Need for Increased Community Outreach for Low-Dose CT Lung Screening in Northwest Arizona/Southeast Nevada

Background: Sunrise Hospital is a tertiary medical center for rural outlying regions including northwest Arizona and southeast Nevada (NW-AZ/SE-NV). Sunrise Hospital & Medical Center (SHMC) provides lung nurse navigation to assist patients with their cancer diagnosis by utilizing oncology pathways that ensure seamless care across the cancer journey for patients and providers. Lung cancer in the United States is identified late, with 57% of patients being diagnosed with stage IV disease.¹ During navigation data analysis, it was discovered that 78% of NW-AZ/SE-NV patients were being diagnosed with stage IV lung cancer at SHMC, which is significantly higher than the national average.

Objective: Lung cancer screening with low-dose CT (LDCT) imaging is integral in identification of premalignant nodules/abnormalities that may develop into lung cancer. LDCT inclusion criteria include being between the ages of 55 and 80 years, have a 30 pack-year smoking history, and being a current/former smoker within the past 15 years. From our navigational data, 0% of SHMC lung cancer patients had an LDCT prior to diagnosis. There is a need for increased awareness for LDCT in this area to potentially help decrease the incidence of late-stage lung cancer diagnosis.

Methods: The CDC identified that the rates of newly diagnosed lung cancer were higher in rural America.² In Arizona and Nevada, only 19.1% and 15.7%, respectively, of cases are caught early when survival is higher; most cases were diagnosed at stage IV. Arizona ranked 39th and Nevada 19th in states with an accredited lung cancer screening center.³

The National Lung Screening Trial identified that screening reduces mortality by 15% to 20% from lung cancer diagnosis by identifying tumors at earlier stages.^4,5 While there is a large push for colorectal and breast cancer screening, annual LDCT screening remains inadequate following US Preventive Services Task Force guidelines.⁶ Public education efforts identified that patients were not aware of the purpose of lung screening, and that patients believed physicians needed to communicate their eligibility.⁷ Research has shown the utilization of navigators and community outreach significantly increase cancer screening among eligible patients.^8,9

Results: Navigational data have shown 78% of NW-AZ/SE-NV patients were diagnosed with stage IV lung cancer, which is significantly higher than the national average of 57%. Research has identified the use of navigators helps to increase cancer screening.

Conclusions: The use of navigators to assist in community outreach in the NW-AZ/SE-NV area can help to increase patient awareness of LDCT screening and its eligibility criteria. SHMC can help to establish relationships with community partners in the area to provide patient educational seminars, patient LDCT screening eligibility informational fliers, and referral sources to pulmonologists and/or cardiothoracic surgeons at SHMC to help manage and treat abnormal findings before it turns into cancer. Additional research can be obtained to determine if patients are aware of lung screening and if there are behavioral and environmental factors that contribute to an increase in lung cancer screening compliance.

References

1. American Lung Association. Trends in Lung Cancer Morbidity and Mortality. Stage Distribution (%) at Time of Diagnosis by Type, 2004-2010. www.lung.org/assets/documents/research/lc-trend-report.pdf. 2014.
2. Centers for Disease Control and Prevention. New CDC Report shows deaths from cancer higher in rural America. www.cdc.gov/media/releases/ 2017/p0706-rural-cancer-deaths.html. 2017.
3. American Lung Association. Lung Cancer Rates. www.lung.org/our-initiatives/research/monitoring-trends-in-lung-disease/state-of-lung-cancer/states/AZ.html. 2019.
4. National Lung Screening Trial Research Team. Reduced lung cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395-409.
5. National Cancer Institute. National Lung Screening Trial: Questions and Answers. www.cancer.gov/types/lung/research/nlst-qa. 2014.
6. American Cancer Society. Lung Cancer Screening Rates Remain Low. www.cancer.org/latest-news/lung-cancer-screening-rates-remain-low.html. (2017).
7. Crothers K, Kross EK, Reisch LM, et al. Patients’ attitudes regarding lung cancer screening and decision aids. a survey and focus group study. Ann Am Thorac Soc. 2016;13:1992-2001.
8. Ali-Faisal S, Coletta TJF, Medina-Jaudes N, et al. Patient navigation effectiveness on improving cancer screening rates: a meta-analysis of randomized control trials. Journal of Oncology Navigation & Survivorship. 2017;8(7):316-324.
9. Wallington S, Oppong B, Dash C, et al. A community-based outreach navigator approach to establishing partnerships for a safety net mammography screening center. J Cancer Educ. 2018;33:782-787.