Feasibility of Single - Encounter Telemedicine Lung Cancer Screening: A Retrospective Cohort Study in an Underserved Population

Abstract

Background COVID-19 forced a delay of non-essential health services, including lung cancer screening. Our institution developed a single-encounter, telemedicine (SET) lung cancer screening whereby patients receive low-dose CT in-person, but counseling regarding results, coordination of follow-up care and smoking cessation is delivered using telemedicine. This study compares outcomes of SET lung cancer screening to our pre-COVID, single-visit, in-person (SIP) lung cancer screening. Methods A retrospective cohort study was performed we recorded independent variables of gender, race/ethnicity, age, educational attainment, smoking status and dependent variables including cancer diagnosis, stage and treatment between March 2019 to July 2021. Using retrospective analysis, we compared outcomes of SIP lung cancer screening before COVID-19 and SET lung cancer screening amid COVID-19. Results There was a significant difference in number of patients screened pre- and amid COVID-19.673 people were screened via SIP, while only 440 were screened via SET. SIP screening consisted of 52.5% Black/African American patients, which decreased to 37% with SET lung cancer screening. There was no significant difference in gender, age, or educational attainment. There was also no significant difference in Lung–RADS score between the 2 methods of screening or diagnostic procedures performed. Ultimately telemedicine based screening diagnosed fewer cancers, 1.6% diagnosed via telemedicine vs 3.3% screened by in person. Conclusion We implemented SET lung cancer screening to continue lung cancer screening during a global pandemic. Our study established feasibility of telemedicine-based lung cancer screening among our predominantly African American/Black population, though fewer patients were screened. We found no difference in distribution between age, or educational attainment suggesting other factors discouraging lung cancer screening amid COVID-19.

Individual- and neighborhood-level characteristics of lung cancer screening participants undergoing telemedicine shared decision making

“…Providers and programs utilizing telemedicine for LCS must carefully consider how to effectively reach all individuals, but especially members of underserved populations. Underscoring the responsibility of incorporating telemedicine into screening programs properly, is that in-person counseling has been shown to diagnosis a greater proportion of lung cancers compared to counseling performed over a telehealth platform [ 39 ]. As telemedicine remains a critical part of healthcare delivery in the US and worldwide, prospective research is urgently needed to determine how telemedicine impacts screening implementation among LCS-eligible populations.…”

Death by a thousand delays

“…Novel strategies, like mobile screening with nurse navigators, rapid reporting of results to patients, streamlined referrals to diagnose and treat cancer, and integration of clinical workflows with information technology are needed, especially for those at elevated risk for delay. 23 , 24 , 25…”

“…Integrating telemedicine into lung cancer screening resulted in similar follow-up rates and similar detection of early-stage lung cancer compared with prepandemic lung cancer screening. E14 Hopefully, COVID-19 has resulted in greater awareness of how socioeconomic factors can impact delay of care, but also that we are capable of developing innovations to improve access and adherence to lung cancer care.…”

“…Care appears to be delayed due to issues with care coordination, communication between patients and providers, and access to specialists. E14 …”

“…The results improved care delivery for all patients, including the underserved. E14 Interventions designed to identify impediments to timely care can improve care delivery and will require participation from multiple providers. New strategies, such as that modeled in the ACCURE trial, will be needed to help reduce the barriers encountered by minority groups as they access treatment for cancer.…”