4 barriers that keep patients from participating in lung cancer screening

Lung cancer screening (LCS) with low-dose CT effectively reduces mortality among high-risk current and former smokers, yet patients face numerous challenges that can keep them from engaging with LCS.

A new analysis published in Radiology explored some of these challenges, letting providers know how to address them and improve patient engagement.

“A better understanding of the difficulties confronted by other stakeholders will help radiologists continue to collaboratively guide the growth of LCS programs in their communities,” wrote Gary X. Wang, MD, PhD, department of radiology at Harvard Medical School in Boston, and colleagues.

These are four barriers currently keeping some patients from participating in LCS:

1. Lack of patient awareness

According to one study, 38 percent of eligible individuals knew nothing about LCS. Numerous other studies have reached similar conclusions.

So how can providers get the word out?

“Radiology groups can produce content for patient-directed interventions to raise awareness, increase health literacy, and invite those eligible to screening,” the authors wrote. “Communication platforms include community health fairs, conventional and social media, educational brochures, and mailed invitations.”

These interventions, Wang and colleagues added, must be easy to understand to truly make an impact.

2. Cost concerns/insurance coverage

Though CMS and private insurance companies cover LCS, not all eligible patients necessarily know that information. The problem gets worse, the authors wrote, when eligible patients speak to their primary care physician for more information, but the physician is unable to help.

Of course, maybe patients lack insurance coverage. In addition, patients sometimes worry about “travel costs and lost income from taking time off from work.”

Again, educational outreach from providers can help resolve this problem for many patients. Another big thing providers can do is work to provide completely free screening.

“For LCS, a radiology-led initiative in Los Angeles secured grant funding to provide free screening for a predominantly uninsured, low-income African American community,” the authors wrote, sharing one notable example. “This collaboration between an academic medical center and community partners used program coordinators and patient navigators to facilitate screening and enrolled nearly 300 patients over 2 years.”

3. Patient perceptions

Some current smokers are afraid of being diagnosed with cancer, so they avoid LCS altogether. Others worry about the “perceived stigma” associated with being a smoker. Other patients are concerned about radiation exposure, the authors noted.

To battle these perceptions, providers can put in work to make sure their invitations for screening are seen as “trustworthy, engaging and relevant.” In addition, some at-risk patients may be more interested in LCS if they are invited to take part by their primary care physician. Partnerships between these physicians and radiology practices could help improve LCS engagement by showing patients that their physicians support the screening.

“Outreach efforts should also address radiation concerns,” the authors wrote. “Radiologists can create patient-directed educational resources to target barriers rooted in knowledge gaps and misinformation.”

4. Challenges to accessing screening

Another common barrier patients face is that patients may be unable to reach the location where the LCS takes place. The most common reason patients declined to take part in the UK Lung Cancer Screening Trial, for instance, was “difficulty with travel related to distance between home and screening site, lack of public transportation, and/or cost of the trip or hospital parking.”

Wang and colleagues suggested that providers partner with local transportation systems, provide courtesy shuttle services or find other ways to make transportation easier for at-risk patients. Mobile screening units have been tested by one LCS program, and the results of that study are still pending.

Also, the American College of Radiology and other groups have “expressed concern that recent CMS cuts in reimbursement for low-dose CT” may make it harder for providers to offer the best possible LCS to patients.

“The potentially negative impact of the current low-dose CT reimbursement rate on access to screening is an important subject that merits investigation, which may help inform future advocacy efforts,” the authors wrote.