Uptake Of Lung Cancer Screening Research Articles

Preferred Lung Cancer Screening Modalities in China: A Discrete Choice Experiment.

Simple SummaryFew results from public attitudes for lung cancer screening are available both in China and abroad. The aims of this study were to explore whether preferences were related to respondent characteristics and identify which kinds of respondents were more likely to opt out of any screening. Preferred screening modality in this study was inconsistent with current Chinese practice. Screening interval was the main determinant of preferred lung cancer screening modality in both the general respondents and in subgroups, this poses a considerable challenge to the implementation of a sustainable, regular screening programme. In addition, those with no endowment insurance were more likely to opt out; indicating that a promotion of financial support is needed to reduce inequalities of attendance of disadvantaged elderly.This study aimed to identify preferred lung cancer screening modalities in a Chinese population and predict uptake rates of different modalities. A discrete choice experiment questionnaire was administered to 392 Chinese individuals aged 50–74 years who were at high risk for lung cancer. Each choice set had two lung screening options and an option to opt-out, and respondents were asked to choose the most preferred one. Both mixed logit analysis and stepwise logistic analysis were conducted to explore whether preferences were related to respondent characteristics and identify which kinds of respondents were more likely to opt out of any screening. On mixed logit analysis, attributes that were predictive of choice at 1% level of statistical significance included the screening interval, screening venue, and out-of-pocket costs. The preferred screening modality seemed to be screening by low-dose computed tomography (LDCT) + blood test once a year in a general hospital at a cost of RMB 50; this could increase the uptake rate by 0.40 compared to the baseline setting. On stepwise logistic regression, those with no endowment insurance were more likely to opt out; those who were older and housewives/househusbands, and those with a health check habit and with commercial endowment insurance were less likely to opt out from a screening programme. There was considerable variance between real risk and self-perceived risk of lung cancer among respondents. Lung cancer screening uptake can be increased by offering various screening modalities, so as to help policymakers further design the screening modality.

Lung cancer screening primer: Key information for primary care providers.

To review new evidence reported since the 2016 publication of the Canadian Task Force on Preventive Health Care recommendations and to summarize key facets of lung cancer screening to better equip primary care providers (PCPs) in anticipation of wider implementation of the recommendations. A new, large randomized controlled trial has been published since 2016, as have updates from 4 other trials. PubMed was searched for studies published between January 1, 2004, and December 31, 2020, using search words including lung cancer screening eligibility, lung cancer screening criteria, and lung cancer screening guidelines. All information from peer-reviewed articles, reference lists, books, and websites was considered. Lung cancers diagnosed at stage 4 have a 5-year survival rate of only 5% and have a disproportionate impact on those with lower socioeconomic status, rural populations, and Indigenous populations. By downstaging, or diagnosing lung cancers at an earlier and more treatable stage, lung cancer screening reduces mortality with a number needed to screen of 250 to prevent 1 death. Practical aspects of lung cancer screening are reviewed, including criteria to screen, appropriate low-dose computed tomography screening, and management of findings. Harms of screening, such as overdiagnosis and incidental findings, are discussed to allow PCPs to appropriately counsel their patients in the face of ongoing implementation of new lung cancer screening programs. Lung cancer screening, with its embedded emphasis on smoking cessation, is an excellent addition to PCPs' preventive health care tools. The implementation of formal and pilot lung cancer screening programs across Canada means that PCPs will be increasingly required to counsel their patients around the uptake of lung cancer screening.

Psychological Targets for Lung Cancer Screening Uptake: A Prospective Longitudinal Cohort Study

IntroductionLow uptake of low-dose computed tomography lung cancer screening by high-risk groups compromises its effectiveness and equity as a population-level early detection strategy. Numerous psychological factors are implicated qualitatively or retrospectively, but prospective data are needed to validate their associations with uptake behavior and specify psychological targets for intervention. MethodsThis is a prospective, longitudinal cohort study evaluating psychological correlates of lung cancer screening uptake. Ever-smokers (aged 55–77 y) were invited to a lung health check, at which low-dose computed tomography screening was offered through the SUMMIT Study—a multicenter screening implementation trial. One week after their screening invitation, 44,000 invitees were mailed the self-regulatory questionnaire for lung cancer screening. Regression analyses evaluated the constructs’ associations with uptake (telephoning for an appointment) and sociodemographic characteristics. ResultsHigher odds of uptake were associated with both positive and negative perceptions. Positive perceptions included lung cancer controllability, benefits of early diagnosis, improved survival when lung cancer is detected early, willingness to be treated, and believing smoking cessation is effective in reducing risk. Negative perceptions included a higher lung cancer risk perception, negative beliefs about the consequences of lung cancer, perceiving lung cancer as stigmatized, and a negative emotional response. Although current smokers held the highest risk perceptions, they also reported negative perceptions that could undermine how they behave in response to their risk. ConclusionsInterventions to improve uptake should focus on changing perceptions that affect how an individual reacts when they believe their risk of lung cancer is high.

Abstract LB219: Methods to improve representation of racial and ethnic minorities in lung cancer screening programs: A systematic review

Abstract Background: Most lung cancer screening trials to date and current screening guidelines overlook vulnerable populations with disproportionate lung cancer burden such as racial and ethnic minorities. Given the barriers, perceptions, and socioeconomic burden of these underserved populations, uptake of lung cancer screening has minimal. To develop and implement better methods of recruitment underserved populations, concerted efforts to understand the barriers and perceptions of these population are needed. Objective: Conduct a systematic review of methods for recruitment of racial and ethnic minorities into lung cancer screening trials or programs. Methods: We searched for studies that reported methods of recruitment and racial and ethnic minorities into lung cancer screening from 2010 to June 2020, using Ovid MEDLINE and Embase databases. Full-text screening and data extraction were completed independently by two reviewers and adjudication was performed by a third, independent reviewer. We compared referral rates of the recruitment modalities by racial/ethnic subgroups and by sex. Results: We identified 525 studies of which 25 were included in the systematic review corresponding to 291,329 patients. The most frequent methods of recruitment were referral, physical mail, community-based strategies, targeted strategies, phone, advertisement, and social media. Referral (n=7; 2,510 patients) was the most effective method of recruitment with response rates ranging from 31% to 97%. Direct mail (n=8 studies; 189,799 patients) was the second most extensively used recruitment method with response rates of 28% to 79%. Direct mail to Hispanic patients (2,995 total) for lung cancer screening programs was more effective than other methods of recruitment. Direct mail was more effective in recruiting African American patients (8,331 total) compared to referral (1,083 total). Conclusion: This review identified recruitment modalities that were more successful and less unsuccessful in recruiting racial and ethnic minorities into lung cancer screening trials and programs. This work highlights priorities and next steps required to improve recruitment of racial and ethnic minorities in lung cancer screening. There is a need to develop culturally relevant lung cancer screening interventions for Hispanics/Latino patients and to create targeted intervention for African American patients. Citation Format: Tiffany J. Gilliard, Jaileene Perez-Morales, Matthew Schabath, Mary Katherine Haver. Methods to improve representation of racial and ethnic minorities in lung cancer screening programs: A systematic review [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB219.

Understanding factors associated with uptake of lung cancer screening among individuals at higher risk.

10559 Background: Lung cancer is the leading cause of cancer death in the U.S, accounting for about 25% of all cancer mortality. The U.S Preventive Services Task Force has recommended annual screening for lung cancer using low-dose computed tomography (LDCT) scanning for individuals at higher risk (aged 55-80 years with a >30 pack-year smoking history). Early detection using LDCT scanning reduces lung cancer specific mortality by 20%. Despite its efficacy, the uptake of annual lung cancer screening among high-risk individuals remains low ( < 18%). The purpose of this study was to identify factors associated with the uptake of lung cancer screening in high-risk individuals in the U.S population. Methods: Data for this study were obtained from the 2017-2019 Behavioral Risk Factor Surveillance System (BRFSS), a population-based survey conducted annually by the Centers for Disease Control and Prevention (CDC) in collaboration with health departments in all 50 states, Washington, DC, and the U.S territories. We restricted our sample to high-risk individuals aged 55-80 years with a >30 pack-year smoking history. Only subjects with complete data on all predictor variables (age, gender, race/ethnicity, marital status, education, income, insurance, COPD, current smoking status, primary care provider) and the outcome variable (uptake of lung cancer screening) (n = 11, 714) were included in the final analysis. Chi-square tests were used to compare the uptake of lung cancer screening by demographic and socioeconomic factors. Multivariable logistic regression models were used to model the association between the predictors and the outcome variable. Results: Individuals with no health insurance (OR: 0.64; 95%CI: 0.46-0.90), no primary healthcare provider (OR: 0.40; 95%CI: 0.31-0.52), no chronic obstructive pulmonary disease (COPD) (OR: 0.35; 95%CI: 0.31-0.0.40) and who were females (OR: 0.86; 95%CI: 0.76-0.96) were less likely to participate in annual lung cancer screening. Individuals aged 65–69 years (OR: 1.65; 95%CI: 1.38-1.97), 70–74 years (OR: 1.77; 95%CI: 1.46-2.14) or 75–80 years (OR: 1.42; 95%CI: 1.16-1.76) were more likely to receive annual lung cancer screening compared with those aged 55-59 years. Race/ethnicity, level of education, level of income, marital status, and current smoking status had no significant association with the uptake of annual lung cancer screening. Conclusions: Our study identifies factors associated with lower uptake of annual lung cancer screening (no health insurance coverage, no primary healthcare provider, no COPD, and female gender). The findings from this study have important implications for the design of more effective interventions to target specific subgroups for the uptake of annual lung cancer screening.

Completion of lung cancer screening after a baseline order for LDCT at five diverse health systems.

10506 Background: In 2014 and 2015, the Affordable Care Act required coverage of, and CMS began reimbursing for lung cancer screening (LCS). Previous studies have shown that when new screening tests or treatments become available, disparities in disease outcomes often increase due to those with fewer resources having less access and greater barriers to care. African American men have historically had higher incidence of and death due to lung cancer than white males in the U.S., raising concerns regarding access to LCS and the potential for increases in disparities in lung cancer. We aimed to determine whether individual or neighborhood level factors were associated with completion of a baseline screening after an order for LCS low dose CT (LDCT) was placed. Methods: In a retrospective study conducted within the five health systems of the Lung Population-based Research to Optimize the Screening Process (PROSPR) Consortium, we determined adherence to baseline LDCT after a health care provider placed an order for LCS (January 2014 through June 2019). Follow-up was available through September 2019. Patients of interest for this analysis were current or former smokers, age 55 to 80 with a 30+ pack-year smoking history. Smoking history and other individual level variables were determined through electronic medical records. Neighborhood factors were derived from the 2010 Census and multivariable logistic regression was used. Results: Of the 13,920 patients that had at least one order for a baseline LCS exam, 14.1% were non-Hispanic Black, 70.3% were non-Hispanic White, and 15.7% were of other or unknown race. Overall, 61.2% of patients completed a LDCT within 90 days and 71.9% completed a scan by the end of follow-up. Completion of a baseline scan differed by health system (LDCT at 90-days, range 51% - 84%, p<0.0001) and increased in general across scan year (range 49.1%-66.0%, p <0.001). In multivariate logistic regression models, males (aOR=1.15, 95% CI 1.07-1.23, p=<0.0001), former smokers (aOR=1.31, 95% CI 1.21-1.40, p <0.0001), and those with a prior history of any cancer (aOR=1.16, 95% CI 1.02-1.32, p=0.03) were more likely to complete LDCT. Blacks were marginally less likely to have completed a baseline LDCT (aOR=0.90, 95% CI 0.81-1.00, p=0.06) within 90 days of an order. Sex modified the associations of race on completion of orders (p=0.08) (Black men aOR=0.81, 95% CI 0.70-0.94, p=0.006 ; Black women aOR=0.99, 95% CI 0.86-1.14, p=0.89). Conclusions: This multisite study indicates Black men in particular may have a lower likelihood of completing a baseline LCS after an order for screening is placed. As lung cancer screening programs move forward, attention should be given to factors associated with reduced uptake and adherence of screening to ensure disparities in lung cancer outcomes do not persist and increase. Provider and health system factors that may impact LCS uptake should be explored in future studies.

Comorbidity Profiles and Lung Cancer Screening among Older Adults: U.S. Behavioral Risk Factor Surveillance System 2017-2019.

Rationale: Although lung cancer screening (LCS) with low-dose computed tomography (LDCT) is now recommended for those meeting standard risk factor-based eligibility criteria, the role of comorbidity in the uptake of LCS with LDCT in an older real-world U.S. population is not well established. Objectives: To examine the relationships between comorbidity, functional status, and LCS utilization in the United States. Methods: Using population-based data from the 2017-2019 Behavioral Risk Factor Surveillance System, we examined the association of comorbid conditions and functional limitations regarding activities of daily living with LCS utilization among participants that met the LCS criteria based on the U.S. Preventive Service Taskforce guidelines. We employed multivariable weighted logistic regression models to evaluate these associations, both overall and within subgroups defined by age (<65 yr vs. ⩾65 yr), sex, and smoking history. Results: Of 11,214 participants who met the eligibility criteria for LCS, 1,731 (16%) underwent LCS with LDCT. The majority were White (90%), male (55%), former smokers (52%), and living with at least one chronic comorbid condition (77%). More than 28% had three or more comorbid conditions, and approximately 40% of participants reported having some form of functional limitations. In the multivariable models, the likelihood of undergoing LCS with LDCT within the past year was positively associated with higher amount of comorbidity (⩾5 vs. 0: adjusted odds ratio, 2.34; 95% confidence interval [CI], 1.22-4.48) but not with functional limitations (⩾3 vs. 0: adjusted odds ratio, 1.00; 95% CI, 0.66-1.50). Conclusions: The presence of comorbid conditions is associated with a higher likelihood of undergoing LCS with LDCT. Because poor health status may diminish the benefits of screening, future research is needed to precisely characterize the health status of LCS-eligible individuals.

Abstract PO-092: Developing a computable phenotype to identify populations eligible/ineligible for lung cancer screening

Abstract Introduction Seventy percent of lung cancer patients are diagnosed at advanced stages. Lung cancer screening (LCS) can potentially produce a stage-shift through early detection of the disease. The 2013 LCS guideline from the U.S. Preventive Services Task Force (USPSTF) recommended screening with low-dose computed tomography (LDCT) for individuals aged between 55 and 80 with 30 pack-year smoking history (i.e., current smoker or had quit smoking within 15 years). However, the high false-positive rate of LCS with LDCT is one of the concerns that hinders the uptake of LCS in real-world settings. An electronic health record (EHR)-based computable phenotyping (CP) algorithm that accurately identifies patients who meet the LCS eligibility criteria can potentially improve the reach of screening eligible population and thereby increase the uptake of LCS. Objective To develop an EHR-based CP algorithm to identify patients eligible for LCS. Method The LCS CP algorithm was developed to extract quantitative smoking information (i.e., pack-years, smoking years, quit year) using both structured EHR and unstructured clinical notes, enabled by advanced natural language processing (NLP) methods. The study cohort consisted of 3,080 patients who received LCS with LDCT based on procedure codes, as documented in EHR data from the UF Health Integrated Data Repository (IDR). The EHR-based LCS CP algorithm included two modules, one to extract smoking information from both structured EHR data and clinical notes using NLP techniques, and the other to integrate the extracted results based on the CP rules (e.g., pack-year &amp;gt; 30; quit year within 15 years; age 55-80) to determine whether a patient is eligible for LCS. For initial evaluation, we conducted a chart review of 20 randomly selected patients and compared the CP algorithm outcomes with the chart review results. Results and Discussion The manual chart review of the 20 patients who underwent LCS with LDCT identified 13 patients were qualified for LCS, 6 patients were not qualified for LCS, and 1 patient was undecidable. Based on this gold standard dataset, the CP algorithm achieved a specificity of 1.00 and a sensitivity of 0.92. Without smoking information extracted from clinical notes using NLP, the specificity score dropped to 0.80. Our results indicate that clinical notes are an important source of information on smoking histories. For all smoking-related information extracted from the clinical notes, smoking history was consistent with the structured EHR in 60% of cases, inconsistent in 10% cases, with the remaining 30% missing. Our results point to (1) suboptimal documentation of smoking information in EHRs, (2) added value of artificial intelligence methods such as NLP in improving CP performance, and (3) potential of an EHR-based CP to accurately identify patients eligible for LCS, and potential relevance to clinical decision support. As the upcoming USPSTF LCS guideline is changing (i.e., from 30 pack-year to 20 pack-year), the CP needs be refined to reflect the changes. Citation Format: Shuang Yang, Tianchen Lyu, Xi Yang, Yonghui Wu, Yi Guo, Michelle Alvarado, Hiren J. Mehta, Ramzi G. Salloum, Dejana Braithwaite, Jinhai Huo, Ya-Chen Tina Shih, Jiang Bian. Developing a computable phenotype to identify populations eligible/ineligible for lung cancer screening [abstract]. In: Proceedings of the AACR Virtual Special Conference on Artificial Intelligence, Diagnosis, and Imaging; 2021 Jan 13-14. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(5_Suppl):Abstract nr PO-092.

Development and psychometric testing of the self-regulatory questionnaire for lung cancer screening (SRQ-LCS)

Background: Research implicates psychological factors in low uptake of lung cancer screening. We developed and psychometrically tested a standardised measure of these psychological determinants in preparation for a prospective, longitudinal cohort study of screening uptake. Methods: Leventhal’s Common-Sense Model of Self-Regulation of Health and Illness provided the theoretical framework to generate the initial item pool. Items were refined during expert review and cognitive interviews which tested for face validity, redundancy, acceptability and comprehensibility. An online survey piloted the refined pool with 1500 current and former (quit ≤ 15 years) smokers aged 55–80. The response distributions, internal reliability and factor structure determined the final retained constructs. Regression analyses examined these constructs’ associations with screening intention, smoking status and demographics. Results: The final measure included seven factor-derived subscales (consequences, personal control, treatment control, illness coherence, emotional representation, behavioural response and appraisal, risk perception) with Cronbach’s alphas ranging from 0.59 to 0.91 and four single-item questions (response efficacy for smoking cessation, treatment intention, perceived stigma and lung cancer survival). Most constructs were associated with smoking status and screening intention (p’s < .05). Conclusions: The Self-Regulatory Questionnaire for Lung Cancer Screening (SRQ-LCS) is an acceptable, reliable and valid measure for investigating the psychological determinants of screening uptake.

Practice, clinician, and patient factors associated with the adoption of lung cancer screening.

Lung cancer remains the leading cause of cancer-related deaths in the United States. In 2013, the US Preventive Services Task Force recommended annual screening for lung cancer with low-dose computed tomography in adults meeting certain criteria. This study seeks to assess lung cancer screening uptake in three health systems. This study was part of a randomized controlled trial to engage underserved populations in preventive care and includes 45 primary care practices in eight states. Practice and clinician characteristics were manually collected. Lung cancer was measured from electronic health record data. A generalized linear mixed model was used to assess characteristics associated with screening. Patient records between 2012 and 2016 were examined. Lung cancer screening uptake overall increased only slightly after the guideline change (2.8-5.6%, p < 0.01). One health system did not show an increase in uptake (0.2-0.1%, p = 0.32), another had a clinically insignificant increase (1.5-2.9%, p < 0.01), and the third nearly doubled its higher baseline screening rate (10.4-19.1%, p < 0.01). Within the third health system, patients more likely to be screened were older, male, had more comorbid conditions, visited the office more frequently, were seen in practices closer to the screening clinic, or were uninsured or covered by Medicare or Medicaid. Certain patients appeared more likely to be screened. The only health system with increased lung cancer screening explicitly promoted screening rather than relying on clinicians to implement the new guideline. Systems approaches may help increase the low uptake of lung cancer screening.

Evaluating Lung Cancer Screening Across Diverse Healthcare Systems: A Process Model from the Lung PROSPR Consortium.

Numerous organizations, including the United States Preventive Services Task Force, recommend annual lung cancer screening (LCS) with low-dose CT for high risk adults who meet specific criteria. Despite recommendations and national coverage for screening eligible adults through the Centers for Medicare and Medicaid Services, LCS uptake in the United States remains low (<4%). In recognition of the need to improve and understand LCS across the population, as part of the larger Population-based Research to Optimize the Screening PRocess (PROSPR) consortium, the NCI (Bethesda, MD) funded the Lung PROSPR Research Consortium consisting of five diverse healthcare systems in Colorado, Hawaii, Michigan, Pennsylvania, and Wisconsin. Using various methods and data sources, the center aims to examine utilization and outcomes of LCS across diverse populations, and assess how variations in the implementation of LCS programs shape outcomes across the screening process. This commentary presents the PROSPR LCS process model, which outlines the interrelated steps needed to complete the screening process from risk assessment to treatment. In addition to guiding planned projects within the Lung PROSPR Research Consortium, this model provides insights on the complex steps needed to implement, evaluate, and improve LCS outcomes in community practice.

ES08.01 Participation of the Target Population in Lung Cancer Screening

The two largest randomized controlled trials performed, The National Lung Screening Trial (NLST) and the Nederlands-Leuvens Longkanker ScreeningsONderzoek (NELSON) 1,2, proved that lung cancer screening using low dose CT scan, resulted in a significant reduction in lung cancer mortality. Following the results of the NLST trial, lung cancer screening was initiated in the United States and Canada. However, the uptake of lung cancer screening is poor, with only 3% to 4% of all eligible persons participating in the implemented screening program 3. Given more recent positive results of the NELSON study that were presented at the World Conference on Lung Cancer last year in Toronto, lung cancer screening is now considered in many countries across the globe. This low uptake of lung cancer screening is however a cause of concern. The reasons for the low participation rate are multi-factorial. The novelty of the lung cancer screening program is such a factor, resulting in lower uptake and might be the easiest one to address. The identification of the target population is more challenging due to the fact that the population to be screened is more defined than just age and sex. In addition, the lower socioeconomic status, which presents a significant portion of the to be screened population, and those who face barriers to care present a major challenge for implementing a successful screening program with a satisfactory uptake rate. Several strategies have been proposed to improve lung cancer screening uptake. In the socioeconomically deprived and heavy smoking communities, lung cancer is perceived as an uncontrollable disease 4, while cure rates in yearly screening programs lead to a cure in the majority of patients when lung cancer is detected 5,6. Therefore, public awareness of the curability of lung cancer when screening programs are implemented could boost the participation rate. Mobile lung cancer testing in supermarket car parks proved to be a successful pilot 7. This strategy avoids difficulties relating to the distance of travel, lack of public transport available, and the cost of either the journey itself or hospital parking. This strategy is currently explored in a larger cohort. One potential intervention that is being evaluated in clinical trials to improve the uptake and implementation of lung cancer screening is a patient navigator. A navigator can be a layperson, a medical assistant, or a nurse who will directly contact potential candidates for lung cancer screening for enrollment 3. The Accelerate, Coordinate, Evaluate (ACE) Programme, initiated in the United Kingdom, is an early diagnosis of cancer initiative focused on testing innovations that either identify individuals at high risk of cancer earlier 8. This program consists of several individual programs in different regions of the UK, of which The Liverpool Healthy Lung Programme is a participant. Among other goals, this initiative tries to improve uptake in the hard to reach cohort. They used general practitioners’ records to invite participants meeting the criteria to a ‘Lung Health Check’. This ‘Lung Health Check’ is a novel approach that may overcome or minimize the emotional barriers associate with the term “lung cancer screening”. This method resulted in an uptake level up to 40% 9. This initiative is an example that a higher uptake rate is indeed possible, even in the hard to reach population. At the IASLC World Conference on Lung Cancer in Barcelona, the issues regarding participation of the target population in lung cancer screening will be addressed and possible strategies will be discussed to overcome these challenges. As lung cancer screening is yet to be implemented in the majority of countries worldwide, we now have a unique opportunity to test and apply these strategies to successfully implement lung cancer screening in order to reduce lung cancer mortality.

IMPACT OF CURRENT SMOKING STATUS ON UPTAKE OF LUNG CANCER SCREENING REFERRAL IN A COHORT OF RACIALLY DIVERSE PATIENTS

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: In 2013, the US Preventive Services Task Force (USPSTF) recommended lung cancer screening by low-dose computed tomography (LDCT) for individuals ages 55-80 with a smoking history of 30 pack-years or more. Factors that affect uptake of screening recommendations are of utmost importance, particularly in marginalized groups, in order to prevent the disparity typically seen with new screening regimens. In this study, we assess factors that may affect the uptake of a referral to lung cancer screening at Henry Ford Health System. Particularly of interest were race and smoking status at the time of the first screening recommendation. METHODS: Using a cohort of patients referred for lung cancer screening between March 1, 2015 and February 28, 2018 (N=4,097), we used multivariable logistic regression to determine whether race or smoking status were associated with completion of an initial lung screening exam. Data were captured using the health system’s electronic medical record. RESULTS: Of all patients referred for screening, 932 (22.7%) were black and 2,747 (67.0%) were white. Current smokers represented 60.7%, 57.3%, and 70.2% of all, white, and black patients, respectively. Overall, 2,791 (68.1%) patients completed an initial LDCT screen. Of these, 614 (22.0%) were black and 1,902 (68.1%) were white. In multivariable analyses, race was not associated with completion of LDCT screen. Former smokers were more likely to complete a screening exam than current smokers (aOR 1.170, 95% CI 1.01-1.36). However, this finding differed by racial group; among whites, the adjusted odds ratio for lung cancer screening uptake comparing former smokers to current smokers was 1.32 (95% CI 1.10-1.59). Among blacks, smoking status was not significantly associated with screening (aOR 0.84 [95% CI 0.60-1.16]). CONCLUSIONS: These findings have implications for promoting uptake of lung screening among diverse patient populations. CLINICAL IMPLICATIONS: Racially diverse patient groups may require tailored shared decision making in lung cancer screening. DISCLOSURES: No relevant relationships Added 03/14/2019 by Elizabeth Alleman, source=Web Response, value=Ownership interest Removed 03/14/2019 by Elizabeth Alleman, source=Web Response No relevant relationships Added 03/14/2019 by Elizabeth Alleman, source=Web Response, value=Ownership interest Removed 03/14/2019 by Elizabeth Alleman, source=Web Response No relevant relationships by Amanda Holm, source=Web Response No relevant relationships by Christine Neslund-Dudas, source=Web Response No relevant relationships by Angel Rolando Peralta, source=Web Response No relevant relationships by Michael Sheehan, source=Web Response Consultant relationship with Auris Health Please note: $1001 - $5000 Added 03/15/2019 by Michael Simoff, source=Web Response, value=Consulting fee Board Member relationship with Intuitive Surgical Please note: $1001 - $5000 Added 03/15/2019 by Michael Simoff, source=Web Response, value=Consulting fee Principle Investigator relationship with Gongwin Biopharm Please note: $5001 - $20000 Added 03/15/2019 by Michael Simoff, source=Web Response, value=Grant/Research Support No relevant relationships by Amy Tang, source=Web Response

Lung Cancer Screening Utilization: A Behavioral Risk Factor Surveillance System Analysis

Lung cancer is the leading cause of cancer-related death in the U.S. The National Lung Screening Trial found that low-dose computed tomography reduced lung cancer mortality in high-risk individuals. As a result, the U.S. Preventive Services Task Force began recommending low-dose computed tomography screening for those at a high risk in 2013. Therefore, it is imperative to continually monitor lung cancer screening uptake. The objective of this study was to determine computed tomography screening uptake across ten states using 2017 Behavioral Risk Factor Surveillance System survey data. In fall 2018, a cross-sectional analysis was performed on survey data from 4,374 low-dose computed tomography-eligible participants, as determined by Task Force recommendations. Weighted percentages were calculated to assess computed tomography screening utilization overall and by state, sociodemographic, and clinical characteristics; Wald chi-squared tests evaluated group differences. Within the study sample, 14.4% of eligible individuals had a computed tomography scan to test for lung cancer within the past 12 months. Significant state-to-state variation was identified (6.5% utilization in Nevada to 18.1% in Florida, p=0.03). Screening utilization was higher among individuals with insurance than among the uninsured (15.2% vs 4.0%, p<0.001), and it was higher among individuals with asthma (22.9% vs 12.9%, p=0.006) or chronic obstructive pulmonary disease (23.7% vs 8.5%, p<0.001) than among those without either condition. Computed tomography screening utilization was higher than in earlier estimates. However, further research is needed to elucidate geographic variation in screening.

Race and sex differences in patient provider communication and awareness of lung cancer screening in the health information National Trends Survey, 2013–2017

Despite demonstrated reduction in lung cancer mortality, lung cancer screening uptake has been low. We investigated differences in discussions with physicians about lung cancer screening and awareness using repeated cross-sectional data from three cycles [4.2 (2013); 4.4(2014) and 5.1 (2017)] of the Health Information National Trends Survey. We included 4207 respondents age 55 to 80 who responded to this question: ‘In the past year, have you talked with your doctor about having a test to check for lung cancer?’. We used logistic regression accounting for complex sample weighting to generate multivariable adjusted odds ratios (ORs) and 95% confidence intervals (CIs). The proportion of participants reporting lung cancer screening discussions was low and did not increase over time. In the most recent cycle, 15.7% of current smokers and 9.9% of former smokers said they had discussed screening. Compared to males, females were 32% less likely to report a lung cancer screening discussion (OR: 0.68, 95% CI: 0.50–0.93) and the association was strongest among non-Hispanic White females. Estimates were similar among never (OR: 0.72, 95% CI: 0.43–1.20), current (OR: 0.73, 95% CI: 0.39–1.36), and former (OR: 0.66, 95% CI: 0.40–1.10) smokers. Females were 32% less likely than males to be aware of a lung cancer screening test (OR: 0.68, 95% CI: 0.47–0.99) and this association was strongest for non-Hispanic Black females (OR: 0.38, 95% CI: 0.19–0.77). Too few providers have discussed lung cancer screening with potentially eligible patients, particularly female patients. Further research is needed to evaluate possible causes for this finding.

LDCT lung cancer screening eligibility and use of CT scans for lung cancer among sexual minorities

ObjectiveTo compare eligibility for lung cancer screening and receipt of a CT scan for lung cancer among sexual minorities. MethodsSecondary data analysis of cross-sectional data from older U.S. adults in the Behavioral Risk Factor Surveillance System survey during the 2017 cycle (n = 20,685). ResultsRates of eligibility for low-dose helical computed tomography (LDCT) were roughly twice as high among sexual minorities than among heterosexuals (21.1% vs. 11.7%). The odds of gay men and lesbian women indicating eligibility for LDCT screening were four to five times higher when compared to their heterosexual peers. No statistically significant differences were found between sexual minorities and heterosexuals with respect to having a CT scan for lung cancer in the past year. ConclusionsThere are potential sexual-identity-related disparities in the utilization of lung cancer screening among eligible smokers. Interventions are needed to increase awareness and uptake of lung cancer screening in order to detect and manage this common form of cancer in the U.S.

Poor Uptake of Lung Cancer Screening: Opportunities for Improvement

Lung cancer screening with low-dose chest CT has been demonstrated to reduce lung cancer mortality among a subset of high-risk current and former smokers. Despite randomized trial evidence and widespread guideline recommendations, uptake of lung cancer screening among currently eligible individuals remains poor. Recent studies estimate that less than 5% of all eligible individuals have undergone screening. Moreover, inappropriate screening of ineligible individuals seems to be common, and among those who have been screened, follow-up may also be poor. In this review, the authors examine recent studies demonstrating the current state of suboptimal implementation of lung cancer screening. The authors also introduce both patient- and provider-facing evidence-based interventions that may improve implementation of screening. These include tailored navigation interventions to overcome patient barriers throughout the screening care continuum and interventions to improve the identification of eligible individuals for providers. Further evidence on best practices around the implementation of lung cancer screening is essential to ensure that recent evidence can be translated into practice to improve the early detection of lung cancer for high-risk individuals.

Barriers to Lung Cancer Screening With Low-Dose Computed Tomography.

Despite lung cancer screening guidelines and insurance coverage changes, rates of lung cancer screening with low-dose computed tomography remain suboptimal among the eligible population in the United States. Electronic literature databases, including PubMed, CINAHL®, PsycINFO, and Google Scholar, were searched. After applying filter information and inclusion and exclusion criteria, 10 articles were reviewed. Methodological rigor was evaluated. Based on the social-ecological approach, barriers to lung cancer screening at the individual level, including sociodemographic characteristics, financial cost, lack of knowledge, inaccurate beliefs about lung cancer screening, distrust of the medical system, stigma around smoking and lung cancer, negative attitudes about outcomes of lung cancer screening, and inconvenience of receiving lung cancer screening, were identified. Barriers at the health-system level included lack of information from primary care providers. Overcoming barriers to lung cancer screening at individual and health-system levels is essential to increase lung cancer screening uptake rates.

A qualitative study exploring patient motivations for screening for lung cancer.

BackgroundLow-dose computed tomography (LDCT) of the chest for lung cancer screening of heavy smokers was given a ‘B’ rating by the U.S. Preventive Services Task Force (USPSTF) in 2013, and gained widespread insurance coverage in the U.S. in 2015. Lung cancer screening has since had low uptake. However, for those that do choose to screen, little is known about patient motivations for completing screening in real-world practice.ObjectiveTo explore the motivations for screening-eligible patients to screen for lung cancer.MethodsSemi-structured qualitative interviews were conducted with 20 LDCT screen-completed men and women who were members of an integrated mixed-model healthcare system in Washington State. From June to September 2015, participants were recruited and individual interviews performed about motivations to screen for lung cancer. Audio-recorded interviews were transcribed and analyzed using inductive content analysis by three investigators.ResultsFour primary themes emerged as motivations for completing LDCT lung cancer screening: 1) trust in the referring clinician; 2) early-detection benefit; 3) low or limited harm perception; and 4) friends or family with advanced cancer.ConclusionParticipants in our study were primarily motivated to screen for lung cancer based on perceived benefit of early-detection, absence of safety concerns, and personal relationships. Our findings provide new insights about patient motivations to screen, and can potentially be used to improve lung cancer screening uptake and shared decision-making processes.

P2.06-005 An Exploration of Attitudes and Barriers to Uptake of Lung Cancer Screening in at Risk Adults in the United Kingdom

Lung cancer screening targets a high risk subgroup of the population, comprising current and ex-smokers. There are data to suggest that smokers view screening in a nihilistic way and perceive early detection to be of limited use and, as such, are less likely to consider screening participation. Other screening programmes have also shown markedly reduced uptake in those from the most deprived groups. Smoking rates and lung cancer incidence are highest in more socially deprived areas and lung cancer survival is worst in this group. An understanding of the key barriers to engagement with lung cancer screening is therefore vital prior to implementation of a national screening programme.