Outreach Efforts Increased Lung Cancer Screening in Primary Care Settings

New findings from a randomized controlled trial revealed outreach contacts significantly increased lung cancer screening (LCS) among primary care patients across 4 practices in Pennsylvania. Results were published in Preventive Medicine.

Although previous data has indicated periodic low dose computed tomography (LDCT) screening can significantly reduce lung cancer mortality, LCS rates are low in the United states with one assessment concluding the current rate among eligible patients is 4.5%, compared with a 7.5% target goal, researchers explained.

CMS does cover the service for individuals aged 55 to 77 and “have at least a 30 pack-year smoking history and currently smoke, or have a history of heavy smoking but have quit smoking within the past 15 years,” as recommended by the United State Preventive Service Task Force (USPSTF).

But the agency also requires shared decision making (SDM) about LCS prior to completion, an infrequent occurrence in clinical practice, according to authors.

In an effort to determine the effects of patient outreach and SDM strategies on LCS uptake, investigators conducted a randomized controlled trial of patients receiving care at Jefferson Health in Pennsylvania.

Of the 4 practices included in the study, 2 were Family and Community Medicine practices and 2 were Internal Medicine practices. In addition, “2 practices (1 Family and Community Medicine and 1 Internal Medicine) served primarily English-speaking white and African American patients. One Family and Community Medicine practice served primarily Chinese patients, and the remaining Internal Medicine practice served mostly Korean patients,” authors wrote.

Eligible participants were identified via electronic medical record (EMR) data, and patients were randomized to an outreach contact plus decision counseling (OC-DC) group, an outreach contact alone (OC) group, or usual care control group (UC).

A total of 2347 patients were included in the final analyses with 302 in the OC-DC group, 297 in the OC group and 1748 in the UC group. A slim majority of patients (52%) were female while 31% were African American and 7% were Asian.

Analyses revealed:

• LCS was significantly higher in the combined OC/OC-DC group versus UC controls (5.5% vs. 1.8%; hazard ratio [HR] = 3.28; 95% CI, 1.98 to 5.41; P = .001)
• LCS was higher in the OC-DC group than in the OC group, although not significantly so (7% vs. 4%, respectively; HR = 1.75; 95% CI, 0.86 to 3.55; P = .123)
• LCS referral/scheduling was also significantly higher in the OC/OC-DC group compared with controls (11% v. 5%; odds ratio [OR] = 2.02; P = .001)
• A similar trend was seen for appointment keeping, but the effect was not statistically significant (86% v. 76%; OR = 1.93; P = .351)
• LCS rates were somewhat lower in African American patients compared with white patients, but the finding was not statistically significant

Overall, screening completion was significantly higher among those who received some form of outreach contact compared with patients receiving usual care. This could be due to an increase in LCS referral and scheduling for the service. While SDM incorporation appeared to have an additive effect, more research is needed to assess this addition to care.

“Even when extended follow-up (up to 9 months) was considered, during which many of the usual care group participants were likely to have had a routine care visit with their provider, their LCS screening rate did not catch up with that of the intervention groups,” authors noted.

Due to limited data in EMRs, researchers were unable to ascertain intervention impact among those with verified LCS eligibility, marking a limitation to the study. Generalizability of findings may also be limited and may not apply to all primary care practices.

Reference:

DiCarlo M, Myers P, Daskalakis C, et al. Outreach to primary care patients in lung cancer screening: a randomized controlled trial. Prev Med. Published online April 22, 2022. doi:10.1016/j.ypmed.2022.107069