A group led by Jessica Currier, PhD, of Oregon Health & Science University in Bend put together a program in rural Oregon that boosted the number of low-dose CT exams for lung cancer screening by almost fivefold in a year.
"Compared with urban areas, residents of rural areas are more likely to report smoking, have a higher incidence of lung cancer, tend to be diagnosed at a later stage of disease, and are more likely to die of lung cancer once diagnosed," the team noted. "Early detection is imperative in improving lung cancer survival rates and has the potential to save lives."
Lung cancer death rates have declined in recent years, but there continue to be screening disparities among people living in rural areas compared with those living in metropolitan ones -- disparities that can lead to later diagnosis of disease and worse outcomes, the authors wrote. In an effort to boost uptake in a rural county of 64,917 people that had high incidence of lung cancer and deaths from the disease, Currier's group created a team approach to lung cancer screening.
The program's components were woven into the community hospital and the practices of primary care providers. It included education of providers about lung cancer incidence and mortality in the county and low-dose CT for lung cancer screening, as well as pre- and postscreening workflow protocols.
To assess the effectiveness of the program, the group measured outcomes over a three-year period (2018 to 2020), during which time 567 low-dose CT scans were performed among a rural population of high-risk individuals.
The overall effect of the initiative was a 4.8-fold increase in the number of low-dose CT scans performed between 2018 and 2019, the team reported. It also found the following:
- Use of low-dose CT for lung cancer screening increased by 54% from 2019 to 2020.
- The adherence rate for annual lung cancer screening increased from 51% in 2019 to 59.6% in 2020.
- Among the patients in whom lung cancer was found, 66.6% of cancers were stage I or II.
From this experience, Currier and colleagues offered four recommendations for designing and putting into place an effective low-dose CT lung cancer screening program:
- Embed lung cancer screening in a continuum of care that includes prescreening, screening, postscreening follow-up, smoking cessation, and annual scans.
- Recognize primary care providers as key to a lung cancer screening program and collaborate with them around the program's design and workflow.
- Establish a dedicated lung cancer screening program coordinator.
- Tap managers who can ensure consistency in communication and accountability for the program.
The main takeaway is that CT lung cancer screening should be seen as part of a larger care framework rather than discrete imaging experiences, according to the authors.
"Approaching screening as a continuum, rather than an episodic radiology event, coupled with engagement of primary care in the planning and design of the screening program, [facilitates] alignment of specialty and primary care in a shared goal of accurately identifying high-risk individuals to screen and supporting them throughout the screening process," they concluded.
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