Patient navigation has been proposed to combat cancer disparities in vulnerable populations. Vulnerable populations often have poorer cancer outcomes and lower levels of screening, adherence, and treatment. Navigation has been studied in various cancers, but few studies have assessed navigation in lung cancer. Additionally, there is a lack of consistency in metrics to assess the quality of navigation programs. The authors conducted a systematic review of published cancer screening studies to identify quality metrics used in navigation programs, as well as to recommend standardized metrics to define excellence in lung cancer navigation. The authors included 26 studies evaluating navigation metrics in breast, cervical, colorectal, prostate, and lung cancer. After reviewing the literature, the authors propose the following navigation metrics for lung cancer screening programs: (1) screening rate, (2) compliance with follow-up, (3) time to treatment initiation, (4) patient satisfaction, (5) quality of life, (6) biopsy complications, and (7) cultural competency.
In order to assess the feasibility and outcome of using prehospital thrombolysis in acute myocardial infarction in a rural community, we performed an open randomized study of patients with symptoms of acute myocardial infarction of less than 6 hours. One hundred and forty-five patients with acute myocardial infarction were allocated to receive IV streptokinase prehospital by means of a mobile coronary care unit (MCCU) (n = 43) or to receive IV streptokinase in hospital (n = 102). The mean delay time to treatment was 138 minutes (MCCU group) and 172 minutes (hospital group) (p less than 0.02). Reperfusion time was 88 minutes for the MCCU group and 92 minutes for the hospital group. Mortality at 14 days was 2.3% for the MCCU group and 11.7% for the hospital group (p less than 0.05). Six month mortality was 4.9% for the MCCU group and 17.3% for the hospital group (p = 0.03). Mortality at 1 year was 6.1% for the MCCU group and 20.0% for the hospital group (p = 0.04). There were no significant adverse events in either treatment group. Thus, prehospital thrombolysis by streptokinase is feasible and allows significant reduction in the delay time to treatment initiation. There are encouraging improvements in both short- and long-term survival with no apparent reduction in safety profile.
Background. Previous studies identified important correlates of receiving low-dose computerized tomography (LDCT) among those referred to a lung cancer screening program in Philadelphia. However, studies have not considered whether distance from the screening site is a factor in whether eligible patients receive screening. In this study, we examine whether residential distance to the screening facility predicts receipt of baseline LDCT among eligible patients referred to the Jefferson Lung Cancer Screening Program (JLCSP), after controlling for covariates. Methods. We retrospectively selected eligible patients referred to JLCSP between 1/1/18 and 8/31/18 (N=399). We geocoded each patients’ address using ArcGIS 10.3. We used ArcGIS Network Analysis to identify the distance from each patients’ residence to the screening facility in downtown Philadelphia. We used bivariate statistical tests (chi- square, t-tests) and multivariable logistic regression to identify correlations between individual-level patient characteristics, including distance to facility, and receipt of baseline screening. Results. Residential distance to facility was not related to receipt of baseline LDCT screening, when we treated distance as a continuous variable.
When we treated distance as categorical by quartiles, residents living in the second quartile (2.41-3.25 miles) had lower odds of receiving LDCT compared to those in the closest quartile (AOR=0.55; CI=0.30-0.99). Other correlates of receiving LDCT screening were younger age, and being a former smoker (compared to current smokers). Conclusion. Individuals that lived 2.41-3.25 miles from the screening facility had lower odds of receiving LDCT compared to those that lived closest to the facility. This relationship may be the result of inadequate public transportation, or may reflect neighborhood poverty and resource inequities in Philadelphia neighborhoods. Our study did not collect patient income data, which could confound this relationship. More research is necessary to identify the extent to which distance from screening facilities serves as a barrier for receipt of LDCT services in order to reduce this barrier and improve screening adherence.
Citation Format: Russell K. McIntire, Seif Butt, Christine Shusted, Denine Crittendon, Brooke Ruane, Charnita Zeigler-Johnson, Hee-Soon Juon, Julie Barta. Does residential distance from a lung cancer screening facility predict baseline screening? [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-271.
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