Abstract C52: Clinic utilization and smoking cessation practices among ethnic minority patients referred for paired lung cancer screening and tobacco treatment services at a community cancer program
Authors: Akindele Ruth N. , Svoboda Ludmila A. , Gonzalez Sabrina G. , Lathan Christopher S. 
Published: March 2017

Background: Studies on outcomes of lung cancer screening and smoking cessation programs among underserved and ethnic minority populations are scarce. These patients, however, have the greatest potential to benefit from these services. African Americans have the highest incidence and mortality rates for lung cancer, often as a result of multiple factors including factors related to disparities in access to quality care. The aim of this study was to determine clinic utilization rates and smoking cessation practices among underserved and ethnic minority patients referred for paired lung cancer screening and smoking cessation services at a community cancer program.

Methods: The Dana-Farber Cancer Institute (DFCI)'s Cancer Care Equity Program (CCEP) added lung cancer screening to the established tobacco treatment arm of its community cancer program, housed in a neighborhood Federally Qualified Community Health Center (FQHC) in 2014. Nearly half (46%) of patients, aged 55 to 77 years who received care at the center in 2015 did not have a recorded smoking history. The paired intervention was offered at no cost to patients. Prospective data approved by the IRB was collected on a secured REDcap database that was designed for the CCEP. Patients referred by primary care providers at the health center had a low-dose computed tomography (LDCT) scan scheduled if they met the U.S. Preventive Services Task Force (USPSTF) criteria for lung cancer screening at their first visit. Concurrently, and at subsequent follow-up visits to review results of LDCT scans, patients who had not quit smoking were encouraged to enroll in the tobacco treatment program (TTP), which is individualized, one-on-one and available in both English and Spanish. A yearly surveillance LDCT plan was established for all participants who had negative scans while those with positive scans (based on American College of Radiology Lung-RADs risk stratification system) received further care at DFCI's main campus. Study outcomes include clinic show rates, smoking status, recommendations for LDCT, attendance at LDCT appointments, willingness to enroll in the TTP, and TTP participation rates. Descriptive statistical analysis on data collected between September 2014 and May 2016 was performed using JMP Pro (version 11, SAS Institute Inc., Cary, NC).

Results: Fifty two out of 70 patients referred for lung cancer screening and tobacco treatment presented to the clinic, indicating a no show rate of 26%. Of the 52, 46 (88%) were current smokers. Among 47 (90%) participants who consented to research, mean age was 59.8 years (SD±5.8), 49 % were men, 74% were African American/Black, and 89% were current smokers. Most participants (87%) met the USPSTF criteria and were recommended for LDCT. Of these, 93% attended their appointments and were screened. None of the participants had a positive screen. While 83% of current smokers were screened and 87% initially expressed willingness to enroll in the TTP, only a third (33%) participated in the TTP.

Conclusion: Compared to a high percentage of attendance at LDCT screenings, study participants had a low attendance at the TTP despite having expressed willingness to participate in the program. Further studies are needed to elucidate the causative factors for this difference. Additionally, the impressive utilization of a free LDCT service by patients who were referred when compared to the much larger number of patients who would fit into the criteria who were not referred, underscores the importance of mitigating health disparities by improving access to care. Efforts should be made to improve smoking-history taking in order to identify and appropriately refer eligible underserved candidates who might benefit from lung cancer screening and tobacco treatment.

Citation Format: Ruth N. Akindele, Ludmila A. Svoboda, Sabrina G. Gonzalez, Christopher S. Lathan. Clinic utilization and smoking cessation practices among ethnic minority patients referred for paired lung cancer screening and tobacco treatment services at a community cancer program. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C52.