A novel rural lung cancer screening program is boosting patient engagement, with nearly 90% of low-dose CT orders completed, according to research published Monday in JACR.

The limited number of imaging facilities and long travel distances can make screening uptake challenging in such settings. Imaging experts in Texas sought to address these challenges, collaborating with community leaders to launch an intervention that included navigation services and tobacco cessation counseling.

In the first year alone, providers referred 570 patients for screening, with 86% eligible for imaging.

“Implementation, uptake and completion of LDCT-based lung cancer screening is feasible in rural settings. Community outreach, health promotion, and algorithm-based navigation may support such efforts,” corresponding author David Gerber, MD, a professor of internal medicine in the Hematology/Oncology Division at UT Southwestern Medical Center, and co-authors wrote Feb. 7. “Given low lung cancer screening rates nationally and heightened lung cancer risk in rural populations, similar programs in other regions may be particularly impactful.”

Providers first implemented their Lung Cancer Screening and Patient Navigation (LSPAN) program in May 2018. It provides support across 18 rural and medically underserved counties in North Texas, targeting 107,000 individuals with an elevated lung cancer risk. The program includes outreach to educate patients on screening; fostering a virtual network of integrated providers; and deploying an algorithm to pinpoint patients who require aid in navigating the process. LSPAN also centralizes reimbursement, so that clinical service costs are supplemented with additional funding for low-income or uninsured patients.

Gerber and co-authors sought to study the impact of the program, collecting data on referrals, orders and completions. In the first year ending in June 2019, providers ordered 381 LDCTs, with 88% completed. Out of those who were referred but ineligible, the most common reasons were age (43%) and insufficient tobacco history (20%). Among the screened patient population, 61% were current smokers and 36% had insurance coverage, with an average program cost per patient of $430.

About one-fourth of eligible referrals didn’t complete their screening, and failure to contact the patient after three attempts accounted for half of such cases.

“Reasons for active and passive refusals to undergo LDCT after referral merit further investigation, because it is unclear whether this behavior reflects patient health beliefs, logistical considerations or other concerns,” the authors advised. “Notably, once an LDCT order was placed, adherence was almost 90%, suggesting such a procedure is feasible despite the distance needed to travel.”

Read more about the program in the Journal of the American College of Radiology here.