KEY TAKEAWAYS
- An interventional study assessed the effectiveness of telephone-based navigation for lung cancer screening in an urban safety-net healthcare system.
- Patients were randomized to receive phone-based navigation to help them complete lung cancer screening steps. Navigation was associated with increased completion of steps.
- There was no significant difference in the completion of lung cancer screening steps between phone-based navigation and usual care groups.
- The study concluded that patient navigation and order placement may improve lung cancer screening rates in safety-net healthcare systems.
Low-dose computed tomography (LDCT)-based lung cancer screening (LCS) can be complex and time-consuming, especially for minority and uninsured patients. The study aimed to assess the effectiveness of telephone-based navigation for lung cancer screening in an urban safety-net healthcare system (Parkland Health, Dallas, Texas).
Patients eligible for LCS (based on USPSTF 2013 Guidelines) were randomly assigned to usual care or phone-based navigation (1:1 ratio). Navigators followed a structured protocol, contacting patients to provide reminders, share information, address barriers, and help with smoking cessation. The primary goal was to assess the completion of the first three consecutive LCS steps (e.g., 3 annual LDCTs or LDCT, other imaging, biopsy). Differences in LCS completion between the navigation and usual care groups were also analyzed based on patient characteristics using the chi-square test.
The study included 447 patients divided into phone-based navigation (n=225) or usual care (n=222) groups between February 2017 and February 2019. No significant difference was found in completing the first three steps of the LCS algorithm between the two groups (12% vs. 9%; P=0.3). Navigation did not impact completion across different subgroups; only 55% of expected steps were ordered in the navigation arm and 52% in the usual care arm. Despite low three-step completion rates, most LCS algorithm steps were completed by >75% of patients. In an exploratory analysis, completion rates for ordered steps were 86% for navigation and 79% for usual care (P=0.03).
They concluded that lack of order placement was a key reason for incomplete LCS steps. Navigation increased completion rates when orders were placed. Improving order placement and navigation may increase LCS uptake and completion.
Source: https://meetings.asco.org/abstracts-presentations/219362
Clinical Trial: https://clinicaltrials.gov/study/NCT02758054
Sheena Bhalla, Vijaya Subbu Natchimuthu, Jessica L. Lee, Urooj Wahid, Hong Zhu, Noel O. Santini, Travis Browning, Heidi A Hamann, David H. Johnson, Hsienchang Chiu, Simon Craddock Lee, and David E Gerber | Journal of Clinical Oncology 2023 41:16_suppl, 10577-10577.
