Achieving Equitable Care for Underrepresented Minority Patients with a Lung Cancer Screening Program

A. Griffith¹, C. Pratt¹, J. Whitrock¹, B. Waits¹, S. Kapur¹, S. L.. Starnes², R. Van Haren^1
1University of Cincinnati, Cincinnati, Ohio ²University of Cincinnati Medical Center, Cincinnati, Ohio

Purpose: Underrepresented minority lung cancer patients have lower resection rates, advanced diagnostic stages, and worse overall survival, especially for Black men. Lung cancer screening (LDCT) can reduce mortality, however the influence of socioeconomic factors on access and navigation is unknown. This study evaluated LDCT’s impact on timely diagnosis and treatment.

Methods: Patients undergoing LDCT at an urban, academic health center were enrolled in a cohort study from November 2012-February 2019. A CT finding concerning for lung malignancy prompted tumor board evaluation. Baseline demographic, staging, type of cancer, time to referral, time to biopsy, time to intervention, type of treatment, and overall survival were analyzed. LDCT Cohort was compared to city and state cancer reports. The cohort was 2,552 patients (male: 51.3%; median age: 63 years [IQR: 59-68]; White: 70.4%; Black: 28.6%; average pack year 43 [IQR: 37-48]). Subgroup analysis was performed by sex.

Results: The study cohort comprised a higher screening rate of Black men (12.9% n=329 vs. (6.11%, p< 0.0001) and Black women (15.7% n=401 vs. 6.68%, p< 0.0001) compared to the greater metropolitan area population) (Figure 1). Lung cancer was identified in 90 (3.7%) incident cases (T1:61.5%; N0:64.1%; M0:93.6%). 63.1% of these patients underwent resection, 45.2% chemotherapy and 28.6% radiation, either alone or concurrently. The incidence of lung cancer was similar between Black and White patients (3.3% vs. 3.9%, p=0.46) with no difference in stage at diagnosis (Table 1). LDCT cohort had significantly increased rates of early-stage diagnosis (Stage I) compared to State level data (52.5% vs. 27.0%, p< 0.0001). Black patients had equitable rates of surgical resection compared to White patients (63.6% vs. 62.9%, p=0.95), rates of surgical resection were also similar in subgroup analysis by sex. No significant differences in delays to care (>8 weeks) were identified between Black and White patients. Of White men screened (n=965), 3.4% had a lung cancer diagnosis, compared with 1.5% of Black men screened (n=329) (p=0.08). Black men were less likely to be diagnosed with lung cancer as compared to Black women (1.5% vs. 4.7%, p=0.02).

Conclusion: A structured LDCT program can provide access to lung cancer screening to a high number of underrepresented minority patients and provide equitable care through timely diagnosis and treatment. This study underscores the importance of LDCT program optimization to deliver equitable outcomes for all lung cancer patients.

Identify the source of the funding for this research project: N/A