Original StudyPerceptions and Utilization of Lung Cancer Screening Among Smokers Enrolled in a Tobacco Cessation Program
Introduction
Lung cancer is the most common cause of cancer death in the United States (US) and worldwide.1 Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality.2 The National Comprehensive Cancer Network (NCCN) and US Preventive Services Task Force (USPSTF) guidelines recommend LCS in high-risk patients, as do a number of other professional organizations.3, 4, 5 The USPSTF recommends screening current and former smokers aged 55 to 80 years who have smoked 30 pack-years or more, and who quit within 15 years if a former smoker. Although no data exist specifically on the proportion of high-risk people who undergo LCS, Pinsky and colleagues estimated, using National Lung Screening Trial (NLST) criteria, that 6.2% of adults over age 40 would be eligible for screening.6 Yet the number of patients screened at most LCS centers is anecdotally very low. We recently reported that only 8% of primary care physicians referred most or all high-risk patients to a LCS center over the prior 12 months.7
A number of barriers to utilization of LCS in high-risk patients exist. Barriers to health care can be organized into patient, physician, and health care system factors. There are relatively few studies on barriers to LCS, in contrast to other cancer screening interventions such as mammography. We previously conducted a survey assessing barriers to LCS among primary care physicians and found the following factors of greatest concern: (1) effectiveness of LDCT to prevent death from lung cancer; (2) potential risks of LDCT; and (3) costs of LDCT. There are several small studies evaluating perceived barriers to LCS among high-risk patients; however, no study has investigated barriers to screening in people eligible for LCS since screening recommendations were made.8, 9, 10, 11, 12, 13 Understanding perceived barriers to LCS in people eligible for LDCT screening is important when devising strategies to improve utilization of LCS for those who stand to benefit. Recently a validated survey tool was developed to assess LCS health beliefs, including perceived barriers to screening.14 Here, we surveyed current smokers who were enrolled in a tobacco cessation program and who met USPSTF eligibility criteria for LDCT regarding their perceptions of lung cancer risk and LCS.
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Materials and Methods
Current smokers who attended at least 1 tobacco cessation group session, part of a 4-session course entitled “Freedom from Tobacco,” at 1 of 4 participating Kaiser Permanente medical centers in Southern California were eligible to participate between January 2017 and December 2017. These 4 centers average approximately 693 participants per year. A total of 185 volunteer participants completed surveys at the end of the class after distribution of the survey by tobacco cessation counselors. The
Results
We included 185 participants, including 122 participants between the ages of 55 and 80 years, who completed surveys. Most (62%) of them were 55 to 65 years old, at least 51% had a 30 pack-year or greater history of smoking, 39% were Hispanic or non-white, and 49% had an annual household income less than $50,000 per year (Table 1). Of respondents older than 55 years, 98 (80.3%) previously underwent colorectal cancer screening (colonoscopy, sigmoidoscopy, or fecal occult blood test). Twenty-three
Discussion
In this study, we reported on LCS adoption, lung cancer risk perception, and perceived barriers to LCS among current smokers who attended a tobacco cessation counseling class. We found that eligible smokers in this health care system had high rates of colorectal cancer screening and that a minority had already undergone at least 1 LDCT for LCS. No survey respondent who had not already undergone LDCT was familiar with LCS. We identified a number of barriers that were important to a large
Disclosure
D.R. reports grant funding from Merck.
Acknowledgments
Research reported in this publication is supported by the Lung Cancer Research Foundation, and the National Cancer Institute of the National Institutes of Health under award numbers NIH 5K12CA001727-20 (Raz) and P30CA33572 through the use of the City of Hope Survey Research Core. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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2022, Lung CancerCitation Excerpt :The modified factors cited most often as contributing to improving uptake of LCS included individualsdeveloping good health beliefs (n = 18) [11,18,26,36–37,40–41,44–45,52–60], intention to quit smoking (n = 2) [37,55], desire to decrease uncertainty (n = 3) [50,53,62], personal reassurance/peace of mind (n = 2) [36,37], self-efficacy beliefs (n = 2) [39,53], concerns about lung cancer (n = 1) [36], recommended LCS or clinical reminders by HCPs (n = 6) [18,33,39,44,54,63], pleasantness of appointment or staff (n = 2) [42,56], nursing intervention (n = 1) [33], and family values (n = 2) [18,37]. The modified factors cited most often as contributing to decreasing uptake of LCS included medical mistrust (n = 8) [15 34,37,39–40,44,52–53], lack of knowledge (n = 10) [18,34,37,39,42–44,46,51,52], fatalistic beliefs (n = 2), [39,53] perceived difficulties in cancer screening (n = 1) [11], psychological distress (e.g., fear, worry, stigma, health anxiety related to screening, claustrophobia/tight spaces) (n = 11) [15 18,34,37,39,41–42,45,52,57,61], discomfort in screening (n = 3) [53–54,56], and complexity of communication between individuals and HCPs (n = 3) [42,46,49]. This is the first systematic review to investigate the barriers and facilitators of LCS uptake at the level of both individuals and HCPs.