R01CA268030

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 the potential to drive down lung cancer incidence and mortality in underserved populations.

Washington University

TO IDENTIFY CANCER RISKS AND RISK REDUCTION STRATEGIES, TO IDENTIFY FACTORS THAT CAUSE CANCER IN HUMANS, AND TO DISCOVER AND DEVELOP MECHANISMS FOR CANCER PREVENTION AND PREVENTIVE INTERVENTIONS IN HUMANS. RESEARCH PROGRAMS INCLUDE: (1) CHEMICAL, PHYSICAL AND MOLECULAR CARCINOGENESIS, (2) SCREENING, EARLY DETECTION AND RISK ASSESSMENT, INCLUDING BIOMARKER DISCOVERY, DEVELOPMENT AND VALIDATION, (3) EPIDEMIOLOGY, (4) NUTRITION AND BIOACTIVE FOOD COMPONENTS, (5) IMMUNOLOGY AND VACCINES, (6) FIELD STUDIES AND STATISTICS, (7) CANCER CHEMOPREVENTION AND INTERCEPTION, (8) PRE-CLINICAL AND CLINICAL AGENT DEVELOPMENT, (9) ORGAN SITE STUDIES AND CLINICAL TRIALS, (10) HEALTH-RELATED QUALITY OF LIFE AND PATIENT-CENTERED OUTCOMES, AND (11) SUPPORTIVE CARE AND MANAGEMENT OF SYMPTOMS AND TOXICITIES. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO STIMULATE TECHNICAL INNOVATION, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY WOMEN AND SOCIALLY/ECONOMICALLY DISADVANTAGED PERSONS. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER THROUGH COOPERATIVE RESEARCH AND DEVELOPMENT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT FUNDING, AND FOSTER PARTICIPATION IN INNOVATION AND ENTREPRENEURSHIP BY WOMEN AND SOCIALLY/ECONOMICALLY DISADVANTAGED PERSONS.

93.393 - Cancer Cause and Prevention Research

National Cancer Institute (NCI) [HHS - NIH]

Saint Louis, Missouri 631101010 United States

Single Zip Code

Increasing Uptake of Evidence-Based Screening in Diverse Adult Populations (R01 Clinical Trial Optional) (PA-18-932)

Amendment Since initial award the total obligations have increased 411% from $652,984 to $3,337,234.