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Precision prevention strategy to increase uptake and engagement in lung cancer screening and smoking cessation treatment

Award Number: R01CA268030
ORGANIZATION: NATIONAL CANCER INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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Precision prevention strategy to increase uptake and engagement in lung cancer screening and smoking cessation treatment - PROJECT SUMMARY/ABSTRACT Lung cancer is the deadliest form of cancer, and more than 80% of lung cancers and lung cancer deaths are caused by cigarette smoking. Lung cancer screening with annual low‐dose computed tomography is recommended for long‐term current and former smokers, yet as few as 2% of 7.6 million eligible patients receive lung cancer screening. Most of these patients are current smokers, yet few receive effective tobacco treatment, with even larger care gaps among African American populations. This problem requires solutions at multiple levels, as uptake of lung cancer screening and tobacco treatment are driven by both physician orders and patient receipt of care. Novel, personalized efforts that target physicians and patients may boost uptake in lung cancer screening and tobacco treatment. We propose a multi-level intervention featuring a precision risk tool designed to stimulate guideline-concordant care by motivating behavior change and facilitating patient- centered discussions between primary care physicians and medically underserved patients at risk for lung cancer. This innovation is motivated by two key findings: 1) clinical and genetic factors inform precision risk for lung cancer and smoking cessation, and 2) high desire for personal genetic risk feedback signals its potential to activate behavior change. Building on important genomic advances, our team developed RiskProfile, a physician- and patient-facing tool that can incorporate genetic risk feedback to promote evidence-based care and cancer risk-reducing behaviors. The overarching goal of this study is to test the impact of RiskProfile, either with or without genetic information and in comparison to usual care, on uptake of lung cancer screening and tobacco treatment. We propose a 3-arm cluster randomized controlled trial of 75 physicians and 825 screen-eligible patients (11 per physician) from a diverse primary care setting. Physicians and patients will be randomized to usual care vs. RiskProfile-Clin (based on clinical factors) vs. RiskProfile-Gen (based on clinical and genetic factors) to evaluate the effect of precision risk interventions on lung cancer screening and tobacco treatment. In Aims 1 and 2, we will test the effect of RiskProfile on physician orders and patient completion of lung cancer screening and tobacco treatment. We predict that RiskProfile-Gen will outperform RiskProfile-Clin, and that both groups will outperform usual care. Primary outcomes will be ordering and completion of lung cancer screening among screen-eligible patients. Secondary outcomes will be ordering and receiving tobacco treatment among screen-eligible current smokers. In Aim 3, we will explore the impact of RiskProfile on potential mechanisms of behavior change (physician perceptions, patient cognitive or engagement factors, and physician-patient interactions) that may increase uptake of lung cancer screening and tobacco treatment. By targeting both physicians and patients and addressing both cancer screening and cessation care, this precision risk feedback tool has potential to drive down lung cancer incidence and mortality in underserved populations.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $579,054 )
2025	2025	WASHINGTON UNIVERSITY, THE	1 BROOKINGS DR	SAINT LOUIS	MO	63130	SAINT LOUIS	USA	Cancer Cause and Prevention Research	000	4	3/14/2025	NON-COMPETING CONTINUATION	$579,054
														Subtotal = $579,054

Issue Date FY: 2024 ( Subtotal = $610,668 )
2024	2024	WASHINGTON UNIVERSITY, THE	ONE BROOKINGS DR	SAINT LOUIS	MO	63110	SAINT LOUIS CITY	USA	Cancer Cause and Prevention Research	001	3	7/10/2024	NON-COMPETING CONTINUATION	$32,141
2024	2024	WASHINGTON UNIVERSITY, THE	ONE BROOKINGS DR	SAINT LOUIS	MO	63110	SAINT LOUIS CITY	USA	Cancer Cause and Prevention Research	000	3	3/15/2024	NON-COMPETING CONTINUATION	$578,527
														Subtotal = $610,668

Issue Date FY: 2023 ( Subtotal = $635,780 )
2023	2023	WASHINGTON UNIVERSITY, THE	ONE BROOKINGS DR	SAINT LOUIS	MO	63130	SAINT LOUIS	USA	Cancer Cause and Prevention Research	000	2	2/24/2023	NON-COMPETING CONTINUATION	$635,780
														Subtotal = $635,780

Issue Date FY: 2022 ( Subtotal = $652,984 )
2022	2022	WASHINGTON UNIVERSITY, THE	ONE BROOKINGS DR	SAINT LOUIS	MO	63130	SAINT LOUIS	USA	Cancer Cause and Prevention Research	000	1	3/21/2022	NEW	$652,984
2022	2022	WASHINGTON UNIVERSITY, THE	ONE BROOKINGS DR	SAINT LOUIS	MO	63130	SAINT LOUIS	USA	Cancer Cause and Prevention Research	001	1	8/31/2022	NEW	$0
														Subtotal = $652,984

Grand Total All Awards = $2,478,486

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Precision prevention strategy to increase uptake and engagement in lung cancer screening and smoking cessation treatment

Award Number: R01CA268030

ORGANIZATION: NATIONAL CANCER INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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