|1R01CA269832-01A1 Interpret this number
|Ohio State University
|Promoting Equity of Cancer Screening and Follow-Up for Lung Cancer
PROJECT SUMMARY/ABSTRACT: Lung cancer is highly lethal and accounts for nearly as many deaths as
breast, cervical, colorectal, and prostate cancers combined, but most lung cancer cases are potentially
preventable. About 80-90% of cases are smoking-related, and screening followed by high-quality treatment has
been shown to reduce the risk of death in people at high-risk. Therefore, smoking cessation interventions plus
screening are two complementary pillars that are recommended together by the US Preventive Services Task
Force and other guidelines to reduce the lung cancer death rate. Unfortunately, uptake of lung cancer screening
(LCS) remains low and although disparities in lung cancer deaths by socioeconomic factors, including rurality,
are widely acknowledged, they remain understudied. Evidence shows that rural areas have higher lung cancer
death rates than urban populations, likely related to risk factors and healthcare access. However, efforts to
understand and address rural-urban disparities are hampered by low representation of rural populations in public
data systems. The goal of this proposal is to elucidate factors that contribute to lung cancer disparities between
rural and urban areas and provide contextual information for future interventions and policies. Our specific aims
are to: (1) Characterize the delivery of evidence-based interventions (EBIs) for lung cancer prevention and early
detection, comparing rural to urban areas, by assessing differences in use of smoking cessation interventions
and LCS at multiple levels of influences; (2) Identify potentially modifiable care gaps across the LCS continuum,
including risk assessment and timely treatment, by examining patients who died of lung cancer relative to patients
who are alive by rural-urban status; and (3) Evaluate similarities and differences in the barriers and promoters
to delivery of EBIs across the LCS continuum (smoking cessation, shared decision-making, screening, and
treatment) in the rural and urban contexts. We will use a multidimensional health equity framework to apply a
convergent, mixed methods approach for our studies. We will leverage the Rochester Epidemiology Project, a
unique population-based data resource for a 27-county contiguous area in the Midwestern US, along with the
Southern Community Cohort Study across 12 states in the Southeastern US, among a diverse population of 50-
80-year-old people. We will use Rural-Urban Commuting Area codes to define rurality and will assess both self-
reported and area-level socioeconomic information. We will conduct semi-structured interviews with patients and
clinical staff to gain perspectives on LCS barriers and promoters, including the potential role of smoking-related
stigma. The proposed research has the potential for high impact by elucidating gaps on lung cancer prevention
and early detection that will translate directly into strategies to address intransigent lung cancer disparities in our
study population, and beyond. We will thus address priorities of the NCI and the President’s Cancer Panel to
advance equity and address the potential COVID-19 impact on the delivery of LCS. Our transdisciplinary team
has a track record of high-impact research and has the needed expertise to successfully complete this research.
Commentary: Health disparities across the cancer care continuum and implications for microsimulation modeling.
, Bailey Z.D.
, Winn R.A.
Journal of the National Cancer Institute. Monographs, 2023-11-08; 2023(62), p. 173-177.