3294 - Breaking Barriers in Lung Cancer Screening: Understanding Provider-Level Challenges

12:45pm - 02:00pm PT

Hall F

Screen: 5

POSTER

Presenter(s)

Akul Munjal, MD - UC Irvine Health, Orange, CA

A. N. Munjal¹, R. Banks², T. Nguyen², M. Nagasaka³, S. Elsa², T. Waddington², and J. P. Harris¹; ¹Department of Radiation Oncology, University of California - Irvine, Orange, CA, ²University of California Irvine, Orange, CA, ³Division of Hematology and Oncology, University of California - Irvine, Orange, CA

Purpose/Objective(s): Early detection of lung cancer improves survival. Despite USPSTF and CMS recommendations, screening rates remain low, with 5% of eligible patients undergoing screening. We aimed to identify barriers to screening from Primary Care Providers (PCPs), recognizing that physician-related factors may contribute to underutilization.

Materials/Methods: An online knowledge- and case-based survey gathered data from PCPs on practice type, patient demographics, patient volume, and familiarity with screening guidelines. Questions assessed medical and sociodemographic factors influencing screening decisions. The survey was distributed to family and internal medicine providers at two academic institutions and one VA VISN, with data analyzed using Wilcoxon rank-sum testing and univariate/multivariate regression.

Results: Eighty-five responses (17% response rate) were obtained. Of respondents, 56% identified as female, 41% as male, and 5% practiced as APPs. Additionally, 8% were unfamiliar with USPSTF guidelines, and 26% were unfamiliar with CMS eligibility criteria. Most ordered fewer than 20 LDCT scans per year. Key factors encouraging screening included eligibility (65%), willingness to participate (62%), and adherence to recommended screenings (43%). Barriers included insurance concerns (34%), time constraints (33%), and comorbidities (31%).

Respondents were presented with five cases; four met USPSTF and three met CMS criteria, with variable complexity. For a 60-year-old smoker, 90% recommended screening. For a former smoker with oral cavity cancer, 51% recommended screening (p < 0.01); for a smoker with housing insecurity, 52% recommended screening (p < 0.01). For a patient meeting USPSTF but not CMS criteria (age 78), 56% recommended screening (p < 0.001).

Univariate analysis showed factors increasing screening likelihood included meeting USPSTF (OR 9.9, p = 0.001) and CMS criteria (OR 7.4, p = 0.001). Housing insecurity decreased screening recommendation likelihood (OR 0.29, p = 0.001). Multivariate analysis showed USPSTF familiarity (OR 3.2, p = 0.007), LDCT ordering frequency (OR 1.5, p = 0.01), years in practice (OR 1.2, p = 0.04), and patient volume (OR 1.3, p = 0.02) as significant predictors.

Multivariate analysis identified USPSTF familiarity (OR 1.87, p = 0.002), years in practice (OR 1.42, p = 0.02), and patient volume (OR 1.35, p = 0.03) as predictors of LDCT ordering frequency.

Conclusion: In this self-reported survey of PCPs, most ordered fewer than 20 LDCT scans per year. Hesitation to order LDCT was observed for patients with social barriers or greater comorbidities. As guideline familiarity increased screening likelihood also increased, and this study highlights the need for education to improve screening rates.