By Abraham Kim, AuntMinnie.com staff writer

June 18, 2018 -- Amidst disappointing uptake of CT lung cancer screening, one group of researchers was able to buck the trend within a U.S. Veterans Affairs (VA) health network. The key? Bolstering outreach to eligible smokers, according to an article in the June American Journal of Managed Care.

Recent research has shown that the screening rate for CT lung cancer is only 1.9% of eligible participants in the U.S. The American College of Radiology (ACR) pointed to a lack of patient and physician awareness as one of the top factors contributing to these low rates.

Acknowledging this trend, researchers, led by first author Angela Fabbrini from the Minneapolis VA Health Care System, evaluated patient information and uptake rates at their health network, which was one of eight sites that participated in a CT lung screening demonstration project organized by the U.S. Veterans Health Administration (VHA).

The group used an algorithm to search for patients in the health network's electronic health records (EHRs) who were potentially eligible for CT lung cancer screening based on preliminary criteria such as being 55 to 80 years old and having a heavy smoking history. The subjects visited one of the hospitals in the healthcare network between January 2014 and May 2015 (Am J Manag Care, June 2018, Vol. 24:6, pp. 272-277).

After exclusion criteria were applied, 918 patients remained. Fabbrini and colleagues mailed an invitation letter that included shared decision-making materials on the topic of CT lung cancer screening, as well as a note to call the program manager to discuss options. They sent the patients an additional reminder letter one week later. They also reached out by phone to the 280 patients who did not respond to the invitation letter during phase I, or the first nine months, of the trial.

In all, 19% of the invited patients consented to CT lung cancer screening, with higher uptake among the patients who received both a letter and a phone call.

Effectiveness of patient outreach for CT lung cancer screening
  Invitation letter Invitation letter + phone call
CT lung cancer screening rate 9% 22%
The difference was statistically significant (p < 0.001).

"Lung cancer screening uptake by patients seemed dependent on the invitation approach," the authors wrote. "Uptake was higher when a phone call was added to shared decision-making [materials] and letters."

The researchers suggested that new screening programs consider alternative strategies for patient outreach such as online interactions on My HealtheVet, screening "drop-in" clinics, and lung health fairs, in addition to calling eligible participants.

"Methods of lung cancer screening invitation must optimize equity and access within the confines of institutional capacity and resources," they wrote. "Further evaluation is needed to determine optimal methods of patient risk stratification, lung cancer screening invitation approaches, [and] shared decision-making."


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