Need: Lung cancer is the most commonly diagnosed cancer affecting both men and women (Bray et al, 2018), and the leading cause of cancer-related deaths in the U.S. and Texas (ACS Facts & Figures, 2019; TX Cancer Registry). Although overall lung cancer incidence and mortality rates have declined over the past decade, disparities between racial and ethnic groups, as well as by gender, educational attainment, and rurality continue to persist (Henley et al. Cancer 2020;126(10):2250-2266). Cigarette smoking is the number one risk factor for lung cancer and >15% of adult Texans are smokers. Annual lung cancer screening, using low-dose computed tomography (LDCT), is recommended for persons who ...

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Need: Lung cancer is the most commonly diagnosed cancer affecting both men and women (Bray et al, 2018), and the leading cause of cancer-related deaths in the U.S. and Texas (ACS Facts & Figures, 2019; TX Cancer Registry). Although overall lung cancer incidence and mortality rates have declined over the past decade, disparities between racial and ethnic groups, as well as by gender, educational attainment, and rurality continue to persist (Henley et al. Cancer 2020;126(10):2250-2266). Cigarette smoking is the number one risk factor for lung cancer and >15% of adult Texans are smokers. Annual lung cancer screening, using low-dose computed tomography (LDCT), is recommended for persons who have a history of heavy smoking (>30 pack years), and smoke now or have quit in <15 years, and are between 55 and 80 years old (USPSTF, 2013). The greatest barriers to smoking cessation among an aging population are high levels of dependence, poverty and a lack of education, and lack of access to services (Smith et al., 2019). A 13-county area of TX, including nine non-metropolitan/rural counties and ten whole-county medically underserved areas has a need for improved opportunities for smoking cessation and lung cancer screening due, in part, to shortages of healthcare providers and high percentages of smokers, low-income and/or rural residents. Lung cancer incidence is higher than the TX state average of 50.6 per 100,000 persons in 11 of the 13 counties – up to 90.0 per 100,000 in Trinity County and 99.1 in Polk County. Ten of the 13 counties have a greater proportion of individuals living below federal poverty level compared to the 14.9% TX state average. More than four-fifths of the combined 1.2M people living in these counties are age 45-64 years, of which at least 20% (TX state average) are generally estimated to be adult smokers. Specific Goals: The overall goal of this new prevention project (response to CPRIT RFA P-21.2-TCL, Option B) is to provide lung cancer prevention education, support smoking cessation activities, perform LDCT screenings, and provide patient navigation across the continuum of care to qualifying persons. It is expected that >75,000 people and professionals will be indirectly reached by this project. Specific goals over 3 years: • CLINICAL SERVICES: At least 315 unique, low-income and medically underserved persons will receive up to 641 clinical services (619 LDCT and 22 related diagnostics). • SMOKING CESSATION/EDUCATION: At least 120 health care providers will be supported with resources to conduct at least 429 shared decision-making/counseling sessions towards enrollment of qualified patients into smoking cessation. • NAVIGATION: At least 429 persons will be directly served by community health workers (CHWs) and program staff with 3,177 navigation services related to smoking cessation and lung cancer screening. Strategy/Methods: Led by the TX A&M Health Science Center’s (TAMHSC) College of Medicine (COM) and the School of Public Health (SPH), this project will: (1) operate in synch with an American College of Radiology lung cancer screening/early detection program at subcontractor St. Joseph Regional Health Center, (2) leverage existing well-established clinical and community partnerships to obtain referrals from safety-net providers, and (3) incorporate CHWs for patient education and intake, barriers reduction, and navigation to services. The project coordinates LDCT screening and relevant diagnostics, with a robust program of smoking cessation intervention. Because smoking cessation for an aging population consists of multi-modal approach, our programming will include provider and patient educational resources, video to be used as an assist for clinician-patient shared decision making (counseling session), use of nicotine replacement therapies, use of apps and quitlines, and CO monitoring. To ensure a continuum of care, St. Joseph lung cancer navigator and project CHWs will assist patients with positive LDCT findings by scheduling repeat LDCT and/or directing patients to hospital charity care and indigent programs for reduced-cost and/or free treatment in the patient’s county of residence. Committed Year 1 referring clinics include the 15-clinic HealthPoint network of federally-qualified health centers, a faith-based healthcare network – Tomagwa Healthcare Ministries, and Tyler County Hospital and Clinic serving East TX. Significance and Impact: Lung cancer is a significant public health problem in Texas, especially in areas with poor and uninsured populations with high percentages of smokers or reduced access to healthcare services. Funding for this project will promote lung cancer prevention education, support smoking cessation programming, and provide residents of 13 counties with lung cancer screenings and patient navigation to reduce barriers and improve early detection of lung cancer.

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