Implementation and Uptake of Rural Lung Cancer Screening

Le, Tri Minh; Miller, Stacie; Berry, Emily; Zamarripa, Sarah; Rodriguez, Aurelio; Barkley, Benjamin; Kandathil, Asha; Brewington, Cecelia; Argenbright, Keith; Gerber, David E.

doi:10.1016/j.jacr.2021.12.003

Cited by 14 publications

(9 citation statements)

References 48 publications

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“…GPs represent the frontline healthcare professional with a comprehensive knowledge of patients’ general status, behavior, and clinical history, and the relationship of trust should not be underestimated. Whereas rurality has been pointed out as a limit in lung cancer screening programs in other studies because of the lack of access to facilities ( 10 ) or inadequacy of referral ( 23 ), our results indirectly suggest that people living in rural areas in Tessin have an adequate healthcare support. Enhancing symptoms awareness is important in detecting lung cancer diagnosis, but it seems to be not sufficient to change prognosis and survival and to increase GP attendance ( 24 ).…”

Section: Discussioncontrasting

confidence: 57%

Urban–Rural Disparities in the Lung Cancer Surgical Treatment Pathway: The Paradox of a Rich, Small Region

et al. 2022

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IntroductionRural populations in large countries often receive delayed or less effective diagnosis and treatment for lung cancer. Differences are related to population-based factors such as lower pro capita income or increased risk factors or to differences in access to facilities. Switzerland is a small, rich country with peculiar geographic and urban characteristics.We explored the relationship between lung cancer diagnostic–surgical pathway and urban–rural residency in our region.MethodsWe retrospectively analyzed the medical records of 280 consecutive patients treated for primary non-small cell lung cancer at our institution (2017–2021). This is a regional tertiary center for diagnosis and treatment, and data were extracted from a prospectively collected clinical database. We included anatomical lung resection. Collected variables included patients and surgical characteristics, risk factors, comorbidities, histology and staging, symptoms (vs. incidental diagnosis), general practitioner (GP) involvement, health insurance, and suspected test-treatment interval. The exposure was rurality, defined by the 2009 rural–urban residency classification from the Department of Land.ResultsA total of 150 patients (54%) lived in rural areas. Rural patients had a higher rate of smoking history (93% vs. 82%; p = 0.007). Symptomatic vs. incidental diagnosis did not differ as well as previous cancer rate, insurance, and pathological staging. In rural patients, there was a greater burden of comorbidities (mean Charlson Comorbidity Index Age-Adjusted 5.3 in rural population vs. 4.8 in urban population, p = 0.05), and GP was more involved in the diagnostic pathway (51% vs. 39%, p = 0.04). The interval between the first suspected test and treatment was significantly shorter (56 vs. 66.5 days, p = 0.03). Multiple linear regression with backward elimination was run. These variables statistically predicted the time from the first suspected test and surgical treatment [F(3, 270), p < .05, R2 = 0.24]: rurality (p = 0.04), GP involvement (p = 0.04), and presence of lung cancer-related symptoms (p = 0.02).ConclusionsIn our territory with inhomogeneous population distribution and geographic barriers, residency has an impact on the lung cancer pathway. It seems paradoxical that rural patients had a shorter route. The more constant involvement of GP might explain this finding, having suggested more tests for high-risk patients in the absence of symptoms or follow-ups. This did not change the staging of surgical patients, but it might be essential for the organization of an effective lung cancer screening program.

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Section: Discussioncontrasting

confidence: 57%

Urban–Rural Disparities in the Lung Cancer Surgical Treatment Pathway: The Paradox of a Rich, Small Region

et al. 2022

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“…Between 2018 and 2020, nearly 67% of lung cancers detected through the initiative were found to be stage I or II, and the reach and adherence of the program increased annually [ 15 ]. A separate but similar initiative focused on rural regions of high tobacco usage in North Texas sought to outline logical steps to increase access to lung cancer screening resources in underserved areas [ 16 ]. This program showed that with key stakeholder involvement, reach and access can be extended to a rural population effectively [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Incidental Metastatic Lung Cancer in a Patient Being Treated for Community-Acquired Pneumonia: The Case for Lung Cancer Screening in Rural America

Heinrich¹,

Stabbert²,

Sanchez³

et al. 2023

Cureus

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Lung cancer is the leading cause of cancer deaths in the United States. Efforts to decrease the number of deaths over the last decade have included the publication of guidelines by the United States Preventive Services Task Force (USPSTF) recommending annual low-dose computed tomography (LDCT) scanning in patients meeting specific criteria in order to facilitate the detection and classification of potential cancers, allowing for earlier and possibly curative intervention. Unfortunately, not every patient who meets these criteria will receive LDCT surveillance due to low socioeconomic status, geographic barriers, and limited access to healthcare related to the growing shortage of primary care physicians. We describe a case in which a patient located in a rural southeastern region of the United States presented to the emergency room with a one-week history of fevers, cough, and shortness of breath. Chest imaging revealed findings consistent with community-acquired pneumonia (CAP). He had over a 30-pack-year history of smoking cigarettes and fit the additional criteria within the USPSTF recommendations for annual LDCT scans for lung cancer screening though no screening records were found. While being treated for CAP as an inpatient, the decision was made to perform additional imaging of the patient’s left hip, as he had been having increasing pain during the hospital stay. A mass lesion was seen on computed tomography (CT) scan in the posterior acetabular roof, prompting additional imaging and biopsy, which led to findings consistent with stage IV metastatic pulmonary adenocarcinoma. While improvements in both imaging and classification of potentially malignant pulmonary nodules and masses have been observed since the USPSTF recommendations were first released in 2013 and with the 2021 update, rural populations with high-risk patients who fit the criteria for LDCT scanning remain vulnerable to non-screening. This patient may have benefitted from annual LDCT screening for lung cancer. Encouraging primary care physicians to not only screen for current tobacco use but also to have necessary resources on hand in clinics to arrange for timely and appropriate screening appointments and follow-up visits is integral to improving the detection and early management of lung cancer. System-wide implementation of actions that may be carried out on multiple levels of care might provide both practitioners and patients with additional tools needed in a rural setting to decrease the number of lung cancer deaths.

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“…There is still work to be done to ensure that a high proportion of eligible patients receive this test. Recent studies have found the benefit of community outreach and health promotion campaigns 21 and provider educational programs. 22…”

Section: Discussionmentioning

confidence: 99%

Implementation and Uptake of Rural Lung Cancer Screening

Cited by 14 publications

References 48 publications

Urban–Rural Disparities in the Lung Cancer Surgical Treatment Pathway: The Paradox of a Rich, Small Region

Urban–Rural Disparities in the Lung Cancer Surgical Treatment Pathway: The Paradox of a Rich, Small Region

Incidental Metastatic Lung Cancer in a Patient Being Treated for Community-Acquired Pneumonia: The Case for Lung Cancer Screening in Rural America

Lung Cancer Screening Knowledge and Perceived Barriers Among Physicians in the United States

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