Lung Cancer Screening Eligibility and Referral Practices in Texas Organizations Serving People with Substance Use Disorders

SIMPLE SUMMARY: People with substance use disorders have extremely elevated rates of smoking and, therefore, are a priority population for lung cancer screening. This paper examines the lung cancer screening practices—determining patients’ eligibility for lung cancer screening and making referrals to screening—of Texas healthcare organizations that provide services to people with substance use disorders. This work demonstrated that few organizations are determining patients’ eligibility and even fewer are making referrals. While not all organizations have the capability to make referrals (i.e., no on-site prescriber), they each have a vital role to play in eligibility determination and patient education. There is a need for researchers to focus intervention and implementation efforts within these organizations to increase capacity and ensure that patients are being navigated to lung cancer screening at multiple touch points across the healthcare continuum. ABSTRACT: For people at elevated risk for lung cancer, lung cancer screening (LCS) reduces lung cancer mortality. People with non-nicotine substance use disorders (SUDs) have elevated rates of smoking compared with the general population, highlighting them as a priority population for LCS consideration. Although research has shown LCS is underutilized, there is little literature to inform whether organizations that serve individuals with SUDs have existing clinical protocols surrounding LCS. In the current study, we examine the LCS eligibility and referral practices among these organizations. We conducted a statewide needs assessment survey in 2021 to discern how tobacco use was being addressed at Texas organizations that provide treatment or services to individuals with SUDs. Respondents were asked to report on their center’s LCS eligibility and referral practices. The analytic sample consists of 125 respondents who represented 23 federally qualified health centers, 29 global local mental health authorities (LMHAs), 12 substance use treatment programs in LMHAs, and 61 standalone substance use treatment centers. Very few respondents indicated that healthcare providers at their center made referrals to LCS for patients (8.8%); a few respondents indicated that their healthcare providers assessed patients’ eligibility for LCS but did not make referrals (3.2%). Intervention and implementation efforts are needed in these and other SUD healthcare settings to bolster organizational capacity and ensure that patients are being navigated to lung cancer screening at multiple touch points across the care continuum.