Need: This proposal responds to a critical need for expanded evidence-based services to prevent lung cancer in populations currently outside the Cancer Prevention & Research Institute of Texas’ (CPRIT) portfolio. These include geographic areas of Texas disproportionately affected by lung cancer incidence, mortality and cancer risk prevalence as well as socio-demographically underserved populations. The project will bring expanded services to Texas Public Health Region 5, which CPRIT has identified as a high priority geographic area, and it will also expand an existing network of clinics in the Harris County to the Harris County Metropolitan area. The expanded program will maintain its commi...

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Need: This proposal responds to a critical need for expanded evidence-based services to prevent lung cancer in populations currently outside the Cancer Prevention & Research Institute of Texas’ (CPRIT) portfolio. These include geographic areas of Texas disproportionately affected by lung cancer incidence, mortality and cancer risk prevalence as well as socio-demographically underserved populations. The project will bring expanded services to Texas Public Health Region 5, which CPRIT has identified as a high priority geographic area, and it will also expand an existing network of clinics in the Harris County to the Harris County Metropolitan area. The expanded program will maintain its commitment to quality assurance and key informant feedback. Based on criteria which included % smokers 18 years and older, age-adjusted invasive lung cancer and age-adjusted lung cancer mortality, % rural population, designation as a Medically Underserved and/or Health Professional Shortage Area, and distance to the closest certified screening site, we identified Polk and San Jacinto Counties from among all counties in Region 5 as primary geographic targets. Polk County had the highest rates of both invasive lung cancer and lung cancer mortality in Region 5, and it is immediately adjacent to San Jacinto County, another hard-hit county. Polk County is 78% rural, while San Jacinto is 100% rural. Both counties are at or above Texas’ average for percent smokers, and both are Medically Underserved/Health Professional Shortage areas. At the same time, we propose expansion from 15 to 29 clinics serving high priority populations in the metropolitan Harris County area. Our proposed expansion reaches key underserved populations, takes lessons learned into account, and matches program ambitions with available program resources. Overall Project Strategy: In partnership with Harris Health System and Baylor-St. Luke’s Medical Group, our LUNG CANCER SCREENING AND TOBACCO CONTROL (LCTC) NETWORK aims to reduce disparities in access and outcomes in Metropolitan Houston and predominantly non-metropolitan high-risk/high poverty populations in TPH Region 5. Our multi-level strategy will operationalize and coordinate services according to a detailed Lung Cancer Screening (LCS) program implementation guide which includes process flow maps, Electronic Medical Records enhancement, clinic-specific plans for integration, and expansion of integrative pharmacotherapy and behavioral therapy services onsite. Specific Goals: 1) expand an evidence-based comprehensive lung cancer screening program to increase equitable access to screening and early detection among high priority populations in metro Houston and Texas Public Health region 5. We shall implement clinic-specific plans for adoption of high-quality LCS practices across our network partner organizations. Plans include the capacity to modify according to local needs. An additional interdisciplinary group of 250 primary care providers will be trained to use evidence-based shared decision making and screening tools that promote increased identification, screening, and management of high-risk patients for lung cancer. We shall deliver 450 Low Dose Computerized Tomography (LDCT) for lung cancer screening paid through the program to eligible uninsured/underinsured patients through the network. 2) Expand a comprehensive evidence-based smoking cessation program to the LCTC network for individuals 55 to 80 years of age to serve as an essential adjunct to lung cancer screening activities. Smoking cessation treatment will be provided before and after LDCT screening to approximately 3,000 patients 55 to 80 years of age with 30 or more pack-years smoking history who currently smoke or who have quit smoking within the past 12 months. An additional interdisciplinary group of 250 primary care providers will be trained on smoking cessation practices, local services, and referral protocols. Outreach and education about lung cancer prevention, including tobacco cessation and screening guidelines and services will reach approximately 20,000 age-eligible community residents served by the LCTC network through our community engagement collaborative. Significance and Impact: LCS can produce a 20% reduction in lung cancer mortality and a 6.7% decrease in all-cause mortality. When combined with smoking cessation treatment in high-risk populations, the anticipated health benefits are increased. In our proposed expansion areas, however, up-to-date, evidence-based lung cancer screening programs with integrated comprehensive smoking cessation services do not exist, nor are primary care providers adequately trained. We aim to address these gaps through an expanded network of high-priority venues. The impact of our program is likely to be scalable and sustainable given strong institutional support and partnerships led by Baylor College of Medicine, Baylor- St. Luke, Harris Health and the Dan Duncan Comprehensive Cancer Center.

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