Addressing Health Care Disparities in Lung Cancer Screening

Lung cancer is a leading cause of cancer-related deaths, accounting for approximately 12.0% of all cancer cases globally. In the U.S., it results in about 218,893 new cases and 131,584 deaths annually. Mortality rates are particularly high among men and African American males. The U.S. Preventive Services Task Force (USPSTF) recommends annual low-dose CT (LDCT) screening for adults aged 50–80 years with a ≥20 pack-year smoking history, who currently smoke or quit within the past 15 years.

This quality improvement (QI) project was conducted at a community-based internal medicine residency clinic in rural Upstate New York, serving a diverse patient population ranging from university faculty to individuals facing financial, housing, and social insecurity. Key stakeholders included patients, residents, attending physicians, nursing and front-desk staff, the radiology department, and clinic leadership.

Aim:

• To increase lung cancer screening rates among eligible patients from baseline to 40% within 12 months in a resident-run primary care clinic.

Interventions included:

• Educating residents and patients about lung cancer screening guidelines and benefits.

• Displaying educational posters in exam rooms and provider offices.

• Reinforcing screening guidelines during monthly QI meetings.

Measured outcomes included LDCT screening rates, screening orders, and smoking history documentation. From 2021 to 2023, baseline data were collected, followed by implementation of multiple Plan-Do-Study-Act (PDSA) cycles. Barriers identified included lack of awareness, transportation, and financial issues.

There was a significant increase in lung cancer screening rates, rising from a baseline of 23.33% to 63.3%. Similarly, the percentage of patients for whom a screening test was ordered increased from 36.66% to 73.33%, representing a substantial improvement of 36.67%. Additionally, documentation of smoking history improved from 66.21% at baseline to 83.72%.

Despite challenges posed by the COVID-19 pandemic, this QI initiative successfully increased lung cancer screening rates by approximately 40%. The project highlights the impact of consistent provider education, patient engagement, and improved clinic workflows in addressing healthcare disparities and facilitating early cancer detection.