Tailoring lung cancer screening (LCS) protocols for smokers with mental health conditions -- perhaps through expanding Medicare's Comprehensive Primary Care (CPC) initiative -- could increase screening rates for millions of at-risk individuals.
This kind of action could address the "dual missed opportunity related to both failing to screen for tobacco use, the primary risk factor for lung cancer, and support screening for lung cancer [among individuals with mental health conditions]," wrote a team led by Robert Volk, PhD, at The University of Texas MD Anderson Cancer Center in Houston. The group explored associations between mental health conditions and cigarette use, lung cancer screening (LCS) eligibility, and screening follow-through and published its findings May 30 in Cancer Medicine.
Cigarette use is more common among people with a history of depression or frequent mental distress, Hernandez and colleagues explained.
"Persons with mental health conditions are often not screened for tobacco use or receive cessation/treatment services in the settings where they receive care," the investigators wrote, noting that nearly 1.8 million people with a history of depressive disorder in the U.S. are eligible for lung cancer screening.
For the research, the team analyzed data gathered from more than 56 million people over the age of 50 from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) cross-sectional dataset. Of the sample, roughly 18% of adults reported having a history of a depressive disorder; 11.9% reported frequent mental distress in the last month.
The authors found that, compared to adults without a history of depression, adults with that history were more likely to currently smoke (19.9% vs. 10.8%); had a slightly higher average pack-year history (26.8 vs. 24 years); and were more likely to be eligible for LCS (18.9% vs. 10.8%).
Multilevel, targeted interventions could both improve rates of lung cancer screening completion and contribute to better physical health outcomes for people living with mental health conditions, according to the investigators. To this end, they offered three suggestions:
- Develop and promote interventions that address the intersectionality of health inequities and what contributes to them, such as social determinants of health and lack of universal screening for smoking history in behavioral health settings.
- Integrate lung cancer screening facilitation into behavioral healthcare settings where individuals with mental health conditions receive care. This would mean more regular contact between mental health providers and their patients.
- Expand Medicare's Comprehensive Primary Care (CPC) initiative and related the primary care medical home mode so that the Centers for Medicare and Medicaid Services (CMS) would reimburse participating primary care sites for risk stratified care management, planned care for chronic conditions and preventive care, and coordination of care across neighborhoods.
"Expansion of the CPC initiative could help address relevant healthcare barriers among at-risk adults with mental health conditions (e.g., cognitive deficits, patient-provider communication challenges, and fragmented primary care and mental health care), and further promote collaborations between patients, providers, and the community to co-design relevant LCS messaging and outreach efforts," Hernandez and colleagues concluded.
Read the full report here.
