support of breast, cervical, and colorectal cancer screening rate improvement in vulnerable populations is determined by both organizational/practice setting and provider factors. Such insights can better facilitate the increased uptake of CDS in CHCs that allows for improved patient tracking, disease management, and early detection in cancer prevention and control within vulnerable populations.

Lung Cancer Screening: Promise and Pitfalls

2012 ◽  
pp. 450-457
Author(s):  
Christine D. Berg ◽  
Denise R. Aberle ◽  
Douglas E. Wood
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Mortality ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
Medical Community ◽  
Helical Computed Tomography ◽  
Screening Guidelines ◽  
Screening Programs ◽  
National Lung Screening Trial

OVERVIEW: The results of the National Lung Screening Trial (NLST) have provided the medical community and American public with considerable optimism about the potential to reduce lung cancer mortality with imaging-based screening. Designed as a randomized trial, the NLST has provided the first evidence of screening benefit by showing a 20% reduction in lung cancer mortality and a 6.7% reduction in all-cause mortality with low dose helical computed tomography (LDCT) screening relative to chest X-ray. The major harms of LDCT screening include the potential for radiation-induced carcinogenesis; high false-positivity rates in individuals without lung cancer, and overdiagnosis. Following the results of the NLST, the National Comprehensive Cancer Network (NCCN) published the first of multiple lung cancer screening guidelines under development by major medical organizations. These recommendations amalgamated screening cohorts, practices, interpretations, and diagnostic follow-up based on the NLST and other published studies to provide guidance for the implementation of LDCT screening. There are major areas of opportunity to optimize implementation. These include standardizing practices in the screening setting, optimizing risk profiles for screening and for managing diagnostic evaluation in individuals with indeterminate nodules, developing interdisciplinary screening programs in conjunction with smoking cessation, and approaching all stakeholders systematically to ensure the broadest education and dissemination of screening benefits relative to risks. The incorporation of validated biomarkers of risk and preclinical lung cancer can substantially enhance the effectiveness screening programs.

scholarly journals Effectiveness of Lung Cancer Screening Implementation in the Community Setting in the United States

2019 ◽  
Vol 15 (7) ◽  
pp. e607-e615 ◽  
Author(s):  
Amy Copeland ◽  
Angela Criswell ◽  
Andrew Ciupek ◽  
Jennifer C. King
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Community Setting ◽  
Lung Cancer Screening ◽  
The United States ◽  
Community Based ◽  
Lung Cancers ◽  
Low Dose Computed Tomography

PURPOSE: The National Lung Screening Trial demonstrated a 20% relative reduction in lung cancer mortality with low-dose computed tomography screening, leading to implementation of lung cancer screening across the United States. The Centers for Medicare and Medicaid Services approved coverage, but questions remained about effectiveness of community-based screening. To assess screening implementation during the first full year of CMS coverage, we surveyed a nationwide network of lung cancer screening centers, comparing results from academic and nonacademic centers. METHODS: One hundred sixty-five lung cancer screening centers that have been designated Screening Centers of Excellence responded to a survey about their 2016 program data and practices. The survey included 21 pretested, closed- and open-ended quantitative and qualitative questions covering implementation, workflow, numbers of screening tests completed, and cancers diagnosed. RESULTS: Centers were predominantly community based (62%), with broad geographic distribution. In both community and academic centers, more than half of lung cancers were diagnosed at stage I or limited stage, demonstrating a clear stage shift compared with historical data. Lung-RADS results were also comparable. There are wide variations in the ways centers address Centers for Medicare and Medicaid Services requirements. The most significant barriers to screening implementation were insurance and billing issues, lack of provider referral, lack of patient awareness, and internal workflow challenges. CONCLUSION: These data validate that responsible screening can take place in a community setting and that lung cancers detected by low-dose computed tomography screening are often diagnosed at an early, more treatable stage. Lung cancer screening programs have developed different ways to address requirements, but many implementation challenges remain.

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