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.

Improving lung cancer screening in the HIV population.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 69-69
Author(s):  
Jose Nahun Galeas ◽  
Robert M. Grossberg ◽  
Maria Serrano ◽  
Anna Shmukler ◽  
Susan Sakalian ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Quality Improvement Initiative ◽  
Total N ◽  
Pareto Chart ◽  
Increased Risk ◽  
Lung Cancer Screening Program

69 Background: Lung cancer screening for high risk populations has a major impact in reducing mortality.In our population, HIV patients are younger (mean age 68.0 vs 56.8, p= 0.014) and have a higher percentage of advanced disease at diagnosis (49% vs 68%, p< 0.001),when compared to non-HIV lung cancer patients.Due to this increased risk and aggressiveness, we embarked on a quality improvement initiative to increase screening in our HIV smoking population. Methods: Data was collected retrospectively from 10/18 to 1/19 in the HIV clinic. A multidisciplinary team was created involving thoracic oncologists, radiologists and HIV physicians to discuss methods to improve screening. We identified areas to be improved and utilized performance improvement tools such as a Pareto chart and PICK chart. Data was then collected prospectively. Results: In the initial 4 month period,among HIV positive patients 55–77 years old with significant smoking history, 13% (total n=54) of patients had a chest CT done for lung cancer screening and only 3.7% were referred for lung cancer screening during that specific period. Main barriers were lack of proper identification of screening candidates, discrepancies in smoking history within the EMR and lack of a consistent system for referral. An algorithm was created in the referral workflow, in which providers would need only to identify patients in the age group of 55-77 years old with any history of smoking and refer to a lung cancer screening program. The screening program would contact the patient and screen as per CMS guidelines. 17 Patients were referred from the HIV clinic from 4/8/19 to 5/2/19. Of these patients, 29% had a lung cancer screening CT scan done or scheduled, 18% of patients did not qualify for screening,and the remaining 53% of referrals are pending to be screened by telephone call. Further data on subsequent PDSAs and results of screening scans will be presented at the meeting. Conclusions: Modifying the screening algorithm for lung cancer in our HIV clinic by adding support from a dedicated screening program increased screening rates by 25% in the first month of intervention. Subsequent interventions include: patient education to reduce the stigma of lung cancer and EMR alerts when a patient meets criteria for screening.

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.

Implementing physician education to increase lung cancer screening compliance.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18282-e18282
Author(s):  
Coral Olazagasti ◽  
Devi Sampat ◽  
Adam Rothman ◽  
Nagashree Seetharamu ◽  
David Steiger
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Lung Cancer Screening ◽  
Physician Education ◽  
Smoking History ◽  
Post Intervention ◽  
Screening Criteria ◽  
Screening Guidelines ◽  
Internal Medicine Clinic

e18282 Background: Lung cancer is the leading cause of cancer-related deaths worldwide. The USPSTF recommends annual low-dose CT chest (LDCT) for lung cancer screening in adults who meet the appropriate criteria: age 55-80, current smokers or former smokers who quit within 15years, with a 30 pack-year smoking history. Even with these recommendations, screening rates in these patients remain low. We created a study to assess compliance in an outpatient Internal Medicine clinic to assess the barriers for obtaining LDCT. We hypothesized that by providing an educational program, overall compliance would increase. Methods: The study was divided in two arms: a pre-intervention arm and a post-intervention assessment. Initially, 35 physicians completed a questionnaire on their attitudes to LDCT screening and their reasons for not screening high risk patients. We created a lung cancer screening education program, which consisted of lectures provided to physicians. Following the lectures, consecutive patient visits were reviewed to assess compliance with screening. Results: In the first arm, 678 visits were reviewed. 115 patients met USPSTF criteria of whom only 26% underwent screening with LDCT. The most common reasons for not ordering LDCT scans in patients meeting criteria included: poor knowledge of criteria (22%), failure to determine if patients qualified (13%), patient refusal (8%). Following the education, 208 patients out of the 955 visits reviewed met USPSTF criteria, of which 78% underwent LDCT. Our study showed how after education, physicians were ten times more likely to screen patients for lung cancer (Odds ratio 9.98, 95% CI 5.87-16.94, p < 0.0001). Conclusions: We confirmed there was suboptimal adherence to established LDCT lung cancer screening guidelines, mainly due to unfamiliarity with the screening criteria. By providing educational lectures, compliance improved significantly. We concluded that educating physicians about lung cancer screening guidelines increased LDCT screening tenfold, and therefore benefit patients that are at high risk for developing lung cancer.

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.

Assessing information available for health professionals and potential participants on lung cancer screening program websites: a cross-sectional study (Preprint)

2021 ◽  
Author(s):  
Rachael Dodd ◽  
Chenyue Zhang ◽  
Ashleigh Rebecca Sharman ◽  
Julie Carlton ◽  
Ruijin Tang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Health Professionals ◽  
Assessment Tool ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Eligibility Criteria ◽  
Cancer Screening Program ◽  
Lung Cancer Screening Program

BACKGROUND Lung cancer is the number one cause of cancer death worldwide. The US Preventive Services Task Force (USPSTF) updated recommendations for lung cancer screening in 2021, adjusting the age of screening to 50 years (from 55 years), and reducing the number of pack-years total firsthand cigarette smoke exposure to 20 (down from 30). With many individuals using the internet for healthcare information, it is important to understand what information is available for individuals contemplating lung cancer screening. OBJECTIVE To assess the eligibility criteria and information available on lung cancer screening program websites for both health professionals and potential screeners. METHODS A descriptive cross-sectional analysis in March 2021 of 151 lung cancer screening program websites of academic (n=76) and community medical centers (n=75) in the United States for data related to information for health professionals and potential screeners was conducted. Presentation of eligibility criteria for potential participants and presence of information available specific to the health professionals about lung cancer screening, were the primary outcomes. Secondary outcomes included presentation of information about cost, smoking cessation, and inclusion of an online risk assessment tool, any clinical guidelines and multimedia used to present information. RESULTS Eligibility criteria is included in nearly all websites, with age range (92.1%) and smoking history (93.4%) included. Age was only consistent with the latest recommendations in 14.5% of the websites and no websites had updated smoking history. Half the websites mention screening costs as related to the type of insurance held. About one in six (15%) featured an online assessment tool to determine eligibility. A similar proportion (15%) hosted information specifically for health professionals. About a third (29%) of websites referred to smoking cessation. Almost a third of websites (30.5%) used multimedia to present information, such as short videos or podcasts. CONCLUSIONS Most US websites of lung cancer screening programs provide information about eligibility criteria, but this is not consistent and has not been updated across all websites following the latest USPSTF recommendations. Online resources require updating to present standardized information that is accessible for all.

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.

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.

scholarly journals Lung cancer screening by low-dose CT among asbestos-exposed workers: first results of a pilot program

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Heidrich ◽  
C Wolff ◽  
A Centmayer ◽  
T Wiethege ◽  
M Duell ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Ct Scans ◽  
Pilot Program ◽  
Detection Rates ◽  
German Regions ◽  
First Results

Abstract Background Occupational asbestos exposure (OAE) is a risk factor for lung cancer (LC) and can cause malignant diseases decades after exposure. Lung cancer screening with low-dose computed tomography (LCS) in heavy smokers has shown LC-mortality reductions in two large trials. Recent guidelines advocate LCS in high-risk populations with OAE and additional smoking history. Methods A structured pilot program on LCS in three German regions has been implemented from 2014 to 2018. Eligibility criteria are: OAE ≥10 years starting before 1985 or diagnosis of OAE-related lung disease other than cancer, age ≥55 years and smoking history ≥30 pack years. Eligible persons are centrally invited for LCS on a voluntary basis in 12 months intervals. All persons willing to participate receive obligatory physician counselling before LCS. CT scans are performed according to a standardized protocol. The program provides technical quality assurance as well as independent double reading of all suspicious findings and of a random sample of all CT scans. Results Of 2715 and 1534 persons invited to first and second LCS, 1571 (57.9%) and 715 (46.6%) agreed to participate, respectively. Main reason for disagreement was principal refusal of LCS (15.5% in first and 22.2% in second LCS), whereas 8.5% and 6.9%, respectively, refused after counselling. Additionally, 12.9% and 5.7% did not respond at all. Effectively, 68.8% and 70.6% of those who initially agreed, received first and second LCS, respectively. Variations between regions were observed (range 61.0% to 79.8%). First preliminary outcome assessment shows detection rates of 0.019 and 0.011 in first and second LCS, respectively. Conclusions A substantial group of eligible persons with OAE participated in LCS after physician counselling. Participation remained stable over two screening rounds. First results show detection of LC in the expected range. The effectiveness of early detection of LC in OAE needs to be evaluated further. Key messages Participation over the first two screening rounds in structured lung cancer screening remained stable among eligible persons with OAE and smoking history who were counselled by physicians. Detection of lung cancer in a structured pilot screening program in three German regions seems to be within the range to be expected from previous research.

Implementation and outcomes of lung cancer screening in a community health care system.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13035-e13035
Author(s):  
Vita McCabe ◽  
Ruth Raleigh ◽  
Alice Pichan ◽  
Beth Irene Lavasseur ◽  
Rajeev Swarup ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Screening Program ◽  
Lung Cancer Screening ◽  
Small Cell ◽  
Smoking History ◽  
Community Health Care ◽  
Cancer Screening Program ◽  
Lung Cancer Screening Program ◽  
Community Health Care System

e13035 Background: Lung cancer screening using low dose computed tomography (LDCT) in patients meeting criteria is a covered preventative service under the Affordable Care Act and policies of CMS. The purpose of this study is to describe implementation and results of a lung cancer screening program in a community health care system. Methods: We prospectively collected data on all patients obtaining a baseline LDCT scan who enrolled beginning February 2015. Referring provider, smoking history, demographics, comorbidity, findings, and, in those found to have an abnormality, diagnosis were collected. The study was reviewed by the St Joseph Mercy Health System Institutional Review Board and was considered exempt. Results: Over the course of 18 months, 955 patients were referred for a baseline LDCT. 57% were current smokers, 53% were male, and 38% had no comorbid conditions. The mean number of pack-years was 50 (range 6 to 160). 76% of patients were referred by primary care providers. The number of new patients referred per month increased from 8 to 89, largely due to outreach and education directed at primary care physicians and office staff. Of the 955 patients screened, we identified cancer in 2% overall (small cell cancer in 0.2% patients and non-small cell lung cancer (NSCLC) in 1.6%). Among those with NSCLC, 60% had Stage I disease, 20% had Stage II, 13% had Stage III, and 7% had Stage IV disease. Compared to the stage distribution of lung cancer patients identified before the implementation of the screening program, there was significant down-staging in those with NSCLC. Barriers to implementation have included lack of clear smoking history documentation and billing code release delays which led to reimbursement difficulties. Conclusions: Successful implementation of a LDCT lung cancer screening program in a community setting. Improving patient/provider education and documentation of tobacco use in electronic medical records will streamline the referral process and increase screening among eligible patients. Outreach to practices that serve minority and other medically-underserved populations will require specific efforts to achieve health equity in the area of lung cancer screening.

Sign in / Sign up

Export Citation Format

Share Document