Lung Cancer Awareness Month: Addressing Inequities and Expanding Access to Care

In recognition of Lung Cancer Awareness Month, November is an apt time to highlight the ongoing need for more robust research, expanded treatment options, and early diagnosis and intervention for a disease that, though it impacts millions of lives, is often under-discussed.

The urgency for progress has never been greater. According to the American Cancer Society, lung cancer continues to be the leading cause of cancer-related mortality in the US, resulting in more deaths than colon, breast, and prostate cancers combined. A key reason for this disparity lies in delayed diagnosis. Nearly half of all lung cancers metastasized from the lungs to distant parts of the body at the time of diagnosis from 2018 to 2022, thus greatly lessening these patients’ chances for survival.

Such challenges are not easily solved, but ACCC is committed to offering diverse educational resources, digital tools, and publications for the entire multidisciplinary cancer care team that aim to address the complex challenges in delivering quality lung cancer care. 

Expanding Screening Access in Rural Appalachia 

In 2021, several state chapters of ACCC launched the Appalachian Community Cancer Alliance (the Alliance) to address the disproportionately high rates of different cancers that affect the Appalachian region, which stretches from southern New York to Mississippi and Alabama. This region is home to over 25 million people, and its residents experience disproportionately high levels of poverty and a systemic lack of health care resources compared to other regions of the country.

Unsurprisingly, lung cancer hits Appalachia particularly hard as well: regions of Ohio, Kentucky, Pennsylvania, Virginia, and West Virginia have higher incidence and mortality rates than anywhere else in the country. In answer, the Alliance was created to identify evidence-based practices that are multidisciplinary and patient-centered in nature to improve the delivery of lung cancer care from prevention through survivorship.

A crucial element in improving a patient’s outcome is early detection. A landmark study by National Cancer Institute researchers demonstrates that the use of routine low-dose CT scans, especially in high-risk populations such as those who are former or current smokers, can reduce the national death rate from lung cancer by up to 20%. Due to social drivers of health such as low socioeconomic status and a lack of education, lung cancer screening levels in Appalachia have historically remained low.

In response to this dire need to improve screening practices for lung cancer among individuals in Appalachia, ACCC emerged as a key organization in the White House Cancer Moonshot Program that began under President Biden in 2022 to bring more cancer screening capabilities to rural communities and challenge the current status quos.

Bolstered by this support, ACCC created the the Rural Appalachian Lung Cancer Screening Initiative in November 2023 to improve screening and early detection rates by identifying the barriers that have kept levels low and creating patient-centric approaches to reduce these barriers and improve resource access. After extensive analysis and consultation with lung cancer specialists, 2 sites were chosen to pilot the program: Pikeville Medical Center in Pikeville, Kentucky, and Buchanan General Hospital in partnership with the University of Virginia. 

Through partnership with local advocates, the initiative engaged in provider education, best practice alerts, patient portal reminders, and outreach events, in the hopes of overcoming informational, literacy, and cultural barriers to timely screening. Since the initiative began, lung cancer screenings in rural Appalachia have increased by more than 53%, and the program was named as one of the 5 key private sector actions answering the Cancer Moonshot’s call to bring cancer screenings to more communities.

Supporting Ongoing Research

Making up 85% of all lung cancer cases, non-small cell lung cancer (NSCLC) is the most common type of lung cancer. When diagnosed early, NSCLC is highly treatable, as it often responds well to surgery, chemotherapy, or immunotherapy, depending on the treatment plan. Unfortunately, sizable gaps exist in the implementation of evidence-based diagnostics and therapies at many community cancer centers—where the majority of patients with lung cancer receive care.

To address this challenge, ACCC launched a 2-phase quality improvement (QI) initiative to improve care for patients with early-stage NSCLC in all care settings. After surveying providers to pinpoint barriers to optimal care, target areas for QI projects were identified at 3 cancer centers, which included biomarker testing rates and use of a multidisciplinary tumor board.

Through biomarker testing, providers examine a patient’s tumor for specific genes or proteins that can be targeted with more effective, personalized treatments. Despite its benefits in patient outcomes, biomarker testing is not currently considered standard-of-care for this patient population, nor is it implemented consistently and broadly at the time of diagnosis at many cancer centers.

In response, ACCC is working to establish guideline-concordant biomarker testing pathways for this patient population, address barriers to the early adoption of interventional care for early-stage NSCLC, and identify ideal care recommendations. By optimizing the use of testing tools and engaging the entire multidisciplinary team to improve treatment plans, cancer programs can achieve more coordinated and streamlined care.

Although treatment options have improved and overall lung cancer death rates have been on the decline in the US, persistent inequities and important research questions remain. In the spirit of more comprehensive, accessible, and equitable cancer care for all, ACCC is proud to recognize Lung Cancer Awareness Month and to share our initiatives that aim to continually improve outcomes and patient care through thoughtful, targeted collaboration.

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