Examination of the Association Between Access to Care and Lung Cancer Screening Among High-Risk Smokers

Abstract

Objective: The purpose of this study was to examine the influence of access to care on the uptake of low-dose computed tomography (LDCT) lung cancer screening among a diverse sample of screening-eligible patients.Methods: We utilized a cross-sectional study design. Our sample included patients evaluated for lung cancer screening at a large academic medical center (AMC) between 2015 and 2017 who met 2013 USPSTF guidelines for LDCT screening eligibility. The completion of LDCT screening (yes, no) was the primary dependent variable. The independent variable was access to care (insurance type, living within the AMC service area). We utilized binary logistic regression analyses to examine the influence of access to care on screening completion after adjusting for demographic factors (age, sex, race) and smoking history (current smoking status, smoking pack-year history).Results: A total of 1,355 individuals met LDCT eligibility criteria, and of those, 29.8% (n = 404) completed screening. Regression analysis results showed individuals with Medicaid insurance (OR, 1.51; 95% CI, 1.03-2.22), individuals living within the AMC service area (OR, 1.71; 95% CI, 1.21–2.40), and those aged 65–74 years (OR, 1.49; 95% CI, 1.12–1.98) had higher odds of receiving LDCT lung cancer screening. Lower odds of screening were associated with having Medicare insurance (OR, 0.30; 95% CI, 0.22–0.41) and out-of-pocket (OR, 0.27; 95% CI, 0.15–0.47).Conclusion: Access to care was independently associated with lowered screening rates. Study results are consistent with prior research identifying the importance of access factors on uptake of cancer early detection screening behaviors.

Access to Care Limits Lung Cancer Screening Eligibility in an Urban Safety Net Hospital

“…Proximity is a recognized indicator of access to care, however other important considerations such as the mode and access to transportation along with the time requirement for commuting to the medical center could not be accurately assessed from this retrospective chart review and would offer more insight into our patients’ barriers to care. 27 , 28 Other studies note that drive time is significant for some patients secondary to the geographic variability of LCS locations, however the method of transportation is not assessed. 16 Patients also face an opportunity cost when obtaining medical care due to other social and financial considerations such as family or work responsibilities but this information is not represented in the available data.…”

“…In addition, factors associated with access to care such as insurance type and geographic relationship to the medical facility have been associated with the utilization of LCS. 28 However, the interplay of factors associated with access to care is complex and does not always directly equate to lack of medical care. Our data is unique in that it quantitates the percentage of LCS-eligible patients diagnosed with lung cancer who would not be able to undergo screening due to lack of access to medical care.…”

Similar Efficacy Observed for First-Line Immunotherapy in Racial/Ethnic Minority Patients With Metastatic NSCLC

“…Studies from the era before immunotherapy that examined socioeconomic characteristics in patients with NSCLC have shown an association of insurance and income with low-dose CT screening, 84,85 staging, 86,87 chemotherapy access, 88 and survival. 89 However, studies that examined the socioeconomic factors of patients treated with immunotherapy are scarce, and only one study has specifically examined income.…”