Lung Cancer Screening in the Community Setting: Challenges for Adoption

2018 ◽  
Vol 84 (9) ◽  
pp. 1415-1421
Author(s):  
Simran Randhawa ◽  
Gary Drizin ◽  
Tracy Kane ◽  
Grace Y. Song ◽  
Thomas Reilly ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Online Survey ◽  
Screening Program ◽  
Task Force ◽  
Community Setting ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
High Risk Population ◽  
Screening Programs ◽  
National Lung Screening Trial

Secondary prevention of lung cancer by screening a high-risk population with low-dose CT (LDCT) of the chest has been shown to save lives. Our Institution offered a free screening program in 2013. The program was promoted through flyers, radio programs, face-to-face information sessions, and a multidisciplinary lung symposium. A lung navigator confirmed the eligibility of patients according to National Lung Screening Trial (NLST) criteria. Data were, prospectively, collected over a 12-month period using Lung-RADs (Lung Imaging Reporting and Data System). After one year, an online survey was sent out to all primary care and referring physicians in the network. One hundred and sixty-nine patients were found to be eligible for screening. Sixty-five per cent were black, 44 per cent white, 9 per cent Hispanic, and 6 per cent were Asian. Sixty per cent patients were referred by their physician. Thirty-one were Lung-RADs 1 (18.3%), 116 were Lung-RADs 2 (68.6%), 16 were Lung-RADs 3 (9.5%), and six were Lung-RADs 4 (3.6%). At the end of the study period, the survey showed that 100 per cent of the providers were aware of the screening program but 15 per cent never referred a patient. Time constraints and requirement for precertification were cited as potential barriers to referral. Twenty-six per cent of providers were unaware that LDCT was recommended by the U.S. Preventive Services Task Force on par with colonoscopy and mammography. The NLST showed that screening with LDCT could reduce lung cancer mortality by 20 per cent. Significant concerns exist about the generalizability of these results and the applicability of screening programs in the community.

Update on Lung Cancer Screening

2020 ◽  
Vol 41 (03) ◽  
pp. 447-452 ◽  
Author(s):  
Andrew R. Brownlee ◽  
Jessica S. Donington
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Task Force ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
General Acceptance ◽  
National Lung Screening Trial ◽  
Adoption And Implementation ◽  
Substantial Progress

AbstractOver the past 10 years, there has been substantial progress in the study and implementation of lung cancer screening using low-dose computed tomography (LDCT). The National Lung Screening Trial, the recently reported NELSON (NEderlands-Leuvens Longkanker Screenings ONderzoek) trial, and other European trials provide strong evidence for the efficacy of LDCT to reduce lung cancer mortality. This has resulted in the United State's Preventative Task Force and numerous professional medical societies adopting lung cancer screening recommendations. Despite the general acceptance of the positive effect of screening, low adoption and implementation rates remain nationally. In this article, the authors discuss the evolution and current state of the evidence for LDCT screening for lung cancer. The authors will also review the associated risks, cost, and challenges of implementation of an LDCT screening program.

Lung Cancer Screening: Promise and Pitfalls

2012 ◽  
pp. 450-457
Author(s):  
Christine D. Berg ◽  
Denise R. Aberle ◽  
Douglas E. Wood
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Mortality ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
Medical Community ◽  
Helical Computed Tomography ◽  
Screening Guidelines ◽  
Screening Programs ◽  
National Lung Screening Trial

OVERVIEW: The results of the National Lung Screening Trial (NLST) have provided the medical community and American public with considerable optimism about the potential to reduce lung cancer mortality with imaging-based screening. Designed as a randomized trial, the NLST has provided the first evidence of screening benefit by showing a 20% reduction in lung cancer mortality and a 6.7% reduction in all-cause mortality with low dose helical computed tomography (LDCT) screening relative to chest X-ray. The major harms of LDCT screening include the potential for radiation-induced carcinogenesis; high false-positivity rates in individuals without lung cancer, and overdiagnosis. Following the results of the NLST, the National Comprehensive Cancer Network (NCCN) published the first of multiple lung cancer screening guidelines under development by major medical organizations. These recommendations amalgamated screening cohorts, practices, interpretations, and diagnostic follow-up based on the NLST and other published studies to provide guidance for the implementation of LDCT screening. There are major areas of opportunity to optimize implementation. These include standardizing practices in the screening setting, optimizing risk profiles for screening and for managing diagnostic evaluation in individuals with indeterminate nodules, developing interdisciplinary screening programs in conjunction with smoking cessation, and approaching all stakeholders systematically to ensure the broadest education and dissemination of screening benefits relative to risks. The incorporation of validated biomarkers of risk and preclinical lung cancer can substantially enhance the effectiveness screening programs.

Effectiveness of low-dose CT scan for lung cancer screening in the community setting.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1543-1543
Author(s):  
Jason Aboudi Mouabbi ◽  
Tarik H. Hadid ◽  
Eugene Uh
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Low Dose ◽  
Task Force ◽  
Demographic Data ◽  
Community Setting ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
The United States

1543 Background: Lung cancer is the leading cause of cancer death in the United States (US) and worldwide. Chest X-ray (CXR) is ineffective in reducing lung cancer mortality. National Lung Cancer Screening Trail (NLST) reported 20% reduction in mortality with the use of low-dose computed tomography (LDCT) scan to screen high risk individuals. Therefore, major organizations including US Preventive Services Task Force has adopted LDCT for lung cancer screening in high risk populations. However, The generalizability of this approach in community setting is yet to be confirmed. Our objective is to assess the ability of LDCT in detection of lung nodules and lung cancer in the community setting and compare the results to those reported in the NLST. Methods: Charts of subjects who underwent LDCT screening between 2013 and 2016 at SJHMC were retrospectively reviewed. Demographic data, the results of the LDCT scans, interventions performed, complications of procedures and pathology findings were collected. All cancer cases found by LDCT and the stage of cancers were documented. The results of our study were statistically compared to the results of both arms of the NLST (CT and CXR arms). Since CXR is ineffective for lung cancer screening, CXR arm serves equivalently to no screening. Results: The baseline characteristics of the subjects are significantly different between this study and NLST. LDCT in our study detected significantly higher positive findings. There are more cancers detected in this study compared to NLST CT and CXR arms, which could reflect higher incidence of cancer in this community or higher proportion of current smokers in our study. In this study, LDCT detected cancers at higher stages compared to that of the NLST CT arm but similar stages to NLST CXR arm. This may indicate that LDCT when performed in the community is less effective in detecting cancer at early stages. Conclusions: The community population have different characteristics compared those enrolled in clinical trials. This may limit the generalizability of the results. Population-based studies are needed to confirm the results of the NLST. [Table: see text]

scholarly journals Cost-Effectiveness of Smoking Cessation Interventions in the Lung Cancer Screening Setting: A Simulation Study

2021 ◽  
Author(s):  
Christopher J Cadham ◽  
Pianpian Cao ◽  
Jinani Jayasekera ◽  
Kathryn L Taylor ◽  
David T Levy ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Smoking Cessation ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Task Force ◽  
Lung Cancer Screening ◽  
Cancer Registries ◽  
Web Based ◽  
Screening Programs ◽  
Life Years

Abstract Background Guidelines recommend offering cessation interventions to smokers eligible for lung cancer screening, but there is little data comparing specific cessation approaches in this setting. We compared the benefits and costs of different smoking cessation interventions to help screening programs select specific cessation approaches. Methods We conducted a societal-perspective cost-effectiveness analysis using a Cancer Intervention and Surveillance Modeling Network model simulating individuals born in 1960 over their lifetimes. Model inputs were derived from Medicare, national cancer registries, published studies, and micro-costing of cessation interventions. We modeled annual lung cancer screening following 2014 US Preventive Services Task Force guidelines plus cessation interventions offered to current smokers at first screen, including pharmacotherapy only or pharmacotherapy with electronic and/or web-based, telephone, individual, or group counseling. Outcomes included lung cancer cases and deaths, life-years saved, quality-adjusted life-years (QALYs) saved, costs, and incremental cost-effectiveness ratios. Results Compared with screening alone, all cessation interventions decreased cases of and deaths from lung cancer. Compared incrementally, efficient cessation strategies included pharmacotherapy with either web-based cessation ($555 per QALY), telephone counseling ($7562 per QALY), or individual counseling ($35 531 per QALY). Cessation interventions continued to have costs per QALY well below accepted willingness to pay thresholds even with the lowest intervention effects and was more cost-effective in cohorts with higher smoking prevalence. Conclusion All smoking cessation interventions delivered with lung cancer screening are likely to provide benefits at reasonable costs. Because the differences between approaches were small, the choice of intervention should be guided by practical concerns such as staff training and availability.

scholarly journals ELIGIBILITY FOR LOW-DOSE COMPUTED TOMOGRAPHY LUNG CANCER SCREENING IN OLDER ASIAN AMERICAN SMOKERS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S189-S189
Author(s):  
Chien-Ching Li ◽  
Kelsey Choi ◽  
Alicia Matthews ◽  
Raj Shah
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Asian American ◽  
Low Dose ◽  
Task Force ◽  
Significant Proportion ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
Eligibility Criteria ◽  
Low Dose Computed Tomography

Abstract Lung cancer is the leading cause of cancer-related deaths in Asian Americans. Low-dose computed tomography lung cancer (LDCT) screening is an effective way to decrease lung cancer mortality. This study aimed to examine the difference in LDCT screening eligibility among Asian American subgroups. The National Health Interview Survey data (2006-2016) was analyzed. The U.S. Preventive Services Task Force guideline was used to determine the LDCT eligibility. A higher and statistically significant proportion of current Filipino smokers (35.4%) met LDCT screening eligibility criteria compared to Chinese (26.5%) and other Asian smokers (22.7%) (p=0.02). Hierarchical logistic regression results further showed that Filipino were more likely to meet LDCT screening criteria than other Asian while adjusting demographics (OR=1.87; p=0.01). The differences in LDCT screening eligibility no longer existed after additionally adjusting socioeconomic factors as well as perceived health status. Future targeted outreach and intervention research is needed for Filipinos with lower socioeconomic status.

scholarly journals Brief Education and a Conjoint Valuation Survey May Reduce Decisional Conflict Regarding Lung Cancer Screening

2020 ◽  
Vol 5 (1) ◽  
pp. 238146831989145
Author(s):  
Jamie L. Studts ◽  
Richard J. Thurer ◽  
Kory Brinker ◽  
Sarah E. Lillie ◽  
Margaret M. Byrne
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Online Survey ◽  
Task Force ◽  
Lung Cancer Screening ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Increased Risk

Background. Recent data and policy decisions have led to the availability of lung cancer screening (LCS) for individuals who are at increased risk of developing lung cancer. In establishing implementation policies, the US Preventive Services Task Force recommended and the Centers for Medicare and Medicaid Services required that individuals who meet eligibility criteria for LCS receive a patient counseling and shared decision-making consultation prior to LCS. Methods. This study evaluated the potential of a values clarification/preference elicitation exercise and brief educational intervention to reduce decisional conflict regarding LCS. Participants ( N = 210) completing a larger online survey responded to a measure of decisional conflict prior to and following administration of a conjoint survey and brief educational narrative about LCS. The conjoint survey included 22 choice sets (two of which were holdout cards), incorporating 5 attributes with 17 levels. Results. Results pertaining to changes in decisional conflict showed that participants reported statistically significantly and clinically meaningful reductions in decisional conflict following administration of the brief educational narrative and conjoint survey across the total score (Δ = 29.30; d = 1.09) and all four decisional conflict subscales: Uncertainty (Δ = 27.75; d = 0.73), Informed (Δ = 35.32; d = 1.11), Values Clarity (Δ = 31.82; d = 0.85), and Support (Δ = 18.78; d = 0.66). Discussion. While the study design precludes differentiating the effects of the brief educational narrative and the conjoint survey, data suggest that these tools offer a reasonable approach to clarifying personal beliefs and perspectives regarding LCS participation. Given the complicated nature of LCS decisions and recent policies advocating informed and shared decision-making approaches, conjoint surveys should be evaluated as one of the tools that could help individuals make choices about LCS participation.

Increasing lung cancer screening rates in HIV clinics.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 189-189
Author(s):  
Shawn Jindal ◽  
Maria Serrano ◽  
Sarah Baron ◽  
Matthew Stuart ◽  
Mariam Alexander ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
Smoking History ◽  
Ct Scans ◽  
Quality Improvement Initiative ◽  
Hiv Patients ◽  
Screening Criteria

189 Background: Data at our institution shows lung cancer is more prevalent and aggressive in HIV patients. A study of lung cancer patients revealed a mean age of 55.8 years in those with HIV vs. 68.0 in those without. Additionally, 67% of HIV patients had metastasis at time of diagnosis, compared to 49% in the overall population. One study found an 18.9% reduction in lung cancer mortality among HIV patients who receive NLST-recommended screening. Despite this, data from 2018 estimated only 13% of eligible HIV patients had completed screening at our institution. We pursued a quality improvement initiative to increase lung cancer screening in our HIV clinics. Methods: Our multi-disciplinary team studied charts of the 628 HIV clinic patients seen in a four-month span to identify those who had not received lung cancer screening and potential reasons why referrals were not made. We also spoke with clinic providers to identify improvement areas. Our intervention encompassed HIV patients that met CMS screening criteria (i.e. age 55-77, 30 pack-year smoking). Our process measure was new referrals to our dedicated screening coordinator, who contacts patients to arrange for CT scans. We plotted trends in appointment referrals on a run chart. Results: Areas for improvement included EMR documentation to assess screening eligibility and an occasional lack of awareness regarding criteria. Providers also cited time constraints may limit referrals. Our team identified patients that met screening criteria and generated EMR reminders for providers to refer patients to radiology. We also held sessions with providers and nursing staff to increase awareness of our screening program. Of 628 patients, 128 (20.4%) had sufficient documented smoking history to assess for screening eligibility. 81 patients (63.3%) met our criteria. Of these patients, 58 (71.6%) had not been screened or referred for screening. Through our most recent interventions, 16 (31.3%) patients have been referred to our screening coordinator, and 7 (12.1%) have received screening CT scans. Our interventions ultimately led to an increase from 23 of 81 (28.4%) patients with completed screening to a projected 46 of 81 (56.8%). Conclusions: Providing education and EMR alerts to raise awareness regarding eligibility, we substantially increased the screening rate in our clinics. Our interventions will be broadened as we return from COVID stoppages. Future interventions include increasing smoking history documentation in the EMR to allow for automated identification of screening eligibility. PDSA and interventions are ongoing with continued follow-up of efficacy.

scholarly journals Attitudes towards Lung Cancer Screening in an Australian High-Risk Population

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Alexandra E. Flynn ◽  
Matthew J. Peters ◽  
Lucy C. Morgan
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Perceived Risk ◽  
Screening Test ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
High Risk Population ◽  
Cancer Screening Test

Objectives. To determine whether persons at high risk of lung cancer would participate in lung cancer screening test if available in Australia and to elicit general attitudes towards cancer screening and factors that might affect participation in a screening program. Methods. We developed a 20-item written questionnaire, based on two published telephone interview scripts, addressing attitudes towards cancer screening, perceived risk of lung cancer, and willingness to be screened for lung cancer and to undertake surgery if lung cancer were detected. The questionnaire was given to 102 current and former smokers attending the respiratory clinic and pulmonary rehabilitation programmes. Results. We gained 90 eligible responses (M:F, 69:21). Mean [SD] age was 63 [11] and smoking history was 32 [21] pack years. 95% of subjects would participate in a lung cancer screening test, and 91% of these would consider surgery if lung cancer was detected. 44% of subjects considered that they were at risk of lung cancer. This was lower in ex-smokers than in current smokers. Conclusions. There is high willingness for lung cancer screening and surgical treatment. There is underrecognition of risk among ex-smokers. This misperception could be a barrier to a successful screening or case-finding programme in Australia.

scholarly journals The decision to biopsy in a lung cancer screening program: Potential impact of risk calculators

2018 ◽  
Vol 26 (1) ◽  
pp. 50-56
Author(s):  
Christopher R Gilbert ◽  
Alexander S Carlson ◽  
Candice L Wilshire ◽  
Ralph W Aye ◽  
Alexander S Farivar ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
National Lung Screening Trial ◽  
Cancer Screening Program ◽  
Potential Impact ◽  
Lung Cancer Screening Program ◽  
Lung Screening ◽  
Screening Trial

Objective The National Lung Screening Trial demonstrated the benefits of lung cancer screening, but the potential high incidence of unnecessary invasive testing for ultimately benign radiologic findings causes concern. We aimed to review current biopsy patterns and outcomes in our community-based program, and retrospectively apply malignancy prediction models in a lung cancer screening population, to identify the potential impact these calculators could have on biopsy decisions. Methods Retrospective review of lung cancer-screening program participants from 2013 to 2016. Demographic, biopsy, and outcome data were collected. Malignancy risk calculators were retrospectively applied and results compared in patients with positive imaging findings. Results From 520 individuals enrolled in the screening program, pulmonary nodule(s) ≥6 mm were identified in 166, with biopsy in 30. Malignancy risk probabilities were significantly higher (Brock p < 0.00001; Mayo p < 0.00001) in those undergoing diagnostic sampling than those not undergoing sampling. However, there was no difference in the Brock ( p = 0.912) or Mayo ( p = 0.435) calculators when discriminating a final diagnosis of cancer from not cancer in those undergoing sampling. Conclusions In our screening program, 5.7% of individuals undergo invasive testing, comparable with the National Lung Screening Trial (6.1%). Both Brock and Mayo calculators perform well in indicating who may be at risk of malignancy, based on clinical and radiologic factors. However, in our invasive testing group, the Brock and Mayo calculators and Lung Cancer Screening Program clinical assessment all lacked clarity in distinguishing individuals who have a cancer from those with a benign abnormality.

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