# Determining organizational structures and processes that improve lung cancer screening adherence among underserved populations

> **NIH NIH F32** · BOSTON UNIVERSITY MEDICAL CAMPUS · 2021 · $72,734

## Abstract

PROJECT SUMMARY/ABSTRACT
Lung cancer remains the leading cause of cancer death, with an estimated 1.8 million deaths annually
worldwide. Racial and ethnic minorities are disproportionately affected as they are more likely to be
impoverished, lack insurance, and suffer disparities in treatment of lung cancer. Lung cancer screening (LCS)
can reduce lung cancer mortality by 20% with close follow-up and adherence to management
recommendations. Yet, how to optimize LCS adherence in a real-world population with diverse backgrounds
and barriers to accessing LCS is unknown. In our recent work, we found that in a national cohort of 28,294
Veterans who underwent initial LCS, only 63% received the recommended next step in the expected time
frame, with delayed or absent follow-up more likely in vulnerable populations, including Veterans who were
racially Black, had mental health comorbidities, earned lower income or had higher copayments to access
care. Encouragingly, Veterans who received care at high-volume LCS or academic facilities were less likely to
have delayed or absent follow-up, suggesting that lessons could be learned from these LCS programs. I
propose two foundational steps to enhance our understanding of the barriers to lung cancer screening and
develop strategies to mitigate disparities: 1) evaluate the current structures and processes at VA facilities
performing LCS designed to support equitable adherence to LCS by developing and administering surveys to
these facilities and 2) conduct hierarchical multivariable regression models to identify barriers to adherence
and strategies that are associated with greater in LCS follow-up overall, and among subgroups of vulnerable
populations. This work represents a critical first step to identify best practices to improve adherence to LCS
and ultimately mitigate lung cancer disparities among vulnerable population. This work will inform the next step
in my career development, in which I will develop a tailored implementation plan and then a pilot
implementation / effectiveness study in a site with a diverse population to improve mortality benefits from LCS.

## Key facts

- **NIH application ID:** 10314581
- **Project number:** 1F32CA265053-01
- **Recipient organization:** BOSTON UNIVERSITY MEDICAL CAMPUS
- **Principal Investigator:** Eduardo Ramon Nunez
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $72,734
- **Award type:** 1
- **Project period:** 2021-09-15 → 2022-06-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10314581

## Citation

> US National Institutes of Health, RePORTER application 10314581, Determining organizational structures and processes that improve lung cancer screening adherence among underserved populations (1F32CA265053-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10314581. Licensed CC0.

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