scholarly journals CO-DESIGNING CANCER SCREENING INTERVENTIONS WITH PEOPLE OVER 55 YEARS OLD AT RISK FOR LUNG CANCER

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S917-S918
Author(s):  
Leah Tuzzio ◽  
Lorella Palazzo ◽  
Sarah Brush ◽  
Kelly Ehrlich ◽  
Melissa Anderson ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Mortality ◽  
Financial Incentives ◽  
Task Force ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
The Us ◽  
Multilevel Interventions

Abstract In 2014, the US Preventive Task Force recommended annual lung cancer screening with low dose CT (LDCT) for adults aged 55 to 80 years old with significant smoking history. Although screening reduces lung cancer mortality, the leading cause of cancer mortality in the US, adherence to screening follow-up remains low. In a human-centered design qualitative study, health services researchers and eight adults over 55 years old from Kaiser Permanente Washington who had recently had an LDCT participated in two co-design sessions. We elicited barriers, facilitators and design principles to develop multilevel interventions that aim to improve adherence to ongoing LDCT. In the initial discussion, participants identified four key areas for improvements to adherence: a) reminders for scheduling and appointments, b) knowledge about tests and follow-up, c) convenience in location and scheduling, and d) financial and non-financial incentives. In a second session, participants referenced patient personas and sketched storyboards, a comic strip-like format showing steps in a journey, to describe different ways to help patients return for LDCTs. Through qualitative analysis, we identified ten elements to consider incorporating in multilevel interventions: versatility (e.g., multiple reminder options), social support (e.g., families, peers), individualization (e.g., tailoring to patient needs), feelings (e.g., fear, relief), knowledge (e.g., harms/benefits, expectations), responsibility (e.g., who is accountable for reminders), continuity (e.g., clear pathway to adherence), consistency (e.g., same messages), cadence (e.g., rhythm of messages), and acknowledgment (e.g., recognition of screening completion). Next steps are to incorporate feedback from clinical stakeholders and develop multilevel interventions for further testing.

Assessment of compliance with USPSTF lung cancer screening guidelines among resident primary care physicians in a university residency program.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 43-43
Author(s):  
Nerea Lopetegui-Lia ◽  
Syed Imran Jafri ◽  
Manish Kumar ◽  
Shashank Sama ◽  
James J. Vredenburgh
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Primary Care Physicians ◽  
Task Force ◽  
Lung Cancer Screening ◽  
The United States ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Screening Methods ◽  
The Us

43 Background: Lung cancer remains the leading cause of morbidity and mortality, with a predicted 1.8 million deaths worldwide yearly. The United States Preventive Services Task Force (USPSTF) recommends screening for lung cancer with Low Dose Computed Tomography (LDCT) for all genres of age 55 to 80 with a 30 pack-year smoking history, current smokers or have quit within the past 15 years. Early detection has shown to reduce mortality. Only 4% of eligible patients in the US actually undergo lung cancer screening. Methods: A retrospective review of data was performed amongst the University of Connecticut Internal Medicine Residents acting as PCPs at a Clinic in Hartford, CT, USA. Results: 369 medical charts were reviewed. 115 patients (31.1%) met the USPSTF criteria for screening. 5.7% had an appropriately ordered LDCT scan. 2.71% had a LDCT completed and 2.98% had LDCT scheduled but pending or cancelled. 4 patients with smoking history who did not meet USPSTF criteria but had a LDCT due to clinical suspicion for lung cancer. Approximately 11% of patients had chronic obstructive pulmonary disease (COPD) or emphysema and asthma. 5 patients had a first degree relative with history of lung cancer. 6 patients had lung cancer, 3 of which had metastatic lung cancer at the time of diagnosis and are deceased. Conclusions: Lung cancer screening amongst resident PCP is insufficient. The results obtained were lower than the national average. This is likely due to newer trainees focusing less in prevention/screening and more on managing chronic medical conditions. Patients that attend resident PCP clinics in the US are typically of lower socio-economic status, less insurance coverage or uninsured and with a lower level of education. LDCT orders that were cancelled were likely because insurers declined it. Patients not realizing the importance of screening could also be contributing. It is unclear if lung disease or family history attributes a higher risk of developing lung cancer. In conclusion, educating resident PCPs and patients on lung cancer screening, as well as evaluating the reasons for cancelling LDCT could help ensure high quality care.

The US Preventive Services Task Force Recommendation on Lung Cancer Screening

JAMA ◽  
2021 ◽  
Vol 326 (5) ◽  
pp. 440
Author(s):  
Bryan S. Squires ◽  
Ronald Levitin ◽  
Inga S. Grills
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Task Force ◽  
Preventive Services ◽  
Lung Cancer Screening ◽  
The Us

Community-based lung cancer screening program: A five-year comprehensive review.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13080-e13080
Author(s):  
Ari Hakimian ◽  
Axel Joob ◽  
Jennifer Aversano ◽  
Michael Vercillo ◽  
Michael Oconnor ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Community Based ◽  
Cancer Screening Program ◽  
History Of ◽  
Lung Cancer Screening Program

e13080 Background: Low-dose chest CT for lung cancer screening has been shown to have a significant impact on the early diagnosis of lung cancer. Initial trials have shown an approximate 20% decrease in overall lung cancer mortality (NLST, 2011). This study incorporates all patients who were evaluated by the Center for Thoracic Disease in a community-based lung cancer screening program from 2013 to 2018. Over the course of the study, thoracic surgeons have evaluated these patients with subsequent interval-based scans to monitor the progression of suspicious nodules. Methods: Eligibility criteria for the program included patients within the age range of 55-80, with a > 30 pack year smoking history, and that were current smokers or quit tobacco less than 15 years ago. Individuals between 50-55 years old were also included if they had > 20 pack year smoking history and at least one additional lung cancer risk factor. All patients included in this analysis completed an initial lung cancer screening consultation and recommended follow-up evaluations with thoracic surgeons from March 2013 to December 2018. All patients with suggestive abnormalities were discussed at a multidisciplinary conference prior to embarking on any invasive procedures. Patient data was collected on REDCap. Descriptive statistics for all continuous (mean ± SD) and categorical [N (%)] variables were calculated on patients. Results: 470 patients were included in the final analysis. The majority of the patients were males (56.4%), mean age was 64 years old (range: 50-81), and 55.3% were current smokers. The average smoking history was 42.3 pack years. 223 (47.6%) patients had a family history of cancer and 70 (14.5%) patients had a personal history of cancer. 25 patients (5.3%) had a diagnosis of primary lung cancer, among whom, 16 patients (64%) had early stage lung cancer (stage 1 and stage 2), 5 patients (20%) had stage 3, and 4 patients (16%) had stage 4 lung cancer. The cancer distribution included 17 adenocarcinomas (68%), 3 squamous cell carcinomas (12%), 3 small cell cancers (12%), 1 large cell cancer (4%) and 1 carcinoid tumor (4%). Conclusions: This study has demonstrated the value of enrolling patients in a community-based lung cancer screening program. Our results have reiterated the prevalence of discovering early staged lung cancer in high risk patients. This comprehensive five-year review indicates the importance of physician coordinated follow-up and evaluation in lung cancer screening patients.

Factors affecting patient adherence to lung cancer screening: A multisite analysis

2020 ◽  
pp. 096914132095078
Author(s):  
Justin T Stowell ◽  
Anand K Narayan ◽  
Gary X Wang ◽  
Florian J Fintelmann ◽  
Efren J Flores ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Patient Adherence ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Factors Affecting ◽  
Lung Cancers ◽  
Logistic Regression Models ◽  
Multiple Variable

Objective To identify factors associated with delayed adherence to follow-up in lung cancer screening. Methods Utilizing a data warehouse and lung cancer screening registry, variables were collected from a referred sample of 3110 unique participants with follow-up CT during the study period (1 January 2016 to 17 October 2018). Adherence was defined as undergoing chest CT within 90 days and 30 days of the recommended time for follow-up and was determined using proportions and multiple variable logistic regression models across the American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS®) categories. Results Of 1954 lung cancer screening participants (51.9% (1014/1954) males, 48.1% (940/1954) female; mean age 65.7 (range 45–87), smoking history median 40 pack-years, 60.2% and 44.5% did not follow-up within 30 and 90 days, respectively. Participants receiving Lung-RADS® category 1 or 2 presented later than those with Lung-RADS® category 3 at 90 days (coefficient −27.24, 95% CI −51.31, −3.16, p = 0.027). Participants with Lung-RADS® category 1 presented later than those with Lung-RADS® category 2 at both 90- and 30-days past due (OR 0.76 95% CI [0.59–0.97], p = 0.029 and OR 0.63 95% CI [0.48–0.83], p = 0.001, respectively). Conclusions Adherence to follow-up was higher among participants receiving more suspicious Lung-RADS® results at index screening CT and among those who had undergone more non-lung cancer screening imaging examinations prior to index lung cancer screening CT. These observations may inform strategies aimed at prospectively identifying participants at risk for delayed or nonadherence to prevent potential morbidity and mortality from incident lung cancers.

Evaluating efficacy of current lung cancer screening guidelines

2017 ◽  
Vol 24 (4) ◽  
pp. 208-213 ◽  
Author(s):  
Barbara Nemesure ◽  
April Plank ◽  
Lisa Reagan ◽  
Denise Albano ◽  
Michael Reiter ◽  
...  
Keyword(s):  
United States ◽  
Lung Cancer ◽  
Cancer Screening ◽  
National Comprehensive Cancer Network ◽  
Task Force ◽  
Preventive Services ◽  
Lung Cancer Screening ◽  
The United States ◽  
Smoking History ◽  
Cancer Network

Objective Current lung cancer screening criteria based primarily on outcomes from the National Lung Screening Trial may not adequately capture all subgroups of the population at risk. We aimed to evaluate the efficacy of lung cancer screening criteria recommended by the United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and the National Comprehensive Cancer Network in identifying known cases of lung cancer. Methods An investigation of the Stony Brook Cancer Center Lung Cancer Evaluation Center's database identified 1207 eligible, biopsy-proven lung cancer cases diagnosed between January 1996 and March 2016. Age at diagnosis, smoking history, and other known risk factors for lung cancer were used to determine the proportion of cases that would have met current United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and National Comprehensive Cancer Network eligibility requirements for lung cancer screening. Results Of the 1046 ever smokers in the study, 40% did not meet the National Lung Screening Trial age requirements, 20% did not have a ≥30 pack year smoking history, and approximately one-third quit smoking >15 years before diagnosis, thus deeming them ineligible for screening. Applying the United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and National Comprehensive Cancer Network eligibility criteria to the Stony Brook Cancer Center's Lung Cancer Evaluation Center cases, 49.2, 46.3, and 69.8%, respectively, would have met the current lung cancer screening guidelines. Conclusions The United States Preventive Services Task Force and Centers for Medicare and Medicaid Services eligibility criteria for lung cancer screening captured less than 50% of lung cancer cases in this investigation. These findings highlight the need to reevaluate the efficacy of current guidelines and may have major public health implications.

Review of annual compliance of low-dose CT for lung cancer screening among internal medicine resident physicians in a university teaching program.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19187-e19187
Author(s):  
Nerea Lopetegui-Lia ◽  
Dimitrios Drekolias ◽  
Syed Imran Mustafa Jafri ◽  
James Vredenburgh
Keyword(s):  
Internal Medicine ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Definitive Treatment ◽  
Internal Medicine Residents ◽  
Annual Screening

e19187 Background: Lung cancer remains the leading cause of morbidity and mortality, with an estimated 2.1 million newly diagnosed cases each year. A large percentage of cases are detected at an advanced stage, making treatment recalcitrant. Only about 15% are diagnosed at an early stage, highlighting the significance of timely screening. USPSTF recommends annual screening with low-dose computed tomography (LDCT) in adults aged 55-80, who have a 30 pack-year smoking history and are current smokers, or former smokers who have quit within the last 15 years. The National Comprehensive Cancer Network (NCCN) guidelines, as well as the National Lung Screening Trial (NLST), recommend annual screening with LDCT until a person is no longer a candidate for definitive treatment. This study aimed to evaluate the compliance with annual LDCT based on USPSTF guidelines among internal medicine residents from the University of Connecticut residency program at a Clinic in Hartford, Connecticut, USA. Methods: Patients who were under the care of internal medicine residents and who had undergone an initial LDCT for lung cancer screening were included. A total of 61 medical charts were reviewed. Three patients were diagnosed with lung cancer and nineteen patients had their initial LDCT in 2019, and therefore excluded. Results: Out of the 39 patients, 10 patients (25.64%) had a follow-up annual LDCT performed, 2 patients before the annual mark due to various clinical concerns, and 9 patients (23%) in the following 24-48 months. 6 patients (15.38%) had a repeat LDCT ordered but was not done or it was canceled. 12 patients (30.77%) had no repeat LDCT ordered at 12 months. Overall, 69.23% had no follow-up CT at 12 months, and 46.15% with no follow up CT at all at the time of chart review. Conclusions: Based on our analysis, follow-up annual LDCT scans for lung cancer screening on patients under the care of residents-in-training are not being ordered frequently enough. The failure to order annual LDCT could be due to a false sense of relief with a normal initial LDCT, the lack of provider’s awareness of USPSTF guidelines, or insurance issues. Educating primary care providers on the importance of follow-up annual LDCT will ensure early detection and decrease mortality from lung cancer in high risk patient population.

scholarly journals Long-Term Follow Up of an Occupational Cohort in Yunnan, People’s Republic of China: 20-Year Postscreening Follow Up and 8-Year Lung Cancer Screening

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 23-23
Author(s):  
Zheng Su ◽  
Meng-Na Wei ◽  
Ya-Guang Fan ◽  
Zhi-Wei Hu ◽  
Jian-Ning Wang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Mortality ◽  
Age Groups ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
People's Republic Of China ◽  
Republic Of China

PURPOSE There is no long-term, population-based cohort screening evidence for lung cancer in China. This study aimed to evaluate whether increased screening rounds could reduce mortality as a result of lung cancer. METHODS We conducted a one-armed, prospective lung cancer screening cohort study with chest radiography and sputum cytology in Yunnan, People’s Republic of China, from 1992 to 1999. A total of 9,295 tin miners age 40 years or older were enrolled in this study and follow up ended on December 31, 2018. We stratified patients into 4 subgroups on the basis of screening rounds—1-2, 3-4, 5-6, or 7-8 rounds within 8 years—and selected 1-2 screening rounds within 8 years as the control group. Hazard ratios (HRs) and 95% CIs for the effect of screening rounds on mortality were estimated using Cox proportional hazards regression models. RESULTS Of participants, 831 (8.9%) were lost to follow up, and 4,517 patients died, 1,600 from cancer (1,135 from lung cancer), 1,519 from circulatory system diseases, and 619 from respiratory diseases. Participants who received 7-8 screening rounds within 8 years had reduced lung cancer mortality by 46% (HR, 0.54; 95% CI, 0.46 to 0.63 in all age groups. For those who received 5-6 screening rounds within 8 years, the benefit of reduction was mostly observed in patients older than age 52 years (HR, 0.63; 95% CI, 0.52 to 0.77), and there was no effect among those age 52 years or younger (HR, 0.72; 95% CI, 0.48 to 1.07). In contrast, only for those patients age 52 years or younger did 3-4 screening rounds within 8 years decrease mortality from lung cancer (HR, 0.56; 95% CI, 0.36 to 0.87). CONCLUSION We showed that increased screening rounds could reduce lung cancer mortality in a high-risk population, but the effect is influenced by age group. The optimal screening strategy for different age groups needs additional investigation.

Completion of lung cancer screening after a baseline order for LDCT at five diverse health systems.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 10506-10506
Author(s):  
Christine Neslund-Dudas ◽  
Amy Tang ◽  
Elizabeth Alleman ◽  
Jennifer Elston Lafata ◽  
Stacey A. Honda ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Logistic Regression ◽  
Cancer Screening ◽  
Health System ◽  
Black Men ◽  
Health Systems ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Former Smokers

10506 Background: In 2014 and 2015, the Affordable Care Act required coverage of, and CMS began reimbursing for lung cancer screening (LCS). Previous studies have shown that when new screening tests or treatments become available, disparities in disease outcomes often increase due to those with fewer resources having less access and greater barriers to care. African American men have historically had higher incidence of and death due to lung cancer than white males in the U.S., raising concerns regarding access to LCS and the potential for increases in disparities in lung cancer. We aimed to determine whether individual or neighborhood level factors were associated with completion of a baseline screening after an order for LCS low dose CT (LDCT) was placed. Methods: In a retrospective study conducted within the five health systems of the Lung Population-based Research to Optimize the Screening Process (PROSPR) Consortium, we determined adherence to baseline LDCT after a health care provider placed an order for LCS (January 2014 through June 2019). Follow-up was available through September 2019. Patients of interest for this analysis were current or former smokers, age 55 to 80 with a 30+ pack-year smoking history. Smoking history and other individual level variables were determined through electronic medical records. Neighborhood factors were derived from the 2010 Census and multivariable logistic regression was used. Results: Of the 13,920 patients that had at least one order for a baseline LCS exam, 14.1% were non-Hispanic Black, 70.3% were non-Hispanic White, and 15.7% were of other or unknown race. Overall, 61.2% of patients completed a LDCT within 90 days and 71.9% completed a scan by the end of follow-up. Completion of a baseline scan differed by health system (LDCT at 90-days, range 51% - 84%, p<0.0001) and increased in general across scan year (range 49.1%-66.0%, p <0.001). In multivariate logistic regression models, males (aOR=1.15, 95% CI 1.07-1.23, p=<0.0001), former smokers (aOR=1.31, 95% CI 1.21-1.40, p <0.0001), and those with a prior history of any cancer (aOR=1.16, 95% CI 1.02-1.32, p=0.03) were more likely to complete LDCT. Blacks were marginally less likely to have completed a baseline LDCT (aOR=0.90, 95% CI 0.81-1.00, p=0.06) within 90 days of an order. Sex modified the associations of race on completion of orders (p=0.08) (Black men aOR=0.81, 95% CI 0.70-0.94, p=0.006 ; Black women aOR=0.99, 95% CI 0.86-1.14, p=0.89). Conclusions: This multisite study indicates Black men in particular may have a lower likelihood of completing a baseline LCS after an order for screening is placed. As lung cancer screening programs move forward, attention should be given to factors associated with reduced uptake and adherence of screening to ensure disparities in lung cancer outcomes do not persist and increase. Provider and health system factors that may impact LCS uptake should be explored in future studies.

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