# Design and Interim Recruitment Outcomes of a Multi-Modal, Multi-Level Patient Navigation Intervention for Lung Cancer Screening in the Southeast U.S

## TL;DR

This study tests a new patient navigation program to help Black patients in the Southeast U.S. overcome barriers to lung cancer screening.

## Contribution

The novel contribution is a community-engaged, multi-modal patient navigation strategy targeting lung cancer screening disparities in Black populations.

## Key findings

- 170 Black participants have been recruited, most of whom are smokers and face cost and insurance barriers.
- The intervention addresses disparities in lung cancer screening access and could serve as a national model.
- The study cohort contrasts with predominantly White groups in prior trials, focusing on medically underserved populations.

## Abstract

Lung cancer is the major cause of cancer death among people living in the United States (U.S.); death rates are highest among Black men. People as young as ages 50–64 who meet the U.S. lung cancer screening guidelines may receive screening, although they will typically not qualify for Medicare coverage for screening. Therefore, the study team obtained funding from Stand Up To Cancer® (SU2C) to test a new patient navigation strategy to assist Black patients from federally qualified health centers with finding resources to overcome their lung cancer screening barriers. To date, 170/675 participants have been recruited. Most were unmarried (58.82%), had a high school education/GED or less (65.29%), currently smoked (83.53%), and were men (62.94%). Reported lung cancer screening barriers included cost and insurance issues. This innovative, community-engaged strategy to improve lung cancer screening rates and reduce lung cancer deaths in high-risk people could serve as a national model.

Background/Objectives: Lung cancer is the leading cause of cancer death in the United States (U.S.). Virginia, South Carolina, and North Carolina are among the U.S. states with extraordinarily high rates of lung cancer mortality, particularly among Black residents. The current lung cancer screening guidelines, revised in 2021, support screening for younger, non-Medicare age-eligible individuals who smoke. However, their health insurance, if any, may not cover their screening. This lack of access could create more disparities in lung cancer mortality rates. Methods: To address this concern, the Virginia Commonwealth University Massey Comprehensive Cancer Center, the Medical University of South Carolina Hollings Cancer Center, and the University of North Carolina Chapel Hill Lineberger Comprehensive Cancer Center secured a four-year Stand Up To Cancer® (SU2C) grant titled “Southeastern Consortium for Lung Cancer Screening (SC3) Study” with a novel aim to test the effectiveness of a multimodal, multilevel, barrier-focused patient navigation intervention to promote lung cancer screening among Black patients from federally qualified health centers. Results: A total of 170/675 Black participants have been recruited to date. The majority of participants (n = 134; 78.82%) were aged 55–74 years. Most participants were unmarried (n = 100; 58.82%), more than half had a high school education/GED or less (n = 111; 65.29%), most currently smoked (n = 142; 83.53%), and more males than females participated (n = 107; 62.94% male). Their reported lung cancer screening barriers, addressed by the patient navigators, were cost concerns, insurance coverage issues, and recent medical history precluding screening. Conclusions with Relevance to Cancer Health Equity: This SC3 study includes a unique lung cancer screening cohort that is in direct contrast to the predominantly White cohort in the National Lung Screening Trial. The SU2C study has created a novel, community-engaged approach to lung cancer screening navigation that could become the gold standard in high-risk medically underserved populations.