Socioeconomic factors alter patient experiences during lung cancer screening

New research among lung cancer screening participants has found that low-dose chest computed tomography (CT) screening is generally well tolerated both physically and emotionally, but experiences vary across socioeconomic groups. Lower-income and safety-net participants experienced higher testing-related burden, with factors such as insurance and employment status associated with more discomfort or anxiety. The findings in the Journal of the American College of Radiology, published by Elsevier, highlight opportunities to improve equity in screening.

Lung cancer remains the leading cause of cancer death in the United States, and the early detection of lung cancer saves lives. Participation and long-term adherence to lung cancer screening with low-dose CT remain low in real-world settings.

Most research has focused on clinical outcomes, with less attention to how patients actually experience the screening test itself. We investigated whether patients experience short-term effects, such as discomfort or anxiety, related to lung cancer screening, particularly among underserved populations where barriers to care are greater."

Jessica H. Porembka, MD, lead investigator, Department of Radiology, University of Texas Southwestern Medical Center

The investigators conducted a prospective study of 468 lung cancer screening participants across both a university health system and a county safety-net system (serving low-income and marginalized communities), using validated patient-reported measures to assess physical and emotional effects of screening. While overall testing-related burden was very low, a meaningful subset of patients reported discomfort or anxiety.

Safety-net participants reported pain or discomfort more often before and during screening. In multivariable analysis, marital status, employment, and insurance coverage were associated with testing-related burden.

Dr. Porembka points out, "Lung cancer screening saves lives, but it only works if patients return year after year. Even small, temporary burdens from screening may influence whether people come back for annual exams - an essential component of screening effectiveness."

The study's findings point to opportunities for targeted interventions, such as: 

• Reducing pre-test anxiety
• Improving the physical screening experience
• Addressing structural barriers in underserved settings

This work is among the first to use a validated instrument to quantify the impact of lung cancer screening and to examine how healthcare setting and social determinants of health influence patient experience. Understanding these factors is essential to improving both adherence and equity in lung cancer screening.

Co-investigator and Editor-in-Chief of the Journal of the American College of Radiology Ruth Carlos, MD, MS, Department of Radiology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, concludes, "We were reassured that overall testing burden was low, suggesting the exam itself is not a major barrier for most patients. At the same time, it was notable that differences in patient experience were closely linked to social and economic factors, reinforcing the importance of a more patient-centered and equity-focused approach to screening."