The Process From Referral to LCS Is a Crucial Point Among Veterans

A vital point in the lung cancer screening process was when veterans needed to connect with the screening program following a referral, and this may be used to design, implement, and review interventions to improve lung cancer screening (LCS) rates among Black veterans, according to Oncology.

Racial disparities in LCS are usually ascribed to obstacles like cost, insurance status, care access, and transportation. Since these barriers are diminished within the Veterans Affairs system, there is a question of whether similar racial disparities are present in a Veterans Affairs health care system in North Carolina.

The aim of this study was to evaluate if racial disparities in completing LCS following referral are present at the Durham Veterans Affairs Health Care System (DVAHCS) and, if so, what factors are linked with screening completion.

There are significant racial disparities in the use and application of LCS. Small studies have discovered that Black patients have a lower likelihood to have undergone LCS than White patients, despite evidence that Black males have the highest age-adjusted rates of lung cancer incidence and highest lung cancer mortality among all US racial and ethnic groups.

X-ray of a lung

Disparities attributed to LCS rates include insurance status, rurality, environmental or occupational exposures outside of tobacco use, care access and transportation, stigma and patient-practitioner communication and decision on making challenges.

First, this cross-sectional study evaluated veterans referred to LCS between July 1, 2013, and August 31, 2021, at the DVAHCS. All veterans included self-identified as White or Black and met the US Preventative Services Task Force eligibility criteria as of January 1, 2021. Participants who died within 15 months of consultation or who were screened prior to consultation weren’t included.

Main outcomes and measures consisted of screening completion defined as completing computed tomography for LCS. The links among screening completion, race, and demographic and socioeconomic risk factors were reviewed using logistic regression models. Exposures consisted of self-reported race.

Then, a total of 4562 veterans (mean [SD] age, 65.4 [5.7] years; 4296 male; 1766 Black and 2796 White) were referred for LCS. Of all participants referred, 1692 ultimately completed screening; 2707 never connected with the LCS program following referral and an informational mailer or telephone call, indicating a vital point in the LCS process. Screening rates were considerably lower among Black compared with White veterans (538 vs 1154), with Black veterans having 0.66 times lower odds (95% CI, 0.54-0.80) of screening completion after adjusting for demographic and socioeconomic factors.

This cross-sectional study gathered that following referral for initial LCS through a centralized program, Black veterans had 34% lower odds of LCS screening completion compared with White veterans, which is a disparity that continued even after accounting for multiple demographic and socioeconomic factors.

“Among the subgroup of Black veterans, the most important risk factors for screening completion include age at consultation, marital status, current smoking status at referral, pack year history, combat veteran status, and CAN scores,” said the researchers.

Additionally, the subgroup analysis results allowed the researchers to focus on factors that can be used to help target possible groups of Black veterans who might benefit from focused interventions to improve racial disparities in LCS rates.

Existing smoking status at LCS referral and mental health or substance use diagnosis were significantly associated with not screening in the complete cohort multivariable analysis.

Finally, a limitation of this study was that it was a single-center study among veterans, so findings might not be generalizable to the general population. Few women were in the cohort as well.

“These findings can inform qualitative and implementation research to design and assess interventions focused on improving LCS rates among Black veterans,” concluded the study authors.

Reference

Navuluri N, Morrison S, Green CL, et al. Racial disparities in lung cancer screening among veterans, 2013 to 2021. JAMA Netw Open. Published online June 16, 2023. doi:10.1001/jamanetworkopen.2023.18795