Closing the gap in health care disparities by improving the rate of lung cancer screening in an intercity hospital.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 195-195
Author(s):  
Anika Bhargava ◽  
Akshay Kohli ◽  
Irina Veytsman
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Health Care Disparities ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Post Intervention ◽  
Clinical Reminder ◽  
Time Period ◽  
Pdsa Cycle ◽  
Number Of Patients

195 Background: The National Lung Cancer Screening Trial showed reduced lung cancer mortality with low-dose computed tomography (LDCT) screening. Although LDCT is generally covered by private and government insurance, the rate of LDCT screening has been reported to be very low (2-3%) in previous studies. One of the main barriers in adequate screening was assessment of smoking history to identify eligible populations. Purpose: To increase the rate of lung cancer screening in Medstar Washington Hospital Center Internal Medicine (WHCIM) clinics from a baseline rate of 2.88% by 50% over a 3-month period. Methods: Retrospective baseline data was collected over a 2-week period 01/06/2020–01/17/2020 from patients visits at WHCIM to assess the rate of lung cancer screening. A session was held with physicians and nursing staff to find the barriers in identifying eligible patients for lung cancer screening and to create a fishbone diagram. The first plan-do-study act cycle (PDSA) was initiated from 02/24/2020–03/13/2020 where we piloted a clinical reminder in the form of a print-out filled out by the medical assistants at check in and then given to physicians. The form included the patient's age and simple smoking questionnaire according to the lung cancer screening guidelines. Data was collected during this time period which included documentation of patient’s smoking history, lung cancer screening eligibility and referral to LDCT. Results: By retrospective analysis from the time period of 01/06/2020-01/17/2020 providers documented a smoking history in only 16% of patients seen and only 2.88% of all patients seen over the age of 55 were referred for lung cancer screening. Post intervention for the time period of 02/24/2020-03/13/2020 increased the amount of documented smoking history by providers to 26% and number of patients sent for lung cancer screening to 6.0%. Of patients who met the criteria for lung cancer screening, prior to the intervention only 42% of patients were referred. However, after the clinical reminder has been initiated, 86% of patients who did meet the criteria were sent for screening. Conclusions: The clinical reminder has increased documentation of smoking history by 62% and lung cancer screening for those who meet the criteria according to the guidelines by a relative increase of 105%. We are currently working on PDSA cycle 2 to incorporate education materials in the encounter room and PDSA cycle 3 to incorporate this clinical reminder into the electronic medical record and to implement hospital wide.

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.

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.

scholarly journals Surgically treated lung cancer patients: do they all smoke and would they all have been detected with lung cancer screening?

2018 ◽  
Vol 4 (3) ◽  
pp. 00001-2018 ◽  
Author(s):  
Tanel Laisaar ◽  
Bruno Sarana ◽  
Indrek Benno ◽  
Kaja-Triin Laisaar
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Cancer Patients ◽  
Lung Cancer Screening ◽  
University Hospital ◽  
Smoking History ◽  
Inclusion Criteria ◽  
Lung Cancer Patients ◽  
Cancer Screening Trial ◽  
Lung Cancer Detection

Since publication of the National Lung Cancer Screening Trial (NLST) results early lung cancer detection has been widely studied, targeting individuals based on smoking history and age. However, over recent decades several changes in lung cancer epidemiology, including risk factors, have taken place. The aim of the current study was to explore smoking prevalence among lung cancer patients who had been treated surgically or undergone a diagnostic operation and whether these patients would have met the NLST inclusion criteria.All patients operated on for lung cancer in a university hospital in Estonia between 2009 and 2015 were included. Data were collected from hospital records.426 patients were operated on for lung cancer, with smoking history properly documented in 327 patients (87 females; median age 67 years). 170 (52%) patients were smokers, 97 (30%) patients were ex-smokers and 60 (18%) patients were nonsmokers. The proportion of females among smokers was 15%, among ex-smokers was 9% and among nonsmokers was 87%. 107 of our patients would not have met the NLST age criteria and 128 of our patients would not have met the NLST smoking criteria. In total, 183 patients (56% (79% of females and 48% of males)) would not have met the NLST inclusion criteria.Only half of surgically treated lung cancer patients were current smokers and more than half did not meet the NLST inclusion criteria.

scholarly journals Ten years of experience in lung cancer screening in Gdańsk, Poland: a comparative study of the evaluation and surgical treatment of 14 200 participants of 2 lung cancer screening programmes

2019 ◽  
Vol 29 (2) ◽  
pp. 266-274 ◽  
Author(s):  
Marcin Ostrowski ◽  
Tomasz Marjański ◽  
Robert Dziedzic ◽  
Małgorzata Jelitto-Górska ◽  
Katarzyna Dziadziuszko ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Pilot Study ◽  
Low Dose ◽  
Screening Programme ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Diagnostic Work ◽  
Low Dose Computed Tomography ◽  
Tomography Scan

Abstract OBJECTIVES The European Society of Thoracic Surgeons’ recommendations confirm the implementation of lung cancer screening in Europe. We compared 2 screening programmes, the Pilot Pomeranian Lung Cancer Screening Programme (pilot study) and the Moltest Bis programme, completed in a single centre. METHODS A total of 8649 healthy volunteers (aged 50–75 years, smoking history ≥20 pack-years) were enrolled in a pilot study between 2009 and 2011, and a total of 5534 healthy volunteers (aged 50–79, smoking history ≥30 pack-years) were enrolled in the Moltest Bis programme between 2016 and 2017. Each participant had a low-dose computed tomography scan of the chest. Participants with a nodule diameter of >10 mm or with suspected tumour morphology underwent a diagnostic work-up in the pilot study. In the Moltest Bis programme, the criteria were based on the volume of the detected nodule on the baseline low-dose computed tomography scan and the volume doubling time in the subsequent rounds. RESULTS Lung cancer was diagnosed in 107 (1.24%) and 105 (1.90%) participants of the pilot study and of the Moltest Bis programme, respectively (P = 0.002). A total of 300 (3.5%) and 199 (3.6%) patients, respectively, were referred for further invasive diagnostic work-ups (P = 0.69). A total of 125 (1.5%) and 80 (1.5%) patients, respectively, underwent surgical resection (P = 0.74). The number of resected benign lesions was similar: 44 (35.0%) and 20 (25.0%), respectively (P = 0.13), but with a downwards trend. Lobectomies and/or segmentectomies were performed in 84.0% and 90.0% of patients with lung cancer, respectively (P = 0.22). Notably, patients in the Moltest Bis programme underwent video-assisted thoracoscopic surgery more often than did those in the pilot study (72.5% vs 24.0%, P < 0.001). Surgical patients with stages I and II non-small-cell lung cancer (NSCLC) accounted for 83.4% of the Moltest patients and 86.4% of the pilot study patients (P = 0.44). CONCLUSIONS Modified inclusion criteria in the screening programme lead to a higher detection rate of NSCLC. Growing expertise in lung cancer screening leads to increased indications for minimally invasive surgery and an increased proportion of lung-sparing resections. A single-team experience in lung cancer screening does not lead to a major reduction in the rate of diagnostic procedures and operations for non-malignant lesions.

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.

Lung cancer: Improving screening in rural clinic.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e13060-e13060
Author(s):  
Thuy Thanh Thi Le ◽  
Helen Johnson-wall ◽  
Katherine Hu
Keyword(s):  
Lung Cancer ◽  
North Carolina ◽  
Cancer Screening ◽  
Chart Review ◽  
Lung Cancer Screening ◽  
The United States ◽  
Smoking History ◽  
Study Patient ◽  
Rural Clinic ◽  
Bronchus Cancer

e13060 Background: Lung cancer is the leading cause of overall cancer-related deaths in both men and women in the United States. In 2009, cancer surpassed cardiovascular disease as the leading cause of death in North Carolina. Between 2010-2014, the age-adjusted incidence rate for lung and bronchus cancers in North Carolina was 70 per 100000 persons per year. Between 2010-2014, the age-adjusted mortality rate for lung and bronchus cancers in North Carolina was 50.6 per 100000 persons per year. It is documented that about half of lung and bronchus cancer cases were diagnosed at the distant stage and about 60 percent of deaths occurred in adults ages 65-84. In 2011, 32 percent of cancer death was from lung/bronchus cancer in Robeson County. A chart review in a rural primary care clinic identified patients not being appropriately screened for targeted intervention. Methods: Our retrospective chart review at Lumberton Medical Clinic, a rural outpatient Internal Medicine Clinic, reviewed 91 records from adults aged 55 to 80 years old during the timeframe of September 2017 through August 2018. Patients with a known history of lung cancer were excluded from this study. Patient records were assessed for compliance with USPTF lung cancer screening guidelines. USPTF recommends adults aged 55 to 80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years to have an annual low-dose computed tomography of the chest to screen for lung cancer. Results: The review showed that during the timeframe studied, 42% of patients who qualified received appropriate screening, while 58% of those qualified were found to have no documentation of screening. Following data analysis, intervention to increase screening rates has been initiated. This involves provider education, posters, and individualized letters mailed to patients found deficient during the study. The success of this direct patient outreach effort will be measured over six months. Conclusions: It is the responsibility of providers to emphasize the importance of proper lung cancer screening. This retrospective review found that a large percentage (58%) of adults were not being adequately screened in our rural clinic. Direct outreach is underway to increase compliance rates in this high-risk population served by our rural clinic.

scholarly journals Likely Uptake of a Future a Lung Cancer Screening Programme in Hodgkin Lymphoma Survivors: a Questionnaire Study

2021 ◽  
Author(s):  
Rachel Broadbent ◽  
Christopher J. Armitage ◽  
Philip Crosbie ◽  
John Radford ◽  
Kim Linton
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Hodgkin Lymphoma ◽  
Multivariable Analysis ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Malignant Neoplasms ◽  
Heavy Smoking ◽  
Factors Associated ◽  
Increased Risk

Abstract Background Many Hodgkin lymphoma (HL) survivors are at increased risk of subsequent malignant neoplasms (SMN), including lung cancer, due to previous treatment for HL. Lung cancer screening (LCS) detects early-stage lung cancers in ever smokers but HL survivors without a heavy smoking history are ineligible for screening. There is a rationale to develop a targeted LCS. The aim of this study was to investigate levels of willingness to undergo LCS in HL survivors, and to identify the psycho-social factors associated with screening hesitancy. Methods A postal questionnaire was sent to 281 HL survivors registered in a long-term follow-up database and at increased risk of SMNs. Demographic, lung cancer risk factors, psycho-social and LCS belief variables were measured. Multivariable logistic regression analysis was performed to determine the factors associated with lung cancer screening hesitancy, defined as those who would ‘probably’ or ‘probably not’ participate. Results The response rate to the questionnaire was 58% (n=165). Participants were more likely to be female, older and living in a less deprived area than non-participants. Uptake (at any time) of breast and bowel cancer screening among those previously invited was 99% and 77% respectively. 159 participants were at excess risk of lung cancer. The following results refer to these 159. Around half perceived themselves to be at greater risk of lung cancer than their peers. Only 6% were eligible for lung cancer screening pilots aimed at ever smokers in the UK. 98% indicated they would probably or definitely participate in LCS were it available. Psycho-social variables associated with LCS hesitancy on multivariable analysis were male gender (OR 5.94 CI 1.64-21.44, p<0.01), living in an area with a high index of multiple deprivation (IMD) decile (deciles 6-10) (OR 8.22 CI 1.59-42.58, p<0.05) and lower levels of self-efficacy (OR 1.64 CI 1.30-2.08 p<0.01). Conclusion HL survivors responding to this survey were willing to participate in a future LCS programme but there was some hesitancy. A future LCS trial for HL survivors should consider the factors associated with screening hesitancy in in order to minimise barriers to participation.

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.

scholarly journals Benefits and Harms of Lung Cancer Screening by Chest Computed Tomography: A Systematic Review and Meta-Analysis

2021 ◽  
pp. JCO.20.02574
Author(s):  
Francesco Passiglia ◽  
Michela Cinquini ◽  
Luca Bertolaccini ◽  
Marzia Del Re ◽  
Francesco Facchinetti ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Cigarette Smoking ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Exposed Population ◽  
Related Mortality

PURPOSE This meta-analysis aims to combine and analyze randomized clinical trials comparing computed tomography lung screening (CTLS) versus either no screening (NS) or chest x-ray (CXR) in subjects with cigarette smoking history, to provide a precise and reliable estimation of the benefits and harms associated with CTLS. MATERIALS AND METHODS Data from all published randomized trials comparing CTLS versus either NS or CXR in a highly tobacco-exposed population were collected, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Subgroup analyses by comparator (NS or CXR) were performed. Pooled risk ratio (RR) and relative 95% CIs were calculated for dichotomous outcomes. The certainty of the evidence was assessed using the GRADE approach. RESULTS Nine eligible trials (88,497 patients) were included. Pooled analysis showed that CTLS is associated with: a significant reduction of lung cancer–related mortality (overall RR, 0.87; 95% CI, 0.78 to 0.98; NS RR, 0.80; 95% CI, 0.69 to 0.92); a significant increase of early-stage tumors diagnosis (overall RR, 2.84; 95% CI 1.76 to 4.58; NS RR, 3.33; 95% CI, 2.27 to 4.89; CXR RR, 1.52; 95% CI, 1.04 to 2.23); a significant decrease of late-stage tumors diagnosis (overall RR, 0.75; 95% CI, 0.68 to 0.83; NS RR, 0.67; 95% CI, 0.56 to 0.80); a significant increase of resectability rate (NS RR, 2.57; 95% CI, 1.76 to 3.74); a nonsignificant reduction of all-cause mortality (overall RR, 0.99; 95% CI, 0.94 to 1.05); and a significant increase of overdiagnosis rate (NS, 38%; 95% CI, 14 to 63). The analysis of lung cancer–related mortality by sex revealed nonsignificant differences between men and women ( P = .21; I-squared = 33.6%). CONCLUSION Despite there still being uncertainty about overdiagnosis estimate, this meta-analysis suggested that the CTLS benefits outweigh harms, in subjects with cigarette smoking history, ultimately supporting the systematic implementation of lung cancer screening worldwide.

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