scholarly journals Randomized Electronic Promotion of Lung Cancer Screening: A Pilot

2017 ◽  
pp. 1-6
Author(s):  
Abbie L. Begnaud ◽  
Anne M. Joseph ◽  
Bruce R. Lindgren
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Usual Care ◽  
Task Force ◽  
Intervention Group ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Care Group ◽  
University Of Minnesota ◽  
Former Smokers

Purpose Screening for lung cancer with low-dose computed tomography is endorsed by the US Preventive Services Task Force, but many eligible patients have yet to be offered screening. Major barriers to the implementation of screening are physician and system related—the requirement for a detailed smoking history, including pack-years, to determine eligibility. We conducted this pilot to determine the feasibility of lung cancer screening (LCS) promotion that would offer screening to eligible persons and patient completion of smoking history to estimate the size of the population of former smokers who may be eligible for LCS in a single health care system. Patients and Methods Two hundred participants were randomly selected from former smokers who were seen at the University of Minnesota Health in the past 2 years and assigned to control (usual care) and electronic promotion, stratified by age. Electronic messages to promote LCS were sent to an intervention group, including a link to complete a detailed smoking history in the electronic health record. Results Of 99 participants, 66 (67%) in the intervention group read the message, 24 (36%) of 66 responded, and 19 (79%) of 24 respondents completed the smoking history. Ten intervention participants and 13 usual care participants were eligible for screening on the basis of pack-year history. Four eligible participants underwent screening in the intervention group compared with one participant in the usual care group. Conclusion Electronic promotion may help identify patients who are eligible for LCS but will not reliably reach all patients because of low response rates. In this sample of former smokers, the majority are ineligible for LCS on the basis of pack-year history. Electronic methods can improve documentation of smoking history.

scholarly journals A Proactive Telephone-Delivered Risk Communication Intervention for Smokers Participating in Lung Cancer Screening: A Pilot Feasibility Trial

2017 ◽  
Vol 13 (3) ◽  
pp. 137-144 ◽  
Author(s):  
Steven B. Zeliadt ◽  
Preston A. Greene ◽  
Paul Krebs ◽  
Deborah E. Klein ◽  
Laura C. Feemster ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Usual Care ◽  
Usual Care Group ◽  
Intervention Group ◽  
Lung Cancer Screening ◽  
Feasibility Trial ◽  
Care Group ◽  
Telephone Counselling ◽  
Tobacco Treatment

Introduction: Many barriers exist to integrating smoking cessation into delivery of lung cancer screening including limited provider time and patient misconceptions.Aims: To demonstrate that proactive outreach from a telephone counsellor outside of the patient's usual care team is feasible and acceptable to patients.Methods: Smokers undergoing lung cancer screening were approached for a telephone counselling study. Patients agreeing to participate in the intervention (n = 27) received two telephone counselling sessions. A 30-day follow-up evaluation was conducted, which also included screening participants receiving usual care (n = 56).Results/Findings: Most (89%) intervention participants reported being satisfied with the proactive calls, and 81% reported the sessions were helpful. Use of behavioural cessation support programs in the intervention group was four times higher (44%) compared to the usual care group (11%); Relative Risk (RR) = 4.1; 95% CI: 1.7 to 9.9), and seven-day abstinence in the intervention group was double (19%) compared to the usual care group (7%); RR = 2.6; 95% CI: 0.8 to 8.9).Conclusions: This practical telephone-based approach, which included risk messages clarifying continued risks of smoking in the context of screening results, suggests such messaging can boost utilisation of evidence-based tobacco treatment, self-efficacy, and potentially increase the likelihood of successful quitting.

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.

scholarly journals Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke

2021 ◽  
Vol 6 (2) ◽  
pp. 238146832110678
Author(s):  
Kristin G. Maki ◽  
Kaiping Liao ◽  
Lisa M. Lowenstein ◽  
M. Angeles Lopez-Olivo ◽  
Robert J. Volk
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Intervention Group ◽  
Secondary Analysis ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Anticipated Regret ◽  
Factors Associated ◽  
Patient Decision ◽  
Low Dose Computed Tomography

Background. Screening with low-dose computed tomography scans can reduce lung cancer deaths but uptake remains low. This study examines psychosocial factors associated with obtaining lung cancer screening (LCS) among individuals. Methods. This is a secondary analysis of a randomized clinical trial conducted with 13 state quitlines’ clients. Participants who met age and smoking history criteria were enrolled and followed-up for 6 months. Only participants randomized to the intervention group (a patient decision aid) were included in this analysis. A logistic regression was performed to identify determinants of obtaining LCS 6 months after the intervention. Results. There were 204 participants included in this study. Regarding individual attitudes, high and moderate levels of concern about overdiagnosis were associated with a decreased likelihood of obtaining LCS compared with lower levels of concern (high levels of concern, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04–0.65; moderate levels of concern, OR 0.15, 95% CI 0.05–0.53). In contrast, higher levels of anticipated regret about not obtaining LCS and later being diagnosed with lung cancer were associated with an increased likelihood of being screened compared with lower levels of anticipated regret (OR 5.59, 95% CI 1.72–18.10). Other potential harms related to LCS were not significant. Limitations. Follow-up may not have been long enough for all individuals who wished to be screened to complete the scan. Additionally, participants may have been more health motivated due to recruitment via tobacco quitlines. Conclusions. Anticipated regret about not obtaining screening is associated with screening behavior, whereas concern about overdiagnosis is associated with decreased likelihood of LCS. Implications. Decision support research may benefit from further examining anticipated regret in screening decisions. Additional training and information may be helpful to address concerns regarding overdiagnosis.

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.

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.

scholarly journals Disparities of National Lung Cancer Screening Guidelines in the US Population

2020 ◽  
Vol 112 (11) ◽  
pp. 1136-1142 ◽  
Author(s):  
Summer S Han ◽  
Eric Chow ◽  
Kevin ten Haaf ◽  
Iakovos Toumazis ◽  
Pianpian Cao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Risk ◽  
Prediction Models ◽  
Lung Cancer Risk ◽  
Task Force ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Screening Guidelines

Abstract Background Current US Preventive Services Task Force (USPSTF) lung cancer screening guidelines are based on smoking history and age (55–80 years). These guidelines may miss those at higher risk, even at lower exposures of smoking or younger ages, because of other risk factors such as race, family history, or comorbidity. In this study, we characterized the demographic and clinical profiles of those selected by risk-based screening criteria but were missed by USPSTF guidelines in younger (50–54 years) and older (71–80 years) age groups. Methods We used data from the National Health Interview Survey, the CISNET Smoking History Generator, and results of logistic prediction models to simulate lifetime lung cancer risk-factor data for 100 000 individuals in the 1950–1960 birth cohorts. We calculated age-specific 6-year lung cancer risk for each individual from ages 50 to 90 years using the PLCOm2012 model and evaluated age-specific screening eligibility by USPSTF guidelines and by risk-based criteria (varying thresholds between 1.3% and 2.5%). Results In the 1950 birth cohort, 5.4% would have been ineligible for screening by USPSTF criteria in their younger ages but eligible based on risk-based criteria. Similarly, 10.4% of the cohort would be ineligible for screening by USPSTF in older ages. Notably, high proportions of blacks were ineligible for screening by USPSTF criteria at younger (15.6%) and older (14.2%) ages, which were statistically significantly greater than those of whites (4.8% and 10.8%, respectively; P &lt; .001). Similar results were observed with other risk thresholds and for the 1960 cohort. Conclusions Further consideration is needed to incorporate comprehensive risk factors, including race and ethnicity, into lung cancer screening to reduce potential racial disparities.

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.

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.

Implementation of a Lung Cancer Screening Program in Two Federally Qualified Health Centers

2021 ◽  
pp. 003335492097171
Author(s):  
Lesley Watson ◽  
Megan M. Cotter ◽  
Shauna Shafer ◽  
Kara Neloms ◽  
Robert A. Smith ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Pilot Project ◽  
Health Centers ◽  
Smoking History ◽  
Federally Qualified Health Centers ◽  
Cancer Society ◽  
Improved Outcomes

Using low-dose computed tomography (LDCT) to screen for lung cancer is associated with improved outcomes among eligible current and former smokers (ie, aged 55-77, at least 30-pack–year smoking history, current smoker or former smoker who quit within the past 15 years). However, the overall uptake of LDCT is low, especially in health care settings with limited personnel and financial resources. To increase access to lung cancer screening services, the American Cancer Society partnered with 2 federally qualified health centers (FQHCs) in Tennessee and West Virginia to conduct a pilot project focused on developing and refining the LDCT screening referral processes and practices. Each FQHC was required to partner with an American College of Radiology–designated lung cancer screening center in its area to ensure high-quality patient care. The pilot project was conducted in 2 phases: 6 months of capacity building (January–June 2016) followed by 2 years of implementation (July 2016–June 2018). One site created a sustainable LDCT referral program, and the other site encountered numerous barriers and failed to overcome them. This case study highlights implementation barriers and factors associated with success and improved outcomes in LDCT screening.

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