Go2 for Lung Cancer

Leveraging navigators such as nurses, community health workers, social workers, and a cadre of allied health professionals to successfully screen and support high-quality lung cancer care delivery to people at risk and experiencing this deadly disease is an evidence-based practice and is gaining ground. A growing body of research demonstrates the value of integrating patient navigation across the care continuum for improved outcomes. This chapter will review the history of patient navigation, define the current roles and responsibilities of the navigator, and discuss the future of navigators as patient and family partners and intermediaries for patients and families, and clinical lung cancer care teams from lung cancer screening through survivorship. This chapter will also outline implementation strategies for models of care with integrated lung cancer navigation to improve the patient’s experience and lung cancer outcomes.

Tobacco use is the primary contributor to disease and death in the United States, and cigarette smoking is the leading risk factor for lung cancer. Safe and effective treatments for tobacco dependence exist; however, access to and use of tobacco treatment remains low. The most recent Centers for Medicare and Medicaid Services National Coverage Determination requires a shared decision-making visit for lung cancer screening that includes counseling on the importance of maintaining cigarette smoking abstinence if a person formerly smoked; or the importance of smoking cessation if a person currently smokes and, if appropriate, furnishing of information about tobacco-cessation interventions. The directive is not well defined and provides little guidance for delivering high-quality cessation services. Effective integration of best practices for tobacco treatment in the context of lung cancer screening must extend far beyond recommendations to quit, patient literature to reinforce quitting, and available evidence-based treatments. To optimize the provision of tobacco treatment and improve health outcomes in people being screened for lung cancer, the American Cancer Society National Lung Cancer Roundtable Tobacco Treatment in the Context of Lung Cancer Screening Task Group recommends: (1) specify quality indicators and document tobacco treatment delivery; (2) embed tobacco treatment in lung cancer screening; (3) advocate for increased access to tobacco treatment; (4) build and train lung cancer screening staff; (5) provide full coverage of treatment medications; (6) leverage electronic health records to improve the provision of cessation services to lung cancer screenees; and (7) identify and address contextual barriers to incorporating tobacco treatment guidelines in screening.

Lung cancer is the leading cause of cancer death, disproportionately affecting Black communities due to delayed diagnoses and low screening rates. While these disparities persist, few educational interventions aim to equip health professional trainees-particularly those at Historically Black Colleges and Universities (HBCUs)-with the knowledge and confidence to address them. Empowering providers early in their training through culturally tailored education may help build a more prepared, equity-focused workforce. The purpose of this project was to evaluate a culturally tailored lung cancer education program, Program CONNECT, for health professional trainees at HBCUs. Program CONNECT was implemented in regions where lung cancer mortality among Black populations was ≥ 1.6 times higher than among White populations. From August to September 2024, healthcare trainees in nursing, medicine, pharmacy, and dentistry participated in a 90-min workshop covering lung cancer disparities, screening guidelines, and navigation strategies. A 21-item pre/post-test assessed changes in knowledge, beliefs, and self-efficacy. Participants (N = 100) were primarily nursing (63%), followed by pharmacy (29%), dentistry (5%), and medical (1%) students. While over half had healthcare experience, few had prior training in lung cancer navigation. Post-training, stigma related to personal responsibility for lung cancer significantly decreased (p = 0.005). Knowledge improved regarding risk factors, screening eligibility, disparities, and biomarker testing (p < 0.001). Confidence in identifying screening-eligible individuals, addressing barriers, and conducting difficult conversations improved significantly (p < 0.001). Recognition of ineligible screening scenarios increased, though shared decision-making knowledge remained unchanged. Interest in pursuing a cancer-related specialty rose from 66 to 78% (p < 0.001). Program CONNECT significantly improved knowledge and navigation self-efficacy among HBCU health trainees. Expanding this training across HBCUs may strengthen oncology workforce diversity and promote more equitable lung cancer outcomes in high-disparity communities.

BackgroundThe efficacy of lung cancer screening (LCS) to reduce lung cancer specific mortality is heavily dependent on adherence to recommended screening guidelines, with real-world adherence rates reported to be drastically lower than rates described in clinical trials. There is a dearth in the literature on reminder processes and clinical workflows used to address adherence and robust data is needed to fully understand which clinical set-ups, processes, and context enhance and increase continued LCS participation. This paper describes a protocol for an environmental scan of adherence and reminder processes that are currently used in LCS programs across the United States.MethodsThis study will triangulate data using a 3-step explanatory sequential mixed methods design to describe mechanisms of current adherence and reminder systems within academic and community LCS programs to pinpoint clinic or system barrier and facilitator combinations that contribute to increased adherence. In step 1, surveys from a nationally representative sample of LCS programs will yield quantitative data about program structure, volume, and tracking/reminder processes and messages. After completion of the survey, interested LCS program personnel will be invited to participate in an in-depth interview (step 2) to explore current processes and interventions used for adherence at the participant and program level. Finally, in step 3, triangulation of quantitative and qualitative data will be completed through qualitative comparative analysis to identify combinations of components that affect higher or lower adherence.DiscussionThis research advances the state of the science by filling a gap in knowledge about LCS program characteristics and processes associated with better adherence which can inform the development and implementation of interventions that are scalable and sustainable across a wide variety of clinical practice settings.

BackgroundIncreased engagement with community-based practices is a promising strategy for increasing clinical trials access of diverse patient populations. In this study we assessed the ability to utilize a patient-advocacy organization led clinical network to engage diverse practices as field sites for clinical research.MethodsGO2 for Lung Cancer led recruitment efforts of 17 field sites from their Centers of Excellence in Lung Cancer Screening Network for participation in an implementation-effectiveness trial focused on smoking cessation integration into screening programs for lung cancer. Sites were engaged by one of three methods: 1) Pre-Grant submission of letters of support, 2) a non-targeted study information dissemination campaign to network members, and 3) proactive, targeted outreach to specific centers informed by previously submitted network member data. Detailed self-reported information on barriers to participation was collected from centers that declined to join the study.ResultsOf 17 total field sites, 16 were recruited via the targeted outreach campaign and 1 via pre-grant letter of support submission. The sites covered 13 states and 4 United States geographic regions, were varied in annual screening volumes and years of screening program experience and were predominantly community-based practices (10 of 17 sites). The most reported reason (by 33% of sites) for declining to participate as a field site was inadequate staffing bandwidth for trial activities. This was especially true in community-based programs among which it was reported by 45% as a reason for declining.ConclusionsOur results suggest that this model of field site recruitment leveraging an existing partnership between an academic research team and an informal clinical network maintained by a disease-specific patient advocacy organization can result in engagement of diverse, community-based field sites. Additionally, reported barriers to participation by sites indicate that solutions centered around providing additional resources to enable greater capacity for site staff may increase community-practice participation in research.

IntroductionPeople diagnosed with lung cancer experience high rates of distress, which can be compounded by the stigma of the disease. This study assessed a real‐world population to understand patient‐reported emotional functioning, types of stigma experienced, and relationship with smoking history.MethodsQuestionnaires using validated survey tools assessing demographics, smoking history, stigma, and quality of life (EORTC QLQ‐C30 Emotional Functioning Scale) were analyzed from 539 global participants in the Lung Cancer Registry between November 2019 and July 2022. The associations between smoking history and self‐reported internalized and perceived stigma and constrained disclosure of lung cancer diagnosis, as well as the potential impact of stigma on emotional functioning, were examined using multivariable logistic regression models.ResultsAmong the broad geographic mix of study participants, all types of lung cancer stigma were associated with decreased emotional functioning due to a combination of factors including depression, anxiety, stress, and irritability. Participants who reported a history of current or former smoking experienced higher levels of internalized stigma and perceived stigma. Constrained disclosure about a diagnosis was common, associated with decreased emotional functioning, and not related to a history of smoking. Smoking status itself was not associated with reduced emotional functioning, implicating the role of stigma in distress.ConclusionsIn this study, all types of lung cancer stigma were associated with clinically important decreases in emotional functioning. This impact was not dependent on smoking history. Internalized and perceived stigma were associated with the presence of a smoking history. These findings have implications for proper psychosocial care of people diagnosed with lung cancer.