Rural barriers to early lung cancer detection: Exploring access to lung cancer screening programs in New Hampshire and Vermont

Hasson, Rian M.; Fay, Kayla A.; Phillips, Joseph D.; Millington, Timothy M.; Finley, David J.

doi:10.1016/j.amjsurg.2020.06.030

Cited by 7 publications

(3 citation statements)

References 39 publications

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“…GPs represent the frontline healthcare professional with a comprehensive knowledge of patients’ general status, behavior, and clinical history, and the relationship of trust should not be underestimated. Whereas rurality has been pointed out as a limit in lung cancer screening programs in other studies because of the lack of access to facilities ( 10 ) or inadequacy of referral ( 23 ), our results indirectly suggest that people living in rural areas in Tessin have an adequate healthcare support. Enhancing symptoms awareness is important in detecting lung cancer diagnosis, but it seems to be not sufficient to change prognosis and survival and to increase GP attendance ( 24 ).…”

Section: Discussioncontrasting

confidence: 58%

“…However, the above-mentioned data are mostly extracted by studies performed in extremely wide and non-homogeneous countries, in terms of both population and socio-economical levels, such as the United States and Australia ( 1 – 3 ). Therefore, it seems to be interesting to study and verify this phenomenon at a local level in order not to generalize the results ( 8 , 9 ), especially with a view to introducing a screening program ( 10 ). Switzerland is a tiny state with 8,670,000 inhabitants, with one of the highest per capita incomes worldwide.…”

Section: Introductionmentioning

confidence: 99%

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Urban–Rural Disparities in the Lung Cancer Surgical Treatment Pathway: The Paradox of a Rich, Small Region

et al. 2022

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IntroductionRural populations in large countries often receive delayed or less effective diagnosis and treatment for lung cancer. Differences are related to population-based factors such as lower pro capita income or increased risk factors or to differences in access to facilities. Switzerland is a small, rich country with peculiar geographic and urban characteristics.We explored the relationship between lung cancer diagnostic–surgical pathway and urban–rural residency in our region.MethodsWe retrospectively analyzed the medical records of 280 consecutive patients treated for primary non-small cell lung cancer at our institution (2017–2021). This is a regional tertiary center for diagnosis and treatment, and data were extracted from a prospectively collected clinical database. We included anatomical lung resection. Collected variables included patients and surgical characteristics, risk factors, comorbidities, histology and staging, symptoms (vs. incidental diagnosis), general practitioner (GP) involvement, health insurance, and suspected test-treatment interval. The exposure was rurality, defined by the 2009 rural–urban residency classification from the Department of Land.ResultsA total of 150 patients (54%) lived in rural areas. Rural patients had a higher rate of smoking history (93% vs. 82%; p = 0.007). Symptomatic vs. incidental diagnosis did not differ as well as previous cancer rate, insurance, and pathological staging. In rural patients, there was a greater burden of comorbidities (mean Charlson Comorbidity Index Age-Adjusted 5.3 in rural population vs. 4.8 in urban population, p = 0.05), and GP was more involved in the diagnostic pathway (51% vs. 39%, p = 0.04). The interval between the first suspected test and treatment was significantly shorter (56 vs. 66.5 days, p = 0.03). Multiple linear regression with backward elimination was run. These variables statistically predicted the time from the first suspected test and surgical treatment [F(3, 270), p < .05, R2 = 0.24]: rurality (p = 0.04), GP involvement (p = 0.04), and presence of lung cancer-related symptoms (p = 0.02).ConclusionsIn our territory with inhomogeneous population distribution and geographic barriers, residency has an impact on the lung cancer pathway. It seems paradoxical that rural patients had a shorter route. The more constant involvement of GP might explain this finding, having suggested more tests for high-risk patients in the absence of symptoms or follow-ups. This did not change the staging of surgical patients, but it might be essential for the organization of an effective lung cancer screening program.

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Section: Discussioncontrasting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Urban–Rural Disparities in the Lung Cancer Surgical Treatment Pathway: The Paradox of a Rich, Small Region

et al. 2022

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“…Our findings support the importance of addressing patient-level barriers to screening that are unique to rural populations and have been shown to diminish patient access and utilization of screening. 58,62,63 Possible solutions that were not mentioned in our study to mitigate transportation barriers include mobile CT scanners, 64,65 shared decision-making interactions conducted via telehealth, 66 increasing awareness of federal cancer centers, 59 and roundtrip transportation vouchers 67 to a qualified medical center for the low-dose CT scan. Lastly, health navigators who provide high-quality communication 60,68,69 and are positioned to support patients through the screening process can help to respond to barriers and address mistrust and health literacy issues among rural-residing patients.…”

Section: Discussionmentioning

confidence: 99%

Primary Care Providers Experiences Implementing Low-Dose Computed Tomography Recommendations for Lung Cancer Screening

Golden,

Currier,

Ramalingam

et al. 2023

J Am Board Fam Med

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Purpose: Describe primary care providers' (PCPs) barriers and facilitators to implementation of lung cancer screening programs in rural settings.Methods: We conducted qualitative interviews with PCPs practicing in rural Oregon from November 2019 to September 2020. The interview questions and analytic framework were informed by the 2009 Consolidated Framework for Implementation Research. We used inductive and deductive approaches for analysis.Results: We interviewed 15 key participants from 12 distinct health care systems. We identified several Consolidated Framework for Implementation Research factors affecting lung cancer screening implementation. 1) Most PCPs did not have workflows to assist in discussing screening and relied on their memory and knowledge of the patient's history to prompt discussions. PCPs supported screening and managed the patient throughout the process. 2) PCPs reported several patient-level barriers, including geographic access to lung cancer screening scans and out-of-pocket cost concerns. 3) PCPs reported that champions are necessary to create opportunities for local practices to adopt lung cancer screening programs.Conclusions: Rural-practicing PCPs were supportive of lung cancer screening, however workflow processes, time challenges, and patient-reported barriers remain impediments to improved screening in their clinics. We identified several areas for improvement in lung cancer screening implementation in rural primary care practices, ranging from designing clinic workflows and processes to designating clinic staff to support referral, screening, and follow-up care for patients. (

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Distance to highway and factory density related to lung cancer death and associated spatial heterogeneity in effects in Jiading District, Shanghai

Zhang

Wang

et al. 2021

Environ Sci Pollut Res

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This study aimed to explore distance to highway and factory density related to lung cancer (LC) death and their spatial heterogeneity in effect. MethodsWe conducted a retrospective cohort study by using the data of registered LC patients in Jiading District from 2002 to 2012. Standard parametric model with weibull distribution was used to explore factors related to LC death and the spatial effect of environmental factors were detected by using spatial survival analysis.

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Rural barriers to early lung cancer detection: Exploring access to lung cancer screening programs in New Hampshire and Vermont

Cited by 7 publications

References 39 publications

Urban–Rural Disparities in the Lung Cancer Surgical Treatment Pathway: The Paradox of a Rich, Small Region

Urban–Rural Disparities in the Lung Cancer Surgical Treatment Pathway: The Paradox of a Rich, Small Region

Primary Care Providers Experiences Implementing Low-Dose Computed Tomography Recommendations for Lung Cancer Screening

Distance to highway and factory density related to lung cancer death and associated spatial heterogeneity in effects in Jiading District, Shanghai

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