Recruitment and retention of Chinese men at high risk for lung Cancer: Lessons learned from a pilot trial of a community health worker intervention to increase lung cancer screening uptake

Background

The U.S. Preventive Services Task Force (USPSTF) currently recommends annual lung cancer screening (LCS) with low-dose computed tomography (LDCT) for asymptomatic 50- to 80-year-old adults with a 20-pack year history who currently smoke or have quit smoking within the past 15 years. Foreign-born Chinese livery drivers are a group at disproportionately high risk for lung cancer due to high smoking prevalence and occupational exposure to airborne contaminants and carcinogens. This paper describes a pilot randomized controlled trial to educate and navigate high-risk, previously unscreened Chinese livery drivers to lung cancer screening, and describes barriers to recruitment and retention.

Study design

Pre-pilot and pilot randomized controlled trial.

Methods

The study was conducted in two phases, a pre-pilot and pilot randomized controlled trial between December 2019 and June 2023. In the pilot RCT, eligible participants were randomized to either (1) the CHW (Community Health Worker) intervention group or (2) a written materials only control group and participated for 6–12 months.

Results

From December 2019 to June 2023, 25 subjects were enrolled: 12 in Phase 1 and 13 in Phase 2 (of 1018 approached). Recruitment barriers included the COVID-19 pandemic, institutional mistrust, smoking-related beliefs, and primary care provider-related barriers.

Conclusions

We identified specific socioenvironmental and cultural barriers to LCS uptake among Chinese immigrant men who smoke. Farther upstream cancer education interventions (e.g., provider and community-level education initiatives on LCS) conducted in partnership with community-based organizations should be considered to meet the needs of this population.