Increased Utilization of Low-Dose CT for Lung Cancer Screening at an Arkansas Community Oncology Clinic

Edgar T Ellis; Michael A Bauer; J Thaddeus Beck; Daniel S Bradford; Joanna Thompson; Abby Holt; Margarete C Kulik; Shelbie D Stahr; Ping-Ching Hsu; L Joseph Su

doi:10.1016/j.jacr.2023.09.015

Increased Utilization of Low-Dose CT for Lung Cancer Screening at an Arkansas Community Oncology Clinic

J Am Coll Radiol. 2023 Nov 19:S1546-1440(23)00939-0. doi: 10.1016/j.jacr.2023.09.015. Online ahead of print.

Authors

Affiliations

¹ Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
² Department of Biomedical Informatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
³ Highlands Oncology, Fayetteville, Arkansas.
⁴ ICF International Inc, Fairfax, Virginia.
⁵ Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Tobacco-Related Disease Research Program, University of California Office of the President, Oakland, California.
⁶ Department of Environmental Health Sciences, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
⁷ Associate Dean for Academic Affairs, Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas. Electronic address: Lihchyun.Su@UTSouthwestern.edu.

PMID: 37984767
DOI: 10.1016/j.jacr.2023.09.015

Abstract

Background: Low-dose CT (LDCT) is underused in Arkansas for lung cancer screening, a rural state with a high incidence of lung cancer. The objective was to determine whether offering free LDCT increased the number of high-risk individuals screened in a rural catchment area.

Methods: There were 5,402 patients enrolled in screening at Highlands Oncology, a community oncology clinic in Northwest Arkansas, from 2013 to 2020. Screenings were separated into time periods: period 1 (10 months for-fee), period 2 (10 months free with targeted advertisements and primary care outreach), and period 3 (62 months free with only primary care outreach). In all, 5,035 high-risk participants were eligible for analysis based on National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Enrollment rates, incidence densities (IDs), Cox proportional hazard models, and Kaplan-Meier curves were performed to investigate differences between enrollment periods and high-risk groups.

Results: Patient volume increased drastically once screenings were offered free of charge (period 1 = 4.6 versus period 2 = 66.0 and period 3 = 69.8 average patients per month). Incidence density per 1,000 person-years increased through each period (ID_{Period 1} = 17.2; ID_{Period 2} = 20.8; ID_{Period 3} = 25.5 cases). Cox models revealed significant differences in lung cancer risk between high-risk groups (P = .012) but not enrollment periods (P = .19). Kaplan-Meier lung cancer-free probabilities differed significantly between high-risk groups (log-rank P = .00068) but not enrollment periods (log-rank P = .18).

Conclusions: This study suggests that eligible patients are more receptive to free LDCT screening, despite most insurances not having a required copay for eligible patients.

Keywords: LDCT; lung cancer; rural; screening.