Need: Low-dose computed tomography (LDCT)-based lung cancer screening for high-risk individuals decreases lung cancer and overall mortality. Paired with evidence-based tobacco cessation efforts, it represents one of the most efficient cancer screening modalities, with a number needed to screen (NNS) of 320 to prevent one lung cancer death. By contrast, NNS for colorectal, breast, and cervical cancer range 780-1140. Despite this evidence, fewer than 4 percent of potentially eligible individuals in the U.S. have received lung cancer screening. Participation and adherence rates may be particularly low among medically underserved populations. Overall Project Strategy: We will sustain a...

Read More

Need: Low-dose computed tomography (LDCT)-based lung cancer screening for high-risk individuals decreases lung cancer and overall mortality. Paired with evidence-based tobacco cessation efforts, it represents one of the most efficient cancer screening modalities, with a number needed to screen (NNS) of 320 to prevent one lung cancer death. By contrast, NNS for colorectal, breast, and cervical cancer range 780-1140. Despite this evidence, fewer than 4 percent of potentially eligible individuals in the U.S. have received lung cancer screening. Participation and adherence rates may be particularly low among medically underserved populations. Overall Project Strategy: We will sustain and expand lung cancer screening and tobacco cessation programs through Parkland Health and Hospital System, the safety net provider in Dallas County, Texas. To improve screening adherence and tobacco quit attempts, Parkland-based nurse navigators will provide education, logistical and psychosocial support. Education, audit, and feedback will be delivered by a Parkland-based physician champion. Through electronic health record data review, surveys, and patient interviews, we will evaluate the effect of the program on LDCT orders and completions, tobacco cessation referrals and quit rates, and patient-reported outcomes. Specific Goals: Goal 1. Sustain and expand a lung cancer screening program in an urban safety-net medical system. Objective 1.1. Increase the LDCT screening rate for eligible individuals according to United States Preventive Services Task Force (USPSTF) guidelines. Objective 1.2. Increase the proportion of referred eligible individuals who complete LDCT. Goal 2. Sustain and increase a tobacco cessation program using evidenced-based methods to promote tobacco cessation among LDCT-eligible individuals. Objective 2.1. Increase referrals to evidence-based tobacco cessation programs for LDCT-eligible persons who are current smokers. Objective 2.2. Increase tobacco cessation rates among LDCT-eligible persons who are current smokers. Significance and Impact: Medically underserved populations have higher rates of tobacco use, face higher rates of lung cancer, and experience worse outcomes after diagnosis. A comprehensive program that links patient and provider education, culturally sensitive navigation services, LDCT-based lung cancer screening, and evidence-based tobacco cessation will have critical impact on a major at-risk and underserved population in Dallas County. Overall, this Program will reach 38,000 uninsured or under-insured adults ages 55-77 years, who will be evaluated for tobacco history, other eligibility for LDCT-based lung cancer screening, and need for evidenced-based tobacco cessation services. Of these, 2,400 unique persons will receive services, including lung cancer screening, tobacco cessation, education, and navigation. Program evaluation will provide data to guide lung cancer screening and tobacco cessation efforts locally, across Texas, and nationwide. Sustainability will be achieved through programmatic and organizational environmental support, funding stability, partnerships, organizational and evaluation capacity, adaptation, communications, and strategic planning. Dissemination will be achieved through transfer of program database to Parkland, Parkland’s national leadership among public health systems, presentations and publications, and the lay press.

Read Less