3626 - Low-Dose CT (LDCT) Discussions for Cancer Survivors with a Smoking History

Purpose/Objective(s): Lung cancer screening with LDCT can lead to early detection and reduced lung cancer mortality. Sadly, uptake remains suboptimal with an estimated 5% of those eligible receiving LDCT. Cancer survivors require continued surveillance and preventative care but may face barriers to receiving recommended cancer screenings. Additionally, evidence suggest that survivors have higher rates of lung cancer diagnosis after LDCT than those without (w/o) a cancer history magnifying the benefit in this population. This study examines smoking status and whether or not LDCT screening were discussed based on survivorship status.

Materials/Methods: Data from the nationally representative Health Information National Trends Survey 2022 were used to assess discussions of LDCT, comparing those with a prior cancer diagnosis (survivors) and those w/o cancer. Sample was limited to prior or current smokers aged 50-80 (pack year history not available); lung cancer survivors were excluded given expected surveillance with diagnostic CT scans. Demographics included age, gender, race/ethnicity, sexual orientation, education, employment, and household income. Univariate analyses and logistic regression focused on predictors of LDCT discussion.

Results: Overall, 3,585 with current or prior smoking history were included of which 560 (15.6%) were cancer survivors. Survivors were older (median 69 vs. 65), less likely employed (26.2% vs. 40.4%), more commonly White (89.8% vs. 84.4%), and less often Black race (23.1% vs. 27.3%) (p < 0.05 for all) than those w/o a cancer history.

Among the cohort, 59 (10.5%) survivors vs. 346 (11.4%) non-survivors are current smokers (p=0.54). Actively smoking survivors were younger than survivors who had quit smoking (median age 63 vs. 68, p= 0.04).

More cancer survivors reported having a LDCT discussion with their provider in the last year than those w/o a cancer history (10.5% vs. 4.8%, p<0.001). Logistic regression confirmed this association, survivors were less likely to have not had a LDCT discussion (OR = 0.43, 95% CI [0.32, 0.59], p < 0.001). Further evaluation limited to survivors showed no significant differences in reported LDCT discussion by age, gender, race, ethnicity, sexual orientation, income, education, or current smoking status.

Conclusion: In this national study, cancer survivors with a smoking history report low rates of discussion of LDCT, despite one in ten being active smokers. Although LDCT discussion was more common in survivors than those w/o a cancer history, only a tenth of potentially eligible survivors and one in twenty for those w/o cancer are having this important cancer screening discussion with their providers. Future interventions should focus on standardizing provider communication, improving survivorship care, and ensuring equitable LDCT screenings among all eligible individuals.