Promoting Equity of Cancer Screening and Follow-up for Lung Cancer

PROJECT SUMMARY/ABSTRACT: Lung cancer is highly lethal and accounts for nearly as many deaths as breast, cervical, colorectal, and prostate cancers combined, but most lung cancer cases are potentially preventable. About 80-90% of cases are smoking-related, and screening followed by high-quality treatment has been shown to reduce the risk of death in people at high-risk. Therefore, smoking cessation interventions plus screening are two complementary pillars that are recommended together by the US Preventive Services Task Force and other guidelines to reduce the lung cancer death rate. Unfortunately, uptake of lung cancer screening (LCS) remains low and although disparities in lung cancer deaths by socioeconomic factors, including rurality, are widely acknowledged, they remain understudied. Evidence shows that rural areas have higher lung cancer death rates than urban populations, likely related to risk factors and healthcare access. However, efforts to understand and address rural-urban disparities are hampered by low representation of rural populations in public data systems. The goal of this proposal is to elucidate factors that contribute to lung cancer disparities between rural and urban areas and provide contextual information for future interventions and policies. Our specific aims are to: (1) Characterize the delivery of evidence-based interventions (EBIs) for lung cancer prevention and early detection, comparing rural to urban areas, by assessing differences in use of smoking cessation interventions and LCS at multiple levels of influences; (2) Identify potentially modifiable care gaps across the LCS continuum, including risk assessment and timely treatment, by examining patients who died of lung cancer relative to patients who are alive by rural-urban status; and (3) Evaluate similarities and differences in the barriers and promoters to delivery of EBIs across the LCS continuum (smoking cessation, shared decision-making, screening, and treatment) in the rural and urban contexts. We will use a multidimensional health equity framework to apply a convergent, mixed methods approach for our studies. We will leverage the Rochester Epidemiology Project, a unique population-based data resource for a 27-county contiguous area in the Midwestern US, along with the Southern Community Cohort Study across 12 states in the Southeastern US, among a diverse population of 50- 80-year-old people. We will use Rural-Urban Commuting Area codes to define rurality and will assess both self- reported and area-level socioeconomic information. We will conduct semi-structured interviews with patients and clinical staff to gain perspectives on LCS barriers and promoters, including the potential role of smoking-related stigma. The proposed research has the potential for high impact by elucidating gaps on lung cancer prevention and early detection that will translate directly into strategies to address intransigent lung cancer disparities in our study population, and beyond. We will thus address priorities of the NCI and the President's Cancer Panel to advance equity and address the potential COVID-19 impact on the delivery of LCS. Our transdisciplinary team has a track record of high-impact research and has the needed expertise to successfully complete this research.