A new article published in Radiology explores the barriers patients face in undergoing lung cancer screening (LCS), and more importantly, what radiologists can do to encourage their participation.
“Radiologists are essential to every LCS program,” wrote Gary X. Wang, of Massachusetts General Hospital in Boston, and colleagues. “Increased awareness of challenges faced by patients and referring providers will empower radiologists to continue to collaboratively guide nationwide multidisciplinary efforts to implement LCS.”
Below are four barriers, applicable to both patients and providers, that Wang et al. argues are hindering lung cancer screening participation, along with potential solutions:
Patients aren’t aware
The lack of awareness is a problem across the U.S. In fact, one Indiana-based study completed in 2017 found that 38 percent of people eligible for LCS didn’t realize they were. Those numbers are consistent across many state-wide surveys.
What can be done? For one, radiologists can produce patient-centered content to promote awareness, but that must be created with the proper audience in mind. That means LCS material created between third and seventh grade reading levels, as recommended by the National Institutes of Health and American Medical Association.
Community health fairs, targeted social media campaigns and mailed invitations are also potential outreach methods, the authors wrote.
Cost and Insurance concerns still loom
CMS and private insurers cover LCS, but concerns over cost and a lack of provider knowledge are both barriers to potential screening.
Patients often rely on their primary care physicians or referring providers for cost information, but multiple studies have shown many of these professionals need more information surrounding insurance, billing and reimbursement to conduct LCS. Wang et al. suggested educational outreach could provide answers to these questions.
For those who may not have insurance, radiology-led initiatives, such as one example cited by authors in Los Angeles, can be something a program to strive toward. That collaboration secured grant funding to provide free screening for a largely uninsured, low-income African American community.
Some smokers’ fear of cancer diagnosis and a perceived stigma surrounding smoking can cause pause in seeking LCS. Similarly, concerns over radiation exposure present additional reasons for patients to avoid screening, the authors wrote.
One campaign in Kentucky talked with LCS-eligible people and created screening invitations that were perceived as “trustworthy, engaging and relevant.” Creating invitations with these characteristics in mind, as well as attention to who is sending such invitations can help patients seek out cancer screening.
Creating campaigns that address radiation concerns should also be top of mind, the authors noted. Reviewing strategies put forth in the Image Wisely Campaign may help in the process.
While some patients may opt to undergo LCS, there remain challenges related to travel distance and even language barriers.
One study of facilities registered in the ACR Lung Cancer Screening Registry in 2016 found “statistically significant” clustering in 36 states, which may indicate these facilities are limited to specific geographic regions.
Similarly, a study of 89,943 outpatient CT and MRI appointments at an urban academic medical center found a primary language outside of English or Spanish as an independent predictor of having missed an appointment.
Strategies to ease transportation costs such as cab vouchers or partnerships with local transit systems may help. And pre-appointment texts, emails, or phone calls in a patient’s preferred language may help ease communication concerns, the authors wrote.
Overall, clinicians must be better at familiarizing themselves with LCS guidelines and issues to ultimately benefit patients and work with groups to increase screening for the disease.
“As multidisciplinary screening programs expand and evolve, increasing awareness and understanding of the challenges confronting patients and referring providers will help radiologists collaboratively guide efforts to broadly and equitably implement LCS,” the authors concluded.