1
|
Lin X, Lei F, Lin J, Li Y, Chen Q, Arbing R, Chen WT, Huang F. Promoting Lung Cancer Screen Decision-Making and Early Detection Behaviors: A Systematic Review and Meta-analysis. Cancer Nurs 2024:00002820-990000000-00227. [PMID: 38498799 DOI: 10.1097/ncc.0000000000001334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Promoting lung cancer screening (LCS) is complex. Previous studies have overlooked that LCS behaviors are stage based and thus did not identify the characteristics of LCS interventions at different screening stages. OBJECTIVE The aims of this study were to explore the characteristics and efficacy of interventions in promoting LCS decision making and behaviors and to evaluate these interventions. METHODS We conducted a study search from the inception of each bibliographic database to April 8, 2023. The precaution adoption process model was used to synthesize and classify the evidence. The RE-AIM framework was used to evaluate the effectiveness of LCS programs. Heterogeneity tests and meta-analysis were performed using RevMan 5.4 software. RESULTS We included 31 studies that covered 4 LCS topics: knowledge of lung cancer, knowledge of LCS, value clarification exercises, and LCS supportive resources. Patient decision aids outperformed educational materials in improving knowledge and decision outcomes with a significant reduction in decision conflict (standardized mean difference, 0.81; 95% confidence interval, -1.15 to -0.47; P < .001). Completion rates of LCS ranged from 3.6% to 98.8%. Interventions that included screening resources outperformed interventions that used patient decision aids alone in improving LCS completion. The proportions of reported RE-AIM indicators were highest for reach (69.59%), followed by adoption (43.87%), effectiveness (36.13%), implementation (33.33%), and maintenance (9.68%). CONCLUSION Evidence from 31 studies identified intervention characteristics and effectiveness of LCS interventions based on different stages of decision making. IMPLICATIONS FOR PRACTICE It is crucial to develop targeted and systematic interventions based on the characteristics of each stage of LCS to maximize intervention effectiveness and reduce the burden of lung cancer.
Collapse
Affiliation(s)
- Xiujing Lin
- Author Affiliations: School of Nursing, Fujian Medical University (Mss X Lin, J Lin, Li, and Q Chen, and Dr Huang), Fuzhou, China; School of Nursing, University of Minnesota (Dr Lei), Twin Cities, Minneapolis; and School of Nursing, University of California Los Angeles (Dr W-T Chen and Ms Arbing)
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Hudson L, Burus T, Park L, Huang B, Hull PC, Vanderford NL. Cancer disparities in Appalachian Kentucky. J Rural Health 2024; 40:87-95. [PMID: 37095596 PMCID: PMC10593907 DOI: 10.1111/jrh.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/15/2023] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Cancer is the second leading cause of death in the United States, and the disease burden is elevated in Appalachian Kentucky, due in part to health behaviors and inequities in social determinants of health. This study's goal was to evaluate Appalachian Kentucky's cancer burden compared to non-Appalachian Kentucky, and Kentucky compared to the United States (excluding Kentucky). METHODS The following data were analyzed: annual all-cause and all-site cancer mortality rates from 1968 to 2018; 5-year all-site and site-specific cancer incidence and mortality rates from 2014 to 2018; aggregated screening and risk factor data from 2016 to 2018 for the United States (excluding Kentucky), Kentucky, non-Appalachian Kentucky, and Appalachian Kentucky; and human papilloma virus vaccination prevalence by sex from 2018 for the United States and Kentucky. FINDINGS Since 1968, the United States has experienced a large decrease in all-cause and cancer mortality, but the reduction in Kentucky has been smaller and slower, driven by even smaller and slower reductions within Appalachian Kentucky. Appalachian Kentucky has higher overall cancer incidence and mortality rates and higher rates for several site-specific cancers compared to non-Appalachian Kentucky. Contributing factors include screening rate disparities and increased rates of obesity and smoking. CONCLUSIONS Appalachian Kentucky has experienced persistent cancer disparities, including elevated all-cause and cancer mortality rates for 50+ years, widening the gap between this region and the rest of the country. In addition to addressing social determinants of health, increased efforts aimed at improving health behaviors and increased access to health care resources could help reduce this disparity.
Collapse
Affiliation(s)
- Lauren Hudson
- College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Todd Burus
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Lee Park
- Department of Statistics, College of Arts & Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
- Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Pamela C. Hull
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Nathan L. Vanderford
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
3
|
Leopold KT, Carter-Bawa L. Barriers to Lung Cancer Screening Access from the Perspective of the Patient and Current Interventions. Thorac Surg Clin 2023; 33:343-351. [PMID: 37806737 DOI: 10.1016/j.thorsurg.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
In the context of the Conceptual Model for Lung Cancer Screening Participation, this article describes patient barriers to lung cancer screening highlighting current interventions. Patient barriers include cognitive factors (lack of awareness, limited information/misinformation, and low perceived risk), factors related to access (logistical issues, no provider recommendation, cost, and other financial/social factors), and psychological factors (fear, fatalism, lung cancer worry, and stigma). Current interventions include the use of educational materials/presentations to address cognitive barriers, use of direct outreach and structural change to address factors related to access, and use of educational material focused on psychological barriers to address psychological barriers.
Collapse
Affiliation(s)
- Katherine T Leopold
- Hackensack University School of Medicine, 123 Metro Boulevard, Nutley, NJ 07110, USA
| | - Lisa Carter-Bawa
- Cancer Prevention Precision Control Institute, Center for Discovery & Innovation, at Hackensack Meridian Health, 111 Ideation Way, B430, Nutley, NJ 07110, USA.
| |
Collapse
|
4
|
Harper LJ, Kidambi P, Kirincich JM, Thornton JD, Khatri SB, Culver DA. Health Disparities: Interventions for Pulmonary Disease - A Narrative Review. Chest 2023; 164:179-189. [PMID: 36858172 PMCID: PMC10329267 DOI: 10.1016/j.chest.2023.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023] Open
Abstract
There is expansive literature documenting the presence of health disparities, but there are disproportionately few studies describing interventions to reduce disparity. In this narrative review, we categorize interventions to reduce health disparity in pulmonary disease within the US health care system to support future initiatives to reduce disparity. We identified 211 articles describing interventions to reduce disparity in pulmonary disease related to race, income, or sex. We grouped the studies into the following four categories: biologic, educational, behavioral, and structural. We identified the following five main themes: (1) there were few interventional trials compared with the breadth of studies describing health disparities, and trials involving patients with asthma who were Black, low income, and living in an urban setting were overrepresented; (2) race or socioeconomic status was not an effective marker of individual pharmacologic treatment response; (3) telehealth enabled scaling of care, but more work is needed to understand how to leverage telehealth to improve outcomes in marginalized communities; (4) future interventions must explicitly target societal drivers of disparity, rather than focusing on individual behavior alone; and (5) individual interventions will only be maximally effective when specifically tailored to local needs. Much work has been done to catalog health disparities in pulmonary disease. Notable gaps in the identified literature include few interventional trials, the need for research in diseases outside of asthma, the need for high quality effectiveness trials, and an understanding of how to implement proven interventions balancing fidelity to the original protocol and the need to adapt to local barriers to care.
Collapse
Affiliation(s)
- Logan J Harper
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| | - Pranav Kidambi
- Michigan State University College of Human Medicine, Grand Rapids, MI; Division of Pulmonary and Critical Care Medicine, Corewell Health Medical Group, Grand Rapids, MI
| | - Jason M Kirincich
- Department of Internal Medicine, Community Care Institute, Cleveland Clinic, Cleveland, OH
| | - J Daryl Thornton
- Center for Reducing Health Disparities, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Population Health Research Institute, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH; Division of Pulmonary, Critical Care, and Sleep Medicine, The MetroHealth Campus of Case Western Reserve University, Cleveland, OH
| | - Sumita B Khatri
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
5
|
Hirsch EA, Studts JL. Using User-Centered Design to Facilitate Adherence to Annual Lung Cancer Screening: Protocol for a Mixed Methods Study for Intervention Development. JMIR Res Protoc 2023; 12:e46657. [PMID: 37058339 PMCID: PMC10162485 DOI: 10.2196/46657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death in the United States, with the majority of lung cancer occurrence diagnosed after the disease has already metastasized. Lung cancer screening (LCS) with low-dose computed tomography can diagnose early-stage disease, especially when eligible individuals participate in screening on a yearly basis. Unfortunately, annual adherence has emerged as a challenge for academic and community screening programs, endangering the individual and population health benefits of LCS. Reminder messages have effectively increased adherence rates in breast, colorectal, and cervical cancer screenings but have not been tested with LCS participants who experience unique barriers to screening associated with the stigma of smoking and social determinants of health. OBJECTIVE This research aims to use a theory-informed, multiphase, and mixed methods approach with LCS experts and participants to develop a set of clear and engaging reminder messages to support LCS annual adherence. METHODS In aim 1, survey data informed by the Cognitive-Social Health Information Processing model will be collected to assess how LCS participants process health information aimed at health protective behavior to develop content for reminder messages and pinpoint options for message targeting and tailoring. Aim 2 focuses on identifying themes for message imagery through a modified photovoice activity that asks participants to identify 3 images that represent LCS and then participate in an interview about the selection, likes, and dislikes of each photo. A pool of candidate messages for multiple delivery platforms will be developed in aim 3, using results from aim 1 for message content and aim 2 for imagery selection. The refinement of message content and imagery combinations will be completed through iterative feedback from LCS experts and participants. RESULTS Data collection began in July 2022 and will be completed by May 2023. The final reminder message candidates are expected to be completed by June 2023. CONCLUSIONS This project proposes a novel approach to facilitate adherence to annual LCS through the development of reminder messages that embrace content and imagery representative of the target population directly in the design process. Developing effective strategies to increase LCS adherence is instrumental in achieving optimal LCS outcomes at individual and population health levels. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46657.
Collapse
Affiliation(s)
- Erin A Hirsch
- Division of Medical Oncology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- University of Colorado Cancer Center, Aurora, CO, United States
| | - Jamie L Studts
- Division of Medical Oncology, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- University of Colorado Cancer Center, Aurora, CO, United States
| |
Collapse
|
6
|
Sayani A, Ali MA, Dey P, Corrado AM, Ziegler C, Nicholson E, Lofters A. Interventions Designed to Increase the Uptake of Lung Cancer Screening: An Equity-Oriented Scoping Review. JTO Clin Res Rep 2023; 4:100469. [PMID: 36938372 PMCID: PMC10015251 DOI: 10.1016/j.jtocrr.2023.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Participation in lung cancer screening (LCS) is lower in populations with the highest burden of lung cancer risk (through the social patterning of smoking behavior) and lowest levels of health care utilization (through structurally inaccessible care) leading to a widening of health inequities. Methods We conducted a scoping review using the Arksey and O'Malley methodological framework to inform equitable access to LCS by illuminating knowledge and implementation gaps in interventions designed to increase the uptake of LCS. We comprehensively searched for LCS interventions (Ovid Medline, Excerpta Medica database, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Scopus from 2000 to June 22, 2021) and included peer-reviewed articles and gray literature published in the English language that describe an intervention designed to increase the uptake of LCS, charted data using our previously published tool and conduced a health equity analysis to determine the intended-unintended and positive-negative outcomes of the interventions for populations experiencing the greatest inequities. Results Our search yielded 3572 peer-reviewed articles and 54,292 pieces of gray literature. Ultimately, we included 35 peer-reviewed articles and one gray literature. The interventions occurred in the United States, United Kingdom, Japan, and Italy, focusing on shared decision-making, the use of electronic health records as reminders, patient navigation, community-based campaigns, and mobile computed tomography scanners. We developed an equity-oriented LCS framework and mapped the dimensions and outcomes of the interventions on access to LCS on the basis of approachability, acceptability, availability, affordability, and appropriateness of the intervention. No intervention was mapped across all five dimensions. Most notably, knowledge and implementation gaps were identified in dimensions of acceptability, availability, and affordability. Conclusions Interventions that were most effective in improving access to LCS targeted priority populations, raised community-level awareness, tailored materials for sociocultural acceptability, did not depend on prior patient engagement/registration with the health care system, proactively considered costs related to participation, and enhanced utilization through informed decision-making.
Collapse
Affiliation(s)
- Ambreen Sayani
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Corresponding author. Address for correspondence: Ambreen Sayani, MD, PhD, Women’s College Research Institute, Women’s College Hospital, 76 Grenville St., Toronto, ON M5S 1B2, Canada.
| | - Muhanad Ahmed Ali
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Pooja Dey
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Ann Marie Corrado
- Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Ontario, Canada
| | - Carolyn Ziegler
- Library Services, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Aisha Lofters
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Peter Gilgan Centre for Women’s Cancers, Women’s College Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| |
Collapse
|
7
|
Moss JL, Stoltzfus KC, Popalis ML, Calo WA, Kraschnewski JL. Assessing the use of constructs from the consolidated framework for implementation research in U.S. rural cancer screening promotion programs: a systematic search and scoping review. BMC Health Serv Res 2023; 23:48. [PMID: 36653800 PMCID: PMC9846667 DOI: 10.1186/s12913-022-08976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer screening is suboptimal in rural areas, and interventions are needed to improve uptake. The Consolidated Framework for Implementation Research (CFIR) is a widely-used implementation science framework to optimize planning and delivery of evidence-based interventions, which may be particularly useful for screening promotion in rural areas. We examined the discussion of CFIR-defined domains and constructs in programs to improve cancer screening in rural areas. METHODS We conducted a systematic search of research databases (e.g., Medline, CINAHL) to identify studies (published through November 2022) of cancer screening promotion programs delivered in rural areas in the United States. We identified 166 records, and 15 studies were included. Next, two reviewers used a standardized abstraction tool to conduct a critical scoping review of CFIR constructs in rural cancer screening promotion programs. RESULTS Each study reported at least some CFIR domains and constructs, but studies varied in how they were reported. Broadly, constructs from the domains of Process, Intervention, and Outer setting were commonly reported, but constructs from the domains of Inner setting and Individuals were less commonly reported. The most common constructs were planning (100% of studies reporting), followed by adaptability, cosmopolitanism, and reflecting and evaluating (86.7% for each). No studies reported tension for change, self-efficacy, or opinion leader. CONCLUSIONS Leveraging CFIR in the planning and delivery of cancer screening promotion programs in rural areas can improve program implementation. Additional studies are needed to evaluate the impact of underutilized CFIR domains, i.e., Inner setting and Individuals, on cancer screening programs.
Collapse
Affiliation(s)
- Jennifer L Moss
- Penn State College of Medicine, Hershey, PA, USA.
- Department of Family and Community Medicine, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, 90 Hope Drive, #2120E, MC A172, P.O. Box 855, Hershey, PA, 17033, USA.
| | | | | | | | | |
Collapse
|
8
|
Schiffelbein JE, Carluzzo KL, Hasson RM, Alford-Teaster JA, Imset I, Onega T. Barriers, Facilitators, and Suggested Interventions for Lung Cancer Screening Among a Rural Screening-Eligible Population. J Prim Care Community Health 2021; 11:2150132720930544. [PMID: 32506999 PMCID: PMC7278309 DOI: 10.1177/2150132720930544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: Rural areas are disproportionally affected by lung cancer late-stage incidence and mortality. Lung cancer screening (LCS) is recommended to find lung cancer early and reduce mortality, yet uptake is low. The purpose of this study was to elucidate the barriers to, facilitators of, and suggested interventions for increasing LCS among a rural screening-eligible population using a mixed methods concurrent embedded design study. Methods: Qualitative and quantitative data were collected from rural-residing adults who met the eligibility criteria for LCS but who were not up-to-date with LCS recommendations. Study participants (n = 23) took part in 1 of 5 focus groups and completed a survey. Focus group discussions were recorded, transcribed, and coded through a mixed deductive and inductive approach. Survey data were used to enhance and clarify focus group results; these data were integrated in the design and during analysis, in accordance with the mixed methods concurrent embedded design approach. Results: Several key barriers to LCS were identified, including an overall lack of knowledge about LCS, not receiving information or recommendation from a health care provider, and lack of transportation. Key facilitators were receiving a provider recommendation and high motivation to know the screening results. Participants suggested that LCS uptake could be increased by addressing provider understanding and recommendation of LCS and conducting community outreach to promote LCS awareness and access. Conclusion: The results suggest that the rural screening-eligible population is generally receptive to LCS. Patient-level factors important to getting this population screened include knowledge, transportation, motivation to know their screening results, and receiving information or recommendation from a provider. Addressing these factors may be important to increase rural LCS uptake.
Collapse
Affiliation(s)
- Jenna E Schiffelbein
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Rian M Hasson
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.,Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jennifer A Alford-Teaster
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Inger Imset
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Tracy Onega
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA.,Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| |
Collapse
|
9
|
Robertson NM, Hudson L, Attia SL, Porterfield JZ, Vanderford NL. Assessing the Effectiveness of Cancer Screening Interventions Targeting Appalachian Populations: A Systematic Review. J Rural Health 2021; 37:602-623. [PMID: 33305886 PMCID: PMC9838639 DOI: 10.1111/jrh.12550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Appalachian residents have higher cancer prevalence and invasive cancer incidence in almost all cancer types relative to non-Appalachian residents. Public health interventions have been carried out to increase preventive cancer screening participation. However, no studies have evaluated the effectiveness of existing interventions targeting cancer screening uptake in this high-risk population. The main objective of this study is to assess the effectiveness of interventions aimed at increasing uptake and/or continuing participation in screened cancers (breast, cervical, colorectal, lung, and prostate) in Appalachia. METHODS We conducted a systematic review of electronic databases and gray literature using a combination of MeSH and free-text search terms related to breast, cervical, colorectal, lung, and prostate cancer; mass screening; health promotion; and Appalachia. We identified 3,014 articles of which 15 articles were included. We assessed methodological quality using validated tools and analyzed findings using narrative synthesis. FINDINGS Fifteen studies reported uptake and/or continued participation in screening interventions; these focused on cervical (n = 7), colorectal (n = 5), breast (n = 2), and lung (n = 1) cancers in Appalachia. Interventions included diverse components: mass media campaigns, community outreach events, community health workers, interpersonal counseling, and educational materials. We found that multi-strategy interventions had higher screening uptake relative to interventions employing 1 intervention strategy. Studies that targeted noncompliant populations and leveraged existing community-based organization partnerships had a substantial increase in screening participation versus others. CONCLUSIONS There is an urgent need for further research and implementation of effective cancer prevention and screening interventions to reduce disparities in cancer morbidity and mortality in Appalachian populations.
Collapse
Affiliation(s)
| | - Lauren Hudson
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Suzanna Labib Attia
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Kentucky College of Medicine, Lexington, Kentucky
| | - J. Zachary Porterfield
- Department of Internal Medicine, Division of Infectious Diseases, University of Kentucky College of Medicine, Lexington, Kentucky,Department of Otolaryngology-Head & Neck Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Nathan L. Vanderford
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky,Department of Toxicology & Cancer Biology, University of Kentucky College of Medicine, Lexington, Kentucky,Center of Health Equity Transformation, University of Kentucky College of Medicine, Lexington, Kentucky
| |
Collapse
|
10
|
Monu JI, Achar C, Wood DE, Flum DR, Agrawal N, Farjah F. Psychological Traits and the Persuasiveness of Lung Cancer Screening Health Messages. Ann Thorac Surg 2021; 113:1341-1347. [PMID: 33957098 DOI: 10.1016/j.athoracsur.2021.04.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lung cancer screening remains underutilized despite its proven mortality benefit. Health systems have attempted to increase screening awareness through advertising. Psychological theories suggest that construal level (a personal orientation towards the big picture or the details) and regulatory focus (goals emphasizing acquisition of a good, or avoidance of a bad outcome) play a key role in health advertising effectiveness. These theories have not been examined in a screen-eligible population. METHODS Using Amazon's crowdsourcing platform, Mechanical Turk, we identified screen-eligible individuals based on United States Preventive Services Task Force criteria. We randomly assigned participants to see one of four screening advertisement images in a 2 (construal level: high vs. low) X 2 (regulatory focus: promotion vs. prevention) between-subjects experimental design. We assessed willingness to undergo screening following the advertisement. RESULTS A total of 191 individuals responded to our study invitation (mean age 61 years). We found that the high construal/promotion focus image led to a greater willingness to screen compared to images representing other psychological states (p-value=0.04). Regarding the personality traits of our respondents, high construal/promotion focus was the most prevalent (40%) trait combination, whereas low construal/prevention focus was the least prevalent (17%). CONCLUSIONS The psychological focus of health-related messages affect an individual's willingness to undergo lung cancer screening. Individuals eligible for lung cancer screening are more persuaded by "big picture" messages describing the benefits of screening. Health systems may use this knowledge to design more effective patient-facing communications that lead to higher rates of screening.
Collapse
Affiliation(s)
- John I Monu
- Department of Surgery, University of Washington, Seattle, WA
| | - Chethana Achar
- Kellogg School of Management, Northwestern University, Evanston, IL
| | - Douglas E Wood
- Department of Surgery, University of Washington, Seattle, WA
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, WA
| | - Nidhi Agrawal
- Michael G. Foster School of Business, University of Washington, Seattle, WA
| | - Farhood Farjah
- Department of Surgery, University of Washington, Seattle, WA.
| |
Collapse
|
11
|
Brainson CF, Huang B, Chen Q, McLouth LE, He C, Hao Z, Arnold SM, Zinner RG, Mullett TW, Bocklage TJ, Orren DK, Villano JL, Durbin EB. Description of a Lung Cancer Hotspot: Disparities in Lung Cancer Histology, Incidence, and Survival in Kentucky and Appalachian Kentucky. Clin Lung Cancer 2021; 22:e911-e920. [PMID: 33958300 DOI: 10.1016/j.cllc.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Kentucky is recognized as the state with the highest lung cancer burden for more than 2 decades, but how lung cancer differs in Kentucky relative to other US populations is not fully understood. PATIENTS AND METHODS We examined lung cancer reported to the Surveillance, Epidemiology, and End Results (SEER) Program by Kentucky and the other SEER regions for patients diagnosed between 2012 and 2016. Our analyses included histologic types, incidence rates, stage at diagnosis, and survival in Kentucky and Appalachian Kentucky relative to other SEER regions. RESULTS We found that both squamous cell carcinomas and small-cell lung cancers represent larger proportions of lung cancer diagnoses in Kentucky and Appalachian Kentucky than they do in the SEER registries. Furthermore, age-adjusted cancer incidence rates were higher in Kentucky for every subtype of lung cancer examined. Most notably, for Appalachian women the rate of small-cell carcinomas was 3.5-fold higher, and for Appalachian men the rate of squamous cell carcinoma was 3.1-fold higher, than the SEER rates. In Kentucky, lung cancers were diagnosed at later stages and lung cancer survival was lower for adenocarcinoma and neuroendocrine carcinomas than in SEER registries. Squamous cell carcinomas and small-cell carcinomas were most lethal in Appalachian Kentucky. CONCLUSION Together, these data highlight the considerable disparities among lung cancer cases in the United States and demonstrate the continuing high burden and poor survival of lung cancer in Kentucky and Appalachian Kentucky. Strategies to identify and rectify causes of these disparities are discussed.
Collapse
Affiliation(s)
- Christine F Brainson
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY; Markey Cancer Center, University of Kentucky, Lexington, KY.
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, KY; Division of Cancer Biostatistics, College of Medicine, University of Kentucky, Lexington, KY; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Quan Chen
- Markey Cancer Center, University of Kentucky, Lexington, KY; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY
| | - Laurie E McLouth
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Behavioral Science, Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY
| | - Chunyan He
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Zhonglin Hao
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Susanne M Arnold
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Ralph G Zinner
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Timothy W Mullett
- Department of Surgery, Division of Cardiothoracic Surgery, College of Medicine, University of Kentucky, Lexington, KY
| | - Therese J Bocklage
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Kentucky, Lexington, KY
| | - David K Orren
- Department of Toxicology and Cancer Biology, College of Medicine, University of Kentucky, Lexington, KY; Markey Cancer Center, University of Kentucky, Lexington, KY
| | - John L Villano
- Markey Cancer Center, University of Kentucky, Lexington, KY; Department of Medicine, Division of Medical Oncology, College of Medicine, University of Kentucky, Lexington, KY
| | - Eric B Durbin
- Markey Cancer Center, University of Kentucky, Lexington, KY; Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY; Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY
| |
Collapse
|
12
|
Lopez-Olivo MA, Maki KG, Choi NJ, Hoffman RM, Shih YCT, Lowenstein LM, Hicklen RS, Volk RJ. Patient Adherence to Screening for Lung Cancer in the US: A Systematic Review and Meta-analysis. JAMA Netw Open 2020; 3:e2025102. [PMID: 33196807 PMCID: PMC7670313 DOI: 10.1001/jamanetworkopen.2020.25102] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/13/2020] [Indexed: 12/19/2022] Open
Abstract
Importance To be effective in reducing deaths from lung cancer among high-risk current and former smokers, screening with low-dose computed tomography must be performed periodically. Objective To examine lung cancer screening (LCS) adherence rates reported in the US, patient characteristics associated with adherence, and diagnostic testing rates after screening. Data Sources Five electronic databases (MEDLINE, Embase, Scopus, CINAHL, and Web of Science) were searched for articles published in the English language from January 1, 2011, through February 28, 2020. Study Selection Two reviewers independently selected prospective and retrospective cohort studies from 95 potentially relevant studies reporting patient LCS adherence. Data Extraction and Synthesis Quality appraisal and data extraction were performed independently by 2 reviewers using the Newcastle-Ottawa Scale for quality assessment. A random-effects model meta-analysis was conducted when at least 2 studies reported on the same outcome. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guideline. Main Outcomes and Measures The primary outcome was LCS adherence after a baseline screening. Secondary measures were the patient characteristics associated with adherence and the rate of diagnostic testing after screening. Results Fifteen studies with a total of 16 863 individuals were included in this systematic review and meta-analysis. The pooled LCS adherence rate across all follow-up periods (range, 12-36 months) was 55% (95% CI, 44%-66%). Regarding patient characteristics associated with adherence rates, current smokers were less likely to adhere to LCS than former smokers (odds ratio [OR], 0.70; 95% CI, 0.62-0.80); White patients were more likely to adhere to LCS than patients of races other than White (OR, 2.0; 95% CI, 1.6-2.6); people 65 to 73 years of age were more likely to adhere to LCS than people 50 to 64 years of age (OR, 1.4; 95% CI, 1.0-1.9); and completion of 4 or more years of college was also associated with increased adherence compared with people not completing college (OR, 1.5; 95% CI, 1.1-2.1). Evidence was insufficient to evaluate diagnostic testing rates after abnormal screening scan results. The main source of variation was attributable to the eligibility criteria for screening used across studies. Conclusions and Relevance In this study, the pooled LCS adherence rate after a baseline screening was far lower than those observed in large randomized clinical trials of screening. Interventions to promote adherence to screening should prioritize current smokers and smokers from minority populations.
Collapse
Affiliation(s)
- Maria A. Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Kristin G. Maki
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Noah J. Choi
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Richard M. Hoffman
- Department of Internal Medicine, The Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Lisa M. Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Rachel S. Hicklen
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston
| | - Robert J. Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| |
Collapse
|
13
|
Strong A, Renaud M. Using Social Media as a Platform for Increasing Knowledge of Lung Cancer Screening in High-Risk Patients. J Adv Pract Oncol 2020; 11:453-459. [PMID: 32974070 PMCID: PMC7508250 DOI: 10.6004/jadpro.2020.11.5.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Uptake in lung cancer screening for high-risk patients remains low. Eligible patients may not know that this preventive service is available and covered by insurance. Objectives The objective of this study was to explore using social media to educate patients about lung cancer screening and assess motivation to discuss lung cancer screening with health-care providers after viewing the educational program. Methods Subjects ages 55 to 77 who were current smokers or former smokers who quit in the past 15 years with a more than 30-pack-year smoking history were recruited via a Facebook advertisement. Subjects completed a demographic survey and the Lung Cancer Screening-12 (LCS-12) knowledge measure tool, watched a YouTube video about lung cancer screening, and completed the LCS-12 tool (post-test). Subjects rated their level of motivation to discuss lung cancer screening with their health-care provider. Results This study used a pre-experimental, one-group pre-test and post-test design. Scores from the pre- and post-test were analyzed using the paired t-test. Descriptive statistics were used to analyze subject self-reporting of motivation to discuss screening with their provider. The mean knowledge score of participants (n = 31) significantly increased from 5.26 to 8.19 after viewing the video (t = -5.956, p < .001). The mean motivational level (1-5) was 3.52, with a mode of 5. Conclusions A lack of knowledge regarding lung cancer screening may negatively impact the health of high-risk patients. This study suggests that social media can be used to increase knowledge of lung cancer screening. These findings demonstrate that the use of social media has a role in improving access to health information.
Collapse
Affiliation(s)
- Aimee Strong
- University of Virginia Health System, Charlottesville, Virginia
| | | |
Collapse
|
14
|
Salazar AS, Sekhon S, Rohatgi KW, Nuako A, Liu J, Harriss C, Brennan E, LaBeau D, Abdalla I, Schulze C, Muenks J, Overlot D, Higgins JA, Jones LS, Swick C, Goings S, Badiu J, Walker J, Colditz GA, James AS. A stepped-wedge randomized trial protocol of a community intervention for increasing lung screening through engaging primary care providers (I-STEP). Contemp Clin Trials 2020; 91:105991. [PMID: 32184197 DOI: 10.1016/j.cct.2020.105991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/28/2020] [Accepted: 03/11/2020] [Indexed: 01/01/2023]
Abstract
Lung cancer screening with low-dose computed tomography (LDCT) reduces lung cancer mortality, yet few eligible high-risk patients receive it annually. This protocol describes a community-partnered intervention (Toolkit) designed to support primary care practices in making referrals for lung screening and guiding patients into appropriate screening pathways. This study uses a stepped-wedge implementation design. Screening centers are randomized by readiness level to enter the intervention phase in three-month "steps" with pre-intervention data serving as the control. The primary outcome is whether delivery of the Toolkit to primary care practices results in a monthly increase in number of initial LDCT screenings. Six participating centers will identify 10 practices and reach 2-3 providers per practice to train them to use the Toolkit. The Toolkit will address known barriers to screening and referral at the patient and provider levels and provide support for required elements of screening. Toolkit components include adaptable evidence-based interventions to maximize compatibility with workflows. We hypothesize that after nine months of intervention delivery, the number of initial screening per center will double. Involving 60 practices achieves 80% power at 5% level of significance. Implementation outcomes such as adoption, acceptability, feasibility, adaptation, and sustainability will be assessed through field-notes and activity logs. LDCT for lung cancer screening currently reaches a small fraction of eligible adults. To reach the full potential to reduce mortality, primary care practices are an important venue for increasing appropriate referrals. This multidisciplinary trial will encourage acceptability and sustainability by using local knowledge and promoting partnership between providers and patients. Trial registration: ClinicalTrials.gov, NCT03958253.
Collapse
Affiliation(s)
- Ana S Salazar
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO 63110-0193, USA.
| | | | - Karthik W Rohatgi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO 63110-0193, USA.
| | - Akua Nuako
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO 63110-0193, USA.
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO 63110-0193, USA.
| | - Courtney Harriss
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO 63110-0193, USA.
| | - Ellen Brennan
- Siteman Cancer Center at Barnes-Jewish St. Peters Hospital, 150 Entrance Way, St. Peters, MO 63376, USA.
| | - Dareld LaBeau
- Siteman Cancer Center at Barnes-Jewish St. Peters Hospital, 150 Entrance Way, St. Peters, MO 63376, USA.
| | - Ibrahim Abdalla
- Hulston Cancer Center, CoxHealth, 3850 S National, Springfield, MO 65807, USA.
| | - Christopher Schulze
- Hulston Cancer Center, CoxHealth, 3850 S National, Springfield, MO 65807, USA.
| | - Jackie Muenks
- Hulston Cancer Center, CoxHealth, 3850 S National, Springfield, MO 65807, USA.
| | - Dave Overlot
- Cancer Care Center of Decatur, Decatur Memorial Hospital, 210 W. McKinley Avenue, Decatur, IL 62526, USA.
| | - Jeri Ann Higgins
- Cancer Care Center of Decatur, Decatur Memorial Hospital, 210 W. McKinley Avenue, Decatur, IL 62526, USA.
| | - Linda S Jones
- Regional Cancer Center, Memorial Health System, 701 N 1(st), Springfield, IL 62781, USA.
| | - Colleen Swick
- Sarah Bush Lincoln Regional Cancer Center, Sarah Bush Lincoln Health System, 1001 Health Center Drive, Mattoon, IL 61938, USA.
| | - Stacia Goings
- Sarah Bush Lincoln Regional Cancer Center, Sarah Bush Lincoln Health System, 1001 Health Center Drive, Mattoon, IL 61938, USA.
| | - Jennifer Badiu
- SIH Cancer Institute, Southern Illinois Healthcare, 1400 Pin Oak Drive, Carterville, IL 62918, USA.
| | - Justin Walker
- SIH Cancer Institute, Southern Illinois Healthcare, 1400 Pin Oak Drive, Carterville, IL 62918, USA.
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO 63110-0193, USA.
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO 63110-0193, USA.
| |
Collapse
|
15
|
Flores EJ, Park ER, Irwin KE. Improving Lung Cancer Screening Access for Individuals With Serious Mental Illness. J Am Coll Radiol 2019; 16:596-600. [PMID: 30947893 DOI: 10.1016/j.jacr.2018.12.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 12/17/2022]
Abstract
Lung cancer continues to be the leading cause of cancer mortality in the United States across all races and ethnicities, but it does not affect everyone equally. Individuals with serious mental illness (SMI), including schizophrenia and bipolar disorder, experience two to four times greater lung cancer mortality in part due to high rates of smoking, delays in cancer diagnosis, and inequities in cancer treatment. Additionally, adults with SMI experience patient, clinician, and health care system-level barriers to accessing cancer screening, such as cognitive deficits that impact understanding of cancer risk, higher rates of poverty and social isolation, patient-provider communication challenges, decreased access to tobacco cessation, and the fragmentation of primary care and mental health care. Despite the proven benefits and mandated coverage by public and private payers, lung cancer screening participation rates remain low among eligible patients, below 4% a year. Given disparities in other cancer screening modalities, these rates are likely to be even lower among individuals with SMI. This article provides a brief overview of current challenges in lung cancer screening and describes a pilot collaboration between radiology and psychiatry that has potential to improve access to lung cancer screening for individuals with serious mental illness.
Collapse
Affiliation(s)
- Efren J Flores
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Elyse R Park
- Department of Psychiatry, Massachusetts General Hospital, Harvard. Medical School, Boston, Massachusetts; Mongan Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kelly E Irwin
- Department of Psychiatry, Massachusetts General Hospital, Harvard. Medical School, Boston, Massachusetts; Mongan Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
16
|
Kennedy AE, Vanderpool RC, Croyle RT, Srinivasan S. An Overview of the National Cancer Institute's Initiatives to Accelerate Rural Cancer Control Research. Cancer Epidemiol Biomarkers Prev 2019; 27:1240-1244. [PMID: 30385495 DOI: 10.1158/1055-9965.epi-18-0934] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 08/30/2018] [Accepted: 09/07/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- Amy E Kennedy
- Center for Research Strategy, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Robin C Vanderpool
- Department of Health, Behavior and Society, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Robert T Croyle
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Shobha Srinivasan
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
| |
Collapse
|
17
|
Wiener RS, Rivera MP. Access to Lung Cancer Screening Programs in the United States. Chest 2019; 155:883-885. [DOI: 10.1016/j.chest.2019.01.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 10/26/2022] Open
|
18
|
Zhang H, He B, Cui J, Zhao M, Zhang Z. Comparison of circulating DNA from plasma and urine for EGFR mutations in NSCLC patients. Cancer Biomark 2019; 23:427-436. [PMID: 30223392 DOI: 10.3233/cbm-181511] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE The need for less invasive procedures for lung cancer probing is critically needed to better understand the disease. The purpose of the current study aims to explore the use of circulating tumor DNA (ctDNA) derived from plasma and urine specimens. METHODS Matched peripheral blood and morning urine specimens were obtained from 160 late stage NSCLC patients. The amount of ctDNA was quantified for each of the patients. Activating and sensitizing EGFR mutations commonly found in NSCLC patients were profiled. Longitudinal analysis was performed to compared DNA variations during disease progression. RESULTS Measurement of EGFR mutations in NSCLC patients using plasma and urinal DNA demonstrated strong concordance to conventional tissue biopsy profiling. Baseline matched tumor samples yielded 82.8% and 84.0% for plasma and urinal DNA respectively. For these measurements, the positive predictive value was 100% for plasma and urinal DNA. In the longitudinal study, we observed strong links to disease severity and survival analysis showed a clear trend with patients having higher DNA concentrations to have worse outcome especially for urinal DNA. HR for patients stratified using plasma and urinal DNA were 1.23 and 2.55 respectively. CONCLUSION Measurements of circulating DNA within body fluids presented potentially new tools for the disease management of NSCLC patients with EGFR mutations. We demonstrated both plasma and urinal DNA correlated well to tissue biopsies and were potentially prognostic to address patients' survival outcome.
Collapse
Affiliation(s)
- Hao Zhang
- Centre for Cardiothoracic Surgery, Xiangyang Central Hospital, Hospital Affiliated to Hubei University of Arts and Science, Xiangyang 441021, Hubei, China.,Centre for Cardiothoracic Surgery, Xiangyang Central Hospital, Hospital Affiliated to Hubei University of Arts and Science, Xiangyang 441021, Hubei, China
| | - Bin He
- Centre for Cardiothoracic Surgery, Xiangyang Central Hospital, Hospital Affiliated to Hubei University of Arts and Science, Xiangyang 441021, Hubei, China.,Centre for Cardiothoracic Surgery, Xiangyang Central Hospital, Hospital Affiliated to Hubei University of Arts and Science, Xiangyang 441021, Hubei, China
| | - Jun Cui
- Centre for Cardiothoracic Surgery, Xiangyang Central Hospital, Hospital Affiliated to Hubei University of Arts and Science, Xiangyang 441021, Hubei, China
| | - Mingzhang Zhao
- General Thoracic Surgery, Yicheng People's Hospital, Xiangyang 441400, Hubei, China
| | - Zengwang Zhang
- Centre for Cardiothoracic Surgery, Xiangyang Central Hospital, Hospital Affiliated to Hubei University of Arts and Science, Xiangyang 441021, Hubei, China
| |
Collapse
|
19
|
Wang GX, Baggett TP, Pandharipande PV, Park ER, Percac-Lima S, Shepard JAO, Fintelmann FJ, Flores EJ. Barriers to Lung Cancer Screening Engagement from the Patient and Provider Perspective. Radiology 2019; 290:278-287. [PMID: 30620258 DOI: 10.1148/radiol.2018180212] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer remains the leading cause of cancer mortality in the United States. Lung cancer screening (LCS) with low-dose CT reduces mortality among high-risk current and former smokers and has been covered by public and private insurers without cost sharing since 2015. Patients and referring providers confront numerous barriers to participation in screening. To best serve in multidisciplinary efforts to expand LCS nationwide, radiologists must be knowledgeable of these challenges. A better understanding of the difficulties confronted by other stakeholders will help radiologists continue to collaboratively guide the growth of LCS programs in their communities. This article reviews barriers to participation in LCS for patients and referring providers, as well as possible solutions and interventions currently underway.
Collapse
Affiliation(s)
- Gary X Wang
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Travis P Baggett
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Pari V Pandharipande
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Elyse R Park
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Sanja Percac-Lima
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Jo-Anne O Shepard
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Florian J Fintelmann
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| | - Efren J Flores
- From the Department of Radiology (G.X.W., P.V.P., J.O.S., F.J.F., E.J.F.), Division of General Internal Medicine (T.P.B., S.P.L.), and Department of Psychiatry (E.R.P.), Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Founders 202, Boston, MA 02114; and Institute for Technology Assessment (P.V.P.), Mongan Institute Health Policy Center (E.R.P.), and Tobacco Research and Treatment Center (E.R.P., T.P.B.), Massachusetts General Hospital, Boston, Mass
| |
Collapse
|
20
|
Rodriguez SD, Vanderford NL, Huang B, Vanderpool RC. A Social-Ecological Review of Cancer Disparities in Kentucky. South Med J 2018; 111:213-219. [PMID: 29719033 DOI: 10.14423/smj.0000000000000794] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cancer continuously ranks among the top 10 leading causes of death in the United States. The burden of cancer is particularly elevated in the Commonwealth of Kentucky and its 54-county Appalachian region, where cancer is the leading cause of death. Kentucky's high rates of cancer have been attributed to a wide range of socioeconomic, behavioral, environmental, and policy influences, resulting in numerous disparities. The present review specifically evaluates the burden of lung, colorectal, cervical, and head and neck cancers in Kentucky, along with resultant cancer control research and community outreach efforts conducted by the state's only National Cancer Institute-designated cancer center using an adapted version of McLeroy's Social-Ecological Model. Here, we categorize disparities and identify relevant intervention approaches based on their level of influence (ie, individual, community, and policy).
Collapse
Affiliation(s)
- Sharon D Rodriguez
- From the Colleges of Public Health and Medicine, University of Kentucky, Lexington
| | - Nathan L Vanderford
- From the Colleges of Public Health and Medicine, University of Kentucky, Lexington
| | - Bin Huang
- From the Colleges of Public Health and Medicine, University of Kentucky, Lexington
| | - Robin C Vanderpool
- From the Colleges of Public Health and Medicine, University of Kentucky, Lexington
| |
Collapse
|
21
|
Eberth JM, McDonnell KK, Sercy E, Khan S, Strayer SM, Dievendorf AC, Munden RF, Vernon SW. A national survey of primary care physicians: Perceptions and practices of low-dose CT lung cancer screening. Prev Med Rep 2018; 11:93-99. [PMID: 29984145 PMCID: PMC6030390 DOI: 10.1016/j.pmedr.2018.05.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/16/2018] [Accepted: 05/14/2018] [Indexed: 12/30/2022] Open
Abstract
Soon after the National Lung Screening Trial, organizations began to endorse low-dose computed tomography (LCDT) screening for lung cancer in high-risk patients. Concerns about the risks versus benefits of screening, as well as the logistics of identifying and referring eligible patients, remained among physicians. This study aimed to examine primary care physicians' knowledge, attitudes, referral practices, and associated barriers regarding LDCT screening. We administered a national survey of primary care physicians in the United States between September 2016 and April 2017. Physicians received up to 3 mailings, 1 follow-up email, and received varying incentives to complete the survey. Overall, 293 physicians participated, for a response rate of 13%. We used weighted descriptive statistics to characterize participants and their responses. Over half of the respondents correctly reported that the US Preventive Services Task Force recommends LDCT screening for high-risk patients. Screening recommendations for patients not meeting high-risk criteria varied. Although 75% agreed that the benefits of LDCT screening outweigh the risks, fewer agreed that there is substantial evidence that screening reduces mortality (50%). The most commonly reported barriers to ordering screening included prior authorization requirements (57%), lack of insurance coverage (53%), and coverage denials (31%). The most frequently cited barrier to conducting LDCT screening shared decision making was patients' competing health priorities (42%). Given the impact of physician recommendations on cancer screening utilization, further understanding of physicians' LDCT screening attitudes and shared decision-making practices is needed. Clinical practice and policy changes are also needed to engage more patients in screening discussions. Most physicians had five or less lung cancer screening referrals in the past year Recommendation strategies varied, but often aligned with USPSTF or NCCN guidelines Physicians were uncertain about the efficacy and cost-effectiveness of screening Insurance coverage and costs were commonly cited as barriers to screening referral A common barrier to performing SDM was patients' competing health priorities
Collapse
Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | | | - Erica Sercy
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Samira Khan
- Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Scott M Strayer
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Amy C Dievendorf
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Reginald F Munden
- Department of Radiology, Wake Forest Baptist Medical Center, Winston Salem, NC, United States
| | - Sally W Vernon
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, United States
| |
Collapse
|
22
|
McClelland S, Leberknight J, Guadagnolo BA, Coleman CN, Petereit DG. The pervasive crisis of diminishing radiation therapy access for vulnerable populations in the United States, part 2: American Indian patients. Adv Radiat Oncol 2018; 3:3-7. [PMID: 29556572 PMCID: PMC5856975 DOI: 10.1016/j.adro.2017.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/14/2017] [Accepted: 08/15/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION American Indian/Alaska Native (AI/AN) patients with cancer disproportionally present with more advanced stages of disease and have the worst cancer-specific survival rates of any racial/ethnic group in the United States. The presence of disparities in radiation therapy (RT) access for AI/AN patients has rarely been examined. METHODS AND MATERIALS National Cancer Institute (NCI) initiatives toward addressing AI/AN disparities were examined. Additionally, an extensive PubMed literature search for studies investigating RT access disparities in AI/AN patients was performed. RESULTS Literature describing RT access disparities for the AI/AN patient population is sparse, revealing only 3 studies, each of which described initiatives from the Walking Forward program, the NCI Cancer Disparity Research Partnership initiative to address barriers to cancer screening among AI populations in the Northern Plains region (eg, geographic remoteness and mistrust of health care providers). This program has used patient navigation, community education, and access to clinical trials for more than 4000 AI/AN patients to combat high cancer mortality rates. Over the course of its 15-year existence, the program has resulted in patients presenting with earlier stages of disease and experiencing higher cure rates. Lung cancer, the most common cause of cancer-related mortality in AI/AN patients, is the most recent and ongoing focus of the program. CONCLUSION The amount of information regarding RT access in AI/AN patients is limited, with nearly all peer-reviewed published progress in this area being associated with the Walking Forward program. Further initiatives from this program will hopefully inspire similar initiatives throughout the country to reduce the barriers to optimized cancer care that these patients face. Given the similarities with cancer disparities of populations worldwide, the AI/AN experience should be included within the broad issue of a global shortage of cancer care among underserved populations.
Collapse
Affiliation(s)
- Shearwood McClelland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - B. Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Daniel G. Petereit
- Walking Forward Program, Rapid City, South Dakota
- International Cancer Expert Corps, Washington, DC
- Rapid City Regional Cancer Care Institute, Rapid City, South Dakota
| |
Collapse
|
23
|
Raz DJ, Wu GX, Consunji M, Nelson RA, Kim H, Sun CL, Sun V, Kim JY. The Effect of Primary Care Physician Knowledge of Lung Cancer Screening Guidelines on Perceptions and Utilization of Low-Dose Computed Tomography. Clin Lung Cancer 2018; 19:51-57. [PMID: 28652090 PMCID: PMC8794575 DOI: 10.1016/j.cllc.2017.05.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/03/2017] [Accepted: 05/16/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is recommended by the U.S. Preventive Services Task Force (USPSTF) in high-risk patients, but a minority of eligible people are screened. It is not clear whether knowledge of USPSTF recommendations among primary care physicians (PCP) affects utilization of LDCT. METHODS A randomly selected sample of 1384 PCPs in Los Angeles County was surveyed between January and October 2015, using surveys sent by mail, fax, and e-mail. The response rate was 18% (n = 250). Training background, years in practice, practice type, and respondent demographics were collected. We analyzed results based on the response to a question on whether the USPSTF recommends the use of LDCT to screen high-risk individuals for lung cancer. RESULTS A total of 117 (47%) PCPs responded that the USPSTF recommends LDCT for LCS. Of PCPs who were aware of USPSTF recommendations, 97% responded that CT was effective at reducing lung cancer mortality among individuals meeting eligibility criteria, compared with 90% who were unaware of guidelines (P = .02). A larger proportion of PCPs aware of guidelines ordered LDCT (71% vs. 38%, P < .001) and initiated a discussion on screening (86% vs. 62%, P < .001). Both groups of PCPs reported similar perceptions of barriers to screening, such as insurance coverage, risks of LCS, and cost to society. Practice size, training background, and years in practice did not affect knowledge of guidelines. DISCUSSION Awareness of USPSTF recommendations for LDCT is associated with increased utilization of LDCT for screening. Educational interventions for PCPs may improve adherence with LCS recommendations.
Collapse
Affiliation(s)
- Dan J Raz
- Division of Thoracic Surgery, City of Hope, Duarte, CA.
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope, Duarte, CA
| | | | | | - Heeyoung Kim
- Department of Population Sciences, City of Hope, Duarte, CA
| | - Can-Lan Sun
- Department of Population Sciences, City of Hope, Duarte, CA
| | - Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope, Duarte, CA
| |
Collapse
|
24
|
Zahnd WE, James AS, Jenkins WD, Izadi SR, Fogleman AJ, Steward DE, Colditz GA, Brard L. Rural-Urban Differences in Cancer Incidence and Trends in the United States. Cancer Epidemiol Biomarkers Prev 2017; 27:1265-1274. [PMID: 28751476 DOI: 10.1158/1055-9965.epi-17-0430] [Citation(s) in RCA: 243] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/27/2017] [Accepted: 07/18/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Cancer incidence and mortality rates in the United States are declining, but this decrease may not be observed in rural areas where residents are more likely to live in poverty, smoke, and forego cancer screening. However, there is limited research exploring national rural-urban differences in cancer incidence and trends.Methods: We analyzed data from the North American Association of Central Cancer Registries' public use dataset, which includes population-based cancer incidence data from 46 states. We calculated age-adjusted incidence rates, rate ratios, and annual percentage change (APC) for: all cancers combined, selected individual cancers, and cancers associated with tobacco use and human papillomavirus (HPV). Rural-urban comparisons were made by demographic, geographic, and socioeconomic characteristics for 2009 to 2013. Trends were analyzed for 1995 to 2013.Results: Combined cancers incidence rates were generally higher in urban populations, except for the South, although the urban decline in incidence rate was greater than in rural populations (10.2% vs. 4.8%, respectively). Rural cancer disparities included higher rates of tobacco-associated, HPV-associated, lung and bronchus, cervical, and colorectal cancers across most population groups. Furthermore, HPV-associated cancer incidence rates increased in rural areas (APC = 0.724, P < 0.05), while temporal trends remained stable in urban areas.Conclusions: Cancer rates associated with modifiable risks-tobacco, HPV, and some preventive screening modalities (e.g., colorectal and cervical cancers)-were higher in rural compared with urban populations.Impact: Population-based, clinical, and/or policy strategies and interventions that address these modifiable risk factors could help reduce cancer disparities experienced in rural populations. Cancer Epidemiol Biomarkers Prev; 27(11); 1265-74. ©2017 AACR.
Collapse
Affiliation(s)
- Whitney E Zahnd
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois.
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Wiley D Jenkins
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Sonya R Izadi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Amanda J Fogleman
- Office of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois
| | - David E Steward
- Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Laurent Brard
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Southern Illinois University School of Medicine, Springfield, Illinois.,Simmons Cancer Institute at SIU, Southern Illinois University School of Medicine, Springfield, Illinois
| |
Collapse
|