Effect of Patient Navigation on Completion of Lung Cancer Screening in Vulnerable Populations
Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
Parkland Health, Dallas, TX
Search for other papers by Sheena Bhalla in
Current site
Google Scholar
PubMed
Search for other papers by Vijaya Natchimuthu in
Current site
Google Scholar
PubMed
Search for other papers by Jessica L. Lee in
Current site
Google Scholar
PubMed
Search for other papers by Urooj Wahid in
Current site
Google Scholar
PubMed
Search for other papers by Hong Zhu in
Current site
Google Scholar
PubMed
Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
Search for other papers by Noel O. Santini in
Current site
Google Scholar
PubMed
Search for other papers by Travis Browning in
Current site
Google Scholar
PubMed
Search for other papers by Heidi A. Hamann in
Current site
Google Scholar
PubMed
Search for other papers by David H. Johnson in
Current site
Google Scholar
PubMed
Search for other papers by Hsienchang Chiu in
Current site
Google Scholar
PubMed
Search for other papers by Simon J. Craddock Lee in
Current site
Google Scholar
PubMed
Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
Parkland Health, Dallas, TX
Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX
Search for other papers by David E. Gerber in
Current site
Google Scholar
PubMed
Background: Although low-dose, CT–based lung cancer screening (LCS) can decrease lung cancer mortality in high-risk individuals, the process may be complex and pose challenges to patients, particularly those from minority underinsured and uninsured populations. We conducted a randomized controlled trial of telephone-based navigation for LCS within an integrated, urban, safety-net health care system. Patients and Methods: Patients eligible for LCS were randomized (1:1) to usual care with or without navigation at Parkland Health in Dallas, Texas. The primary endpoint was completion of the first 3 consecutive steps in a patient’s LCS process. We explored differences in completion of LCS steps between navigation and usual care groups, controlling for patient characteristics using the chi-square test. Results: Patients (N=447) were randomized to either navigation (n=225) or usual care (n=222). Mean patient age was 62 years, 46% were female, and 69% were racial/ethnic minorities. There was no difference in completion of the first 3 steps of the LCS algorithm between arms (12% vs 9%, respectively; P=.30). For ordered LCS steps, completion rates were higher among patients who received navigation (86% vs 79%; P=.03). The primary reason for step noncompletion was lack of order placement. Conclusions: In this study, lack of order placement was a key reason for incomplete LCS steps. When orders were placed, patients who received navigation had higher rates of completion. Clinical team education and enhanced electronic health record processes to simplify order placement, coupled with patient navigation, may improve LCS in safety-net health care systems.
Submitted May 29, 2023; final revision received August 29, 2023; accepted for publication October 4, 2023. Published online March 15, 2024.
Author contributions: Conceptualization: Hamann, Craddock Lee, Gerber. Data curation: Wahid, Zhu. Formal analysis: Wahid, Zhu. Funding acquisition: Hamann, Craddock Lee, Gerber. Investigation: Bhalla, Craddock Lee, Gerber. Methodology: Craddock Lee, Gerber. Project administration: Lee. Supervision: Gerber. Visualization: Bhalla, Wahid. Writing—original draft: Bhalla. Writing—review and editing: All authors.
Disclosures: Dr. Bhalla has disclosed serving on a data safety monitoring board for Mirati Therapeutics; and serving on an advisory board for AstraZeneca, Merus, Novocure, and Takeda. Dr. Browning has disclosed serving as a consultant for Change Healthcare. Dr. Gerber has disclosed receiving grant/research support from AstraZeneca, BerGenBio, Karyopharm, and Novocure; serving as a consultant for BeiGene, Catalyst, Daiichi-Sankyo, Elevation Oncology, Janssen, Mirati Therapeutics, Regeneron, and Sanofi; owning stock/having ownership interest in Gilead Sciences, Medtronic, and Walgreens; and holding an executive position at OncoSeer Diagnostics. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: Research reported in this publication was supported by Cancer Prevention and Research Institute of Texas (RP160030, PP190052, PP230041; H.A. Hamann, S.J. Craddock Lee, D.E. Gerber), Biostatistics Shared Resource in the Harold C. Simmons Comprehensive Cancer Center (5P30 CA142543), and UT Southwestern Center for Patient-Centered Outcomes Research (R24 HS022418).
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2023.7094. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.
Supplementary Materials
- Supplemental Materials (PDF 752 KB)
© 2019-2024 National Comprehensive Cancer Network