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May 01, 2023
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More eligible lung cancer screening patients identified with proactive recruitment

Fact checked byKristen Dowd
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Key takeaways:

  • Proactive recruitment resulted in finding more eligible patients for low-dose CT screening.
  • Talking with a nurse navigator demonstrated 59.2% of patients expressing interest in cancer screening.

Use of a nurse navigator led to the discovery of more patients eligible for low-dose CT lung cancer screening and more screenings ordered, according to results published in Annals of Family Medicine.

Sowmyanarayanan Thuppal

“In spite of various measures to improve the uptake of low-dose CT [LDCT] for lung cancer screening, the national screening rate for lung cancer is less than 6%,” Sowmyanarayanan Thuppal, MD, PhD, research assistant professor in the department of surgery at Southern Illinois University School of Medicine, and Traves Crabtree, MD, professor and chair of the division of cardiothoracic surgery at Southern Illinois University School of Medicine, told Healio in a statement. “Unlike other cancer screening programs, additional effort/time is required for LDCT screening to discuss clinical significance of LDCT screening, smoking cessation counselling and referral to smoking cessation interventions as part of the shared decision-making and detailed documentation.”

Infographic showing percentages of responses among 206 individuals who talked with a nurse navigator.
Data were derived from Thuppal S, et al. Ann Fam Med. 2023;doi:10.1370/afm.2905.
Traves Crabtree

Using patients from four family medicine physicians from the Department of Family and Community Medicine, Southern Illinois University School of Medicine, Thuppal, Crabtree and colleagues analyzed 451 current/former smokers (median age, 61 years; 54.4% women; 75% white) aged 55 to 80 years to determine if proactive patient education/recruitment impacts LDCT screening rates.

This study was divided into two phases to assess differences in screening between patients who received proactive recruitment (prospective) and those who did not (retrospective). The retrospective phase took place from March 2019 to August 2019, whereas the prospective phase took place in 2020.

Researchers grouped patients according to their smoking status and pack-years to figure out if they qualified for screening and then noted how many eligible patients participated in LDCT within 1 year.

The later phase involved patients from the earlier phase who were identified as eligible but did not go through with LDCT screening, as well as patients who did not have a complete smoking history. In this cohort of patients, a nurse navigator reached out to them.

“Our nurse navigator called each patient to assess eligibility and confirm their smoking history,” Thuppal and Crabtree told Healio. “If the individual was eligible, they referred the patient to their primary care provider.”

From the total cohort in the phase without proactive recruitment/education, researchers identified 184 (40.8%) eligible screening patients who had necessary electronic medical record data to figure out pack-years, but only 34 (18.5%) patients ordered for LDCT. All but two of these patients went through with LDCT, of which 10 ended up with a detected lesion.

Researchers initially found a slightly higher number of eligible patients in the other phase, (n = 189), but only 150 of them ended up being included because they had no past records of LDCT. They further found 156 patients without a complete smoking history record, so the nurse navigator contacted them to see if they were eligible. This method contributed 56 more patients to the total (n = 206).

The prospective phase that utilized a nurse navigator showed a 37.3% increase in the number of patients eligible for screening vs. the retrospective phase that only relied on electronic medical records to grant eligibility.

From this cohort of individuals who talked with a nurse navigator, 122 (59.2%) patients expressed interest in screening and agreed to it over the phone, 94 (45.6%) went to see their physician to discuss the screening and 42 (20.4%) had an LDCT ordered.

Of those who were not interested in screening when speaking with the nurse navigator, researchers noted various patient-reported reasons, such as other health problems, no means of transportation and no issues with their lungs.

Of the 42 patients approved for LDCT, 32 (15.5%) went through with the screening, and researchers found that 17 patients (8.3%) had a nodule, whereas two patients had squamous cell carcinoma.

Patients who received education over the phone had more LDCTs ordered and lesions detected than patients who did not.

“One of the physician-related barriers associated with LDCT screening is the need for additional physician time and staffing to discuss LDCT and for shared decision-making,” Thuppal and Crabtree said. “Use of a nurse navigator for LDCT lung cancer screening will help reduce this burden and identify more eligible high-risk individuals for screening.

“In future studies, it would be essential to see if use of nurse navigator along with telehealth can improve lung cancer screening rates among high-risk individuals,” Thuppal and Crabtree added.

For more information:

Sowmyanarayanan Thuppal, MD, PhD, can be reached at sthuppal83@siumed.edu.

Traves Crabtree, MD, can be reached at tcrabtree53@siumed.edu.

Reference:

  • Study indicates that proactive patient education and recruitment can help improve lung cancer screening rates in the primary care setting. https://www.eurekalert.org/news-releases/984196. Published March 28, 2023. Accessed March 29, 2023.