Increased Utilization of Low-Dose Computed Tomography for Lung Cancer Screening at an Arkansas Community Oncology Clinic

BACKGROUND:Low-dose computed tomography (LDCT) is underutilized in Arkansas for lung cancer screening, a rural state with high incidence of lung cancer. The objective was to determine whether offering free LDCT increased the number of high-risk individuals screened in a rural catchment area. METHODS:5,402 patients enrolled in screening at Highlands Oncology, a community oncology clinic in Northwest Arkansas, from 2013 - 2020. Screenings were separated into time periods: Period 1 (10 months for-fee), Period 2 (10 months free with targeted advertisements and primary care outreach), and Period 3 (62 months free with only primary care outreach). 5,035 high-risk participants were eligible for analysis based on NCCN Clinical Practice Guidelines in Oncology. Enrollment rates, incidence densities (ID), Cox proportional hazard models, and Kaplan-Meier curves were performed to investigate differences between enrollment periods and high-risk groups. RESULTS:Patient volume increased drastically once screenings were offered free of charge (Period 1 = 4.6 vs. Period 2 = 66.0; Period 3 = 69.8 average patients per month). Incidence density per 1,000 person-years increased through each period (IDPeriod 1 = 17.2; IDPeriod 2 = 20.8; IDPeriod 3 = 25.5 cases). Cox models revealed significant differences in lung cancer risk between high-risk groups (P = 0.012), but not enrollment periods (P = 0.19). Kaplan-Meier lung cancer-free probabilities differed significantly between high-risk groups (log-rank P = 0.00068), but not enrollment periods (log-rank P = 0.18). CONCLUSIONS:This study suggests that eligible patients are more receptive to free LDCT screening, despite most insurances not having a required copay for eligible patients.