Abstract
Annual chest computed tomography (CT) can decrease lung cancer mortality in high‐risk individuals. Patient navigation improves cancer screening rates in underserved populations. Randomized controlled trial was conducted from February 2016 to January 2017 to evaluate the impact of a patient navigation program on lung cancer screening (LCS) among current smokers in five community health centers (CHCs) affiliated with an academic primary care network. We randomized 1200 smokers aged 55–77 years to intervention (n = 400) or usual care (n = 800). Navigators contacted patients to determine LCS eligibility, introduce shared decision making about screening, schedule appointments with primary care physicians (PCPs), and help overcome barriers to obtaining screening and follow‐up. Control patients received usual care. The main outcome was the proportion of patients who had any chest CT. Secondary outcomes were the proportion of patients contacted, proportion receiving LCS CTs, screening results and number of lung cancers diagnosed. Of the 400 intervention patients, 335 were contacted and 76 refused participation. Of the 259 participants, 124 (48%) were ineligible for screening; 119 had smoked <30 pack‐years, and five had competing comorbidities. Among the 135 eligible participants in the intervention group, 124 (92%) had any chest CT performed. In intention‐to‐treat analyses, 124 intervention patients (31%) had any chest CT versus 138 control patients (17.3%, P < 0.001). LCS CTs were performed in 94 intervention patients (23.5%) versus 69 controls (8.6%, P < 0.001). A total of 20% of screened patients required follow‐up. Lung cancer was diagnosed in eight intervention (2%) and four control (0.5%) patients. A patient navigation program implemented in CHCs significantly increased LCS among high‐risk current smokers.
Highlights
Lung cancer is the leading cause of cancer death among men and women in the United States
Using the primary care practice network’s existing population health management information technology system [27, 31, 32], we developed a registry to identify current smokers who might be eligible for lung cancer screening
This study evaluated the impact of a patient navigation program for lung cancer screening among current smokers receiving care in community health centers
Summary
Lung cancer is the leading cause of cancer death among men and women in the United States. An estimated 220,500 new cases of lung cancer are expected in 2017 along with 155,870 lung cancer related deaths [1]. The majority of individuals with lung cancer are diagnosed at an advanced stage when cure is no longer an option [2]. This is true for underserved populations where low socioeconomic status and inadequate access to care contribute to inequities in lung cancer care and higher rates of morbidity and mortality [3,4,5,6,7].
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