A patient navigation program implemented in community health centers significantly increased lung cancer screening among underserved populations, according to research presented at the 2017 ASCO Annual Meeting (June 2-6, 2017; Chicago, IL).
Undergoing an annual chest computed tomography (CT) scan can decrease lung cancer mortality in high-risk individuals. Patient navigation programs have shown to improve cancer screening rates in underserved populations.
Sanja Percac-Lima, MD, Massachusetts General Hospital (Boston, MA), and colleagues conducted a study to evaluate patient navigation programs on lung cancer screening among current smokers in community health centers. Researchers enrolled 1200 current smokers aged 55 to 77 years receiving care at 5 community health centers from 2016 to 2017, 400 of whom were randomly assigned to patient navigation and 800 to usual care. In the patient navigation group, patient navigators determined screening eligibility, provided brief smoking cessation counseling, introduced shared decision-making about screening, scheduled appointments with primary care providers, and reminded patients about appointments as well as primary care providers to order CT scans.
Primary outcome was the proportion of patients in each group who had any chest CT scan during the study period. Secondary outcomes included proportion of patients receiving lung screening CTs and the number of lung cancers diagnosed in each group.
Researchers found that patient navigators contacted 335 (84%) of the patients in navigation group, 76 of whom refused further participation. Among the participating patients, 135 (52%) were eligible for lung cancer screening. One hundred and nineteen patients were excluded due to insufficient smoking history.
In the intention-to-treat analysis, 124 patients (31%) in the navigation group had chest CT scans, compared with 138 (17.3%) in the usual care group. Lung cancer screening CT scans were performed in 94 patients (23.5%) in the navigation group, compared with 69 (8.6%) in the usual care group. As a result, lung cancer was diagnosed in 8 patients (2%) in the navigation group, compared with 4 (0.5%) in the usual care group.
“We believe that navigation may help underserved low-income smokers complete lung cancer screening and increase equity in care while decreasing lung cancer mortality,” said Dr Percac-Lima in her presentation.—Zachary Bessette