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Evaluating Centralizing Interventions to Address Low Adherence to Lung Cancer Screening Follow-up in Decentralized Settings

Award Number: R01CA284032
ORGANIZATION: NATIONAL CANCER INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/01/2023
PERIOD OF PERFORMANCE END DATE: 07/31/2028

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Evaluating Centralizing Interventions to Address Low Adherence to Lung Cancer Screening Follow-up in Decentralized Settings - Lung cancer is the leading cause of cancer death in the United States, and lung cancer screening has been demonstrated to effectively reduce lung cancer by 20-26% in eligible persons. Despite 10 years of recommendations endorsing screening, evidence suggests that real-world implementation of screening along the care continuum has been poor. Specifically, prior work reveals that adherence to routine annual screening and specialized follow-up after positive lung cancer screening exams is suboptimal, with a median adherence of 40-60% across clinical programs. Follow-up after either negative or positive lung cancer screening is a critical target to achieve mortality benefits seen in clinical trials, as adherence to follow-up was >90% in these studies, and more than half of all screen-detected lung cancers were diagnosed in follow-up. Prior studies of adherence to follow-up have been largely observational, single center and performed in academic settings, but have demonstrated that clinical lung cancer screening programs which contain centralized program-level interventions such as care coordination have two-to-three times the rate of follow-up adherence compared to programs where lung cancer screening is largely managed by primary providers. It is therefore critical to adapt and prospectively evaluate feasible and effective centralized program interventions in community settings to translate the benefits to screening programs and patients. To fill this important knowledge gap, the central objective of this study is to generate evidence of barriers and facilitators to lung cancer screening follow-up in decentralized community programs, adapt and introduce centralizing interventions in these settings and rigorously measure the effectiveness and implementation of these interventions. This objective will be met by achievement of three specific aims performed at 3 non-academic regional partnering sites with large rural and Hispanic populations. In the first aim, we will determine system-, provider- and patient-level facilitators to LCS follow-up in these settings using an innovative rapid ethnographic approach supplemented by semi-structure interviews. In the second aim, we will adapt and evaluate centralizing interventions including defined care pathways and after-screening care coordination measuring the impact on adherence as well as differences in impact by site and patient rurality and socioeconomic status. Finally in the third aim, we will evaluate the implementation of these strategies with a key focus on the tension between fidelity and adaptations as these interventions mature. The aims will be grounded in an integration of the Consolidative Framework of Implementation Research and RE-AIM to ensure attention to intervention efficacy and implementation. Our team has extensive experience in lung cancer screening implementation, and expertise in adapting and evaluating pragmatic interventions in community settings. This project will generate essential knowledge to improve lung cancer screening follow-up in real-world clinical programs.


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 = $575,491 )
2025	2025	FRED HUTCHINSON CANCER CENTER	1100 FAIRVIEW AVE N	SEATTLE	WA	98109	KING	USA	21st Century Cures Act - Beau Biden Cancer Moonshot	000	3	7/21/2025	NON-COMPETING CONTINUATION	$575,491
														Subtotal = $575,491

Issue Date FY: 2024 ( Subtotal = $549,920 )
2024	2024	FRED HUTCHINSON CANCER CENTER	1100 FAIRVIEW AVE N	SEATTLE	WA	98109	KING	USA	21st Century Cures Act - Beau Biden Cancer Moonshot	001	2	7/16/2024	NON-COMPETING CONTINUATION	$549,920
2024	2023	FRED HUTCHINSON CANCER CENTER	1100 FAIRVIEW AVE N	SEATTLE	WA	98109	KING	USA	21st Century Cures Act - Beau Biden Cancer Moonshot	000	1	6/12/2024	NEW	$0
														Subtotal = $549,920

Issue Date FY: 2023 ( Subtotal = $560,138 )
2023	2023	FRED HUTCHINSON CANCER CENTER	1100 FAIRVIEW AVE N	SEATTLE	WA	98109	KING	USA	21st Century Cures Act - Beau Biden Cancer Moonshot	001	1	8/17/2023	NEW	$0
2023	2023	FRED HUTCHINSON CANCER CENTER	1100 FAIRVIEW AVE N	SEATTLE	WA	98109	KING	USA	21st Century Cures Act - Beau Biden Cancer Moonshot	000	1	8/1/2023	NEW	$560,138
														Subtotal = $560,138

Grand Total All Awards = $1,685,549

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Evaluating Centralizing Interventions to Address Low Adherence to Lung Cancer Screening Follow-up in Decentralized Settings

Award Number: R01CA284032

ORGANIZATION: NATIONAL CANCER INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

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

PERIOD OF PERFORMANCE START DATE: 08/01/2023

PERIOD OF PERFORMANCE END DATE: 07/31/2028

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