Noonan and Colleague Submit CTSI Application

Kudos to Devon Noonan, associate professor, and her collaborator Jenni Dania from the Lung Cancer Initiative of North Carolina, for the submission of their Duke Clinical & Translational Science Institute (CTSI) application entitled "Optimizing the uptake of evidenced-based lung cancer screening in rural communities of the Northern Piedmont region of North Carolina." This proposal requests funds for a one-year period with a start date of July 1, 2019.

Cancer is the leading cause of death in North Carolina,1 and people living in poor, rural counties have increased vulnerability to poor cancer outcomes.2,3 Lung cancer is the leading cause of cancer deaths in North Carolina; and morbidity and mortality of lung cancer is higher in rural counties with a Rural Urban Continuum Code (RUCC) of 4 or higher.4,5,6 In particular, the rural counties just north of Durham, in the Northern Piedmont Region including Granville, Vance and Warren counties, have cancer mortality rates well above state levels.4

Screening offers a way to reduce mortality from cancer. Given the high incidence of lung cancer, the screening that might have the biggest impact on improving health is lung cancer screening. Lung cancer screening, however, has not been adopted fully in these rural counties. Further, residents struggle to follow up on positive results. Screening high-risk residents for lung cancer and navigating them to receive care can improve their survival and quality of life. We propose to focus on increasing lung cancer screening and connecting patients to care by partnering with our stakeholder collaborators. Specifically, we will partner with the Lung Cancer Initiative of North Carolina, the state's leading non-profit organization that specializes in educating and connecting patients to lung cancer screening. Together we will explore facilitators and barriers of lung cancer screening and create solutions that reduce barriers that currently limit access to effective lung cancer screening information and services in the region.

We will build on our team's long-standing community and stakeholder connections in the Northern Piedmont Region to: 1) understand current lung cancer screening practices, contextual factors and barriers and facilitators of screening and follow-up from a clinician and patient perspective and 2) facilitate a mini learning collaborative around best practices in lung cancer screening with the goal of developing a process to increase screening rates and eliminate barriers to screening and follow-up. Our team will leverage our previously established stakeholder connections in the area with Granville Vance Public Health, Primary Care Practices, and Maria Parham Health System. The specific aims are:

Aim 1: Conduct structured interviews with stakeholders including public health, primary care, oncologists, radiologists and pulmonologists (n=20) to understand current lung cancer screening practices and the contextual factors, local barriers and facilitators of lung cancer screening and follow-up.

Aim 2: Conduct surveys (n=50) and in-depth interviews (n=10) with patients to understand the unique local barriers and facilitators of lung cancer screening and follow-up.

Aim 3: Implement a cross-county and cross-discipline learning collaborative around best practices of lung cancer screening to optimize the uptake of evidenced-based lung cancer screening.

Our partnership has the potential for significantly improving our understanding of how to help residents in this underserved community receive vital cancer screening and follow-up. The long-term goal of this project is to develop sustainable solutions to increase lung cancer screening in rural communities.