Homelessness, Patient Navigation, and Lung Cancer Screening in a Health Center Setting: A Subgroup Analysis of a...

Area of Science:

• Public Health
• Cancer Screening
• Health Disparities

Background:

• Lung cancer is a leading cause of mortality among individuals experiencing homelessness.
• Patient navigation is a proven strategy to enhance lung cancer screening (LCS) uptake in Health Care for the Homeless (HCH) settings.
• Limited data exist on whether LCS patient navigation's effectiveness varies between currently and formerly homeless populations.

Purpose of the Study:

• To evaluate the impact of LCS patient navigation on individuals currently versus formerly experiencing homelessness.
• To investigate differences in navigation process measures between these subgroups.

Main Methods:

• Subgroup analysis of the pragmatic randomized clinical trial, Investigating Navigation to Help Advance Lung Equity (INHALE).
• Included English-proficient primary care patients with a history of homelessness eligible for LCS.
• Primary outcome: verified receipt of a 1-time LCS low-dose computed tomography (LDCT) scan within 6 months.

Main Results:

• Patient navigation significantly increased LCS LDCT completion in both currently (26.8%) and formerly (51.3%) homeless groups.
• The treatment effect was significantly smaller for currently homeless individuals (Risk Difference [RD], 19.7%) compared to formerly homeless individuals (RD, 41.1%).
• Communication challenges were noted with currently homeless participants; housing stability did not significantly alter outcomes for formerly homeless individuals.

Conclusions:

• Patient navigation improves LCS participation for both currently and formerly homeless individuals.
• The smaller effect size in the currently homeless group suggests a need for refined navigation strategies and policy interventions.
• Addressing housing attainment is crucial for improving cancer outcomes in HCH populations.