Comprehensive patient navigation is associated with increased active treatment retention in lung cancer care in rural Appalachia.

Background: Lung cancer mortality is disproportionately concentrated in rural Appalachia. Patient navigation may improve access, but evidence supporting comprehensive lung cancer navigation across all diagnostic pathways remains limited. We evaluated an all-pathway navigation program at a community cancer center serving a high-burden, predominantly publicly insured Appalachian population. Methods: We conducted a retrospective cohort study of 470 patients diagnosed with lung cancer at a single Commission on Cancer (CoC)-accredited community center between 2018 and 2022. In January 2019, a respiratory therapist-led program expanded to cover screening-detected, incidentally detected, and symptomatic presentations. The primary outcome was active treatment retention at the diagnosing institution, ascertained from the institutional cancer registry. Results: Treatment retention was higher in the navigation era than before navigation [83.4% Conclusions: In a high-burden Appalachian population, comprehensive all-pathway navigation was associated with higher treatment retention at the diagnosing institution; navigation itself was not independently associated with survival, which was more strongly associated with treatment receipt, consistent with an indirect care-delivery mechanism. These findings show that a respiratory therapist-led, all-pathway navigation program can be built and sustained in a small community center, and support further consideration of navigation as core community cancer infrastructure.