Pilot study aims to increase lung cancer screening in urban primary care settings

A new study aimed at improving lung cancer screening in urban primary care settings led by a faculty member in the School of Nursing faculty has received a $49,000 grant to help providers become more effective and timely in detecting this prevalent disease.

Darryl Somayaji, assistant professor of nursing and adjunct assistant professor of oncology, cancer screening and survivorship at Roswell Park Comprehensive Cancer Center, was awarded the grant by the Clinical and Translational Science Institute (CTSI) Pilot Study program; the grant is also supported by the National Institutes of Health’s National Center for Advancing Translational Sciences.

The study, “Increasing Lung Cancer Screening: An Urban Primary Care Health Center Approach,” focuses on cancer disparities and access to cancer care resources. This is particularly crucial considering that despite an increase in lung cancer survival nationally, only 4.9% of those at high risk are screened in New York State.

“What is also concerning is that Black New Yorkers are the least likely to be screened and diagnosed early,” says Somayaji, who is also actively involved with the New York State Cancer Consortium (NYSCC). “The NYSCC strongly urges all New Yorkers to learn more about their risk factors, how to reduce their risk factors and encourages individuals to talk with a health care provider about lung cancer screening.”

The pilot study addresses a critical issue: the historically low rates of lung cancer screening, which can be attributed to gaps in patient and provider knowledge. These gaps hinder the ability of providers to engage in shared decision-making conversations with patients about lung cancer screening, ultimately resulting in lower referral rates for high-risk individuals.

In addition to Somayaji, co-authors on the study are Ranjit Singh, associate professor and vice chair for research, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences; Patrick D. Glasgow, clinical assistant professor, Department of Family Medicine, Jacobs School; Ekaterina “Katia” Noyes, professor and director of the Division of Public Health Services Policy and Practice, School of Public Health and Health Professions; and Gregory Wilding, professor, Department of Biostatistics, School of Public Health and Health Professions.

Their collaborative approach aims to bridge these gaps in patient and provider knowledge by developing an innovative lung cancer screening educational intervention for providers, tailored to both patient and provider knowledge and needs.

The study will utilize a sequential mixed-methods design, including surveys and key informant interviews. The primary aim is to identify multilevel gaps in lung cancer knowledge among patients and providers, and challenges faced during lung cancer prevention and screening discussions in patient-provider interactions.

In New York, the rate of new lung cancer cases stands at 55.9 per 100,000, according to the American Lung Association, higher than the national average of 54.6.

Former Gov. Andrew Cuomo launched a cancer research initiative in 2017 that highlighted regions of the state with disproportionately high cancer rates, including East Buffalo/West Cheektowaga in Western New York. The New York State Department of Health identified this area as a cancer cluster, with elevated rates of not only lung cancer, but also colorectal, esophageal, kidney, oral cavity and prostate cancers.

 Individuals in these neighborhoods — the focus of this proposed study — are predominately African American, receive public assistance insurance, have a median income below the poverty level, and have health outcomes that are significantly poorer than Erie County residents as a whole.

Somayaji also plans to involve patients, providers and a community ambassador board in planning sessions to gather insights on perceptions related to lung cancer knowledge and screening barriers. This collaborative approach will inform development of a co-designed provider educational intervention prototype, which will later be tested for its effectiveness in improving lung cancer screening rates.

Researchers say it’s a vital step toward reducing lung cancer mortality in underserved communities and highlights the importance of targeted educational interventions in primary care settings.

The outcomes of this study are expected to provide preliminary data, paving the way for future research that could potentially lead to testing the intervention more broadly and strategizing for its sustainability and adequate reach — especially in communities served by safety-net hospitals.

“To improve lung cancer screening rates, we need to tease apart what individuals and health care providers understand about symptoms and risk factors, patient and provider level barriers within health care practice sites, and the neighborhoods they serve,” says Somayaji.