Implementing a Lung Cancer Detection and Navigation Program in the Antelope Valley: Improving Timeliness, Utilization, and Outcomes in a Low-resource Community

Background Lung cancer screening (LCS) is severely underutilized in low-resource communities. Health outcomes in these communities are further exacerbated by barriers to healthcare, such as transportation concerns, poor healthcare availability, and lack of access to the internet. We set out to develop a program at City of Hope (COH) to improve the early detection of lung cancer and patient outcomes in a low-resource community with a high rate of smoking – the Antelope Valley (AV) region in Southern California. The present work highlights the outcomes and impact of this program at COH-AV. Methods To improve LCS volume in AV, we organized physician- and community-focused LCS-related outreach events. To improve patient outcomes, a community-based lay navigator identified patients with a new lung cancer diagnosis or suspicious radiographic findings, conducted a needs assessment to identify potential barriers to care, and scheduled follow-up encounters to provide interventions. We tracked program outcomes such as timeliness of care and percentage of no-show appointments. We also gathered reflections of the navigator on the patients’ lived experience during their enrollment in the program. Results LCS volume increased during the program period, although a direct impact of the program could not be established. Over 60% of patients who were navigated by our lay navigator had ≥ 1 barriers, which were resolved through services (transportation gift cards and loaner tablets) or referrals. Notably, 85% of the patients who did not have a cancer diagnosis at the start of the program completed their diagnostic evaluation. Moreover, 72% of the participants who had stage I-IIIa lung cancer initiated treatment within 12 weeks of diagnosis. The mean percentage of no-show appointments was 31% lower (non-significant) among navigated patients than a comparable cohort of unnavigated patients. Additionally, participants responded favorably toward telehealth and appreciated the lay navigator’s ability to provide emotional support and compassionate interactions, financial assistance and guidance, and assistance in navigating the complexities of healthcare. Conclusions Our results demonstrate the feasibility and potential impact of a community-based navigation program in improving care coordination, timeliness of care, and access while fostering a more supportive patient experience for individuals with lung cancer in a low-resource region served by COH.