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.

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.

scholarly journals Lung Cancer Screening in Patients with COPD—A Case Report

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 364
Author(s):  
Roxana Amirahmadi ◽  
Avnee J. Kumar ◽  
Mark Cowan ◽  
Janaki Deepak M.B.B.S.
Keyword(s):  
Lung Cancer ◽  
Case Report ◽  
Cancer Screening ◽  
Lung Cancer Screening ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
Poor Functional Status ◽  
The Impact

We present two cases demonstrating the nuances that must be considered when determining if a patient could benefit from low dose computed tomography (LDCT) lung cancer screening. Our case report discusses the available literature, where it exists, on lung cancer screening with special attention to the impact of chronic obstructive pulmonary disease (COPD), and poor functional status. Patients with COPD and concurrent smoking history are at higher risk of lung cancer and may therefore benefit from lung cancer screening. However, this population is at increased risk for complications related to biopsies and lobar resections. Appropriate interventions other than surgical resection exist for COPD patients with poor pulmonary reserve. Risks and benefits of lung cancer screening are unique to each patient and require shared decision-making.

LOW-DOSE COMPUTED TOMOGRAPHY IN MOSCOW FOR LUNG CANCER SCREENING (LDCT-MLCS): BASELINE RESULTS

2019 ◽  
Vol 65 (2) ◽  
pp. 224-233
Author(s):  
Sergey Morozov ◽  
Viktor Gombolevskiy ◽  
Anton Vladzimirskiy ◽  
Albina Laypan ◽  
Pavel Kononets ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Early Stage ◽  
Lung Cancer Screening ◽  
Stage I ◽  
Malignant Neoplasms ◽  
Number Needed To Screen ◽  
Low Dose Computed Tomography

Study aim. To justify selective lung cancer screening via low-dose computed tomography and evaluate its effectiveness. Materials and methods. In 2017 we have concluded the baseline stage of “Lowdose computed tomography in Moscow for lung cancer screening (LDCT-MLCS)” trial. The trial included 10 outpatient clinics with 64-detector CT units (Toshiba Aquilion 64 and Toshiba CLX). Special low-dose protocols have been developed for each unit with maximum effective dose of 1 mSv (in accordance with the requirements of paragraph 2.2.1, Sanitary Regulations 2.6.1.1192-03). The study involved 5,310 patients (53% men, 47% women) aged 18-92 years (mean age 62 years). Diagnosis verification was carried out in the specialized medical organizations via consultations, additional instrumental, laboratory as well as pathohistological studies. The results were then entered into the “National Cancer Registry”. Results. 5310 patients (53% men, 47% women) aged 18 to 92 years (an average of 62 years) participated in the LDCT-MLCS. The final cohort was comprised of 4762 (89.6%) patients. We have detected 291 (6.1%) Lung-RADS 3 lesions, 228 (4.8%) Lung- RADS 4A lesions and 196 (4.1%) Lung-RADS 4B/4X lesions. All 4B and 4X lesions were routed in accordance with the project's methodology and legislative documents. Malignant neoplasms were verified in 84 cases (1.76% of the cohort). Stage I-II lung cancer was actively detected in 40.3% of these individuals. For the first time in the Russian Federation we have calculated the number needed to screen (NNS) to identify one lung cancer (NNS=57) and to detect one Stage I lung cancer (NNS=207). Conclusions. Based on the global experience and our own practices, we argue that selective LDCT is the most systematic solution to the problem of early-stage lung cancer screening.

scholarly journals Implementation of Shared Decision Making for Lung Cancer Screening Among the Privately Insured Nonelderly

2021 ◽  
Vol 6 (1) ◽  
pp. 238146832098477
Author(s):  
Ya-Chen Tina Shih ◽  
Ying Xu ◽  
Lisa M. Lowenstein ◽  
Robert J. Volk
Keyword(s):  
Lung Cancer ◽  
Decision Making ◽  
Cancer Screening ◽  
Shared Decision Making ◽  
Private Insurance ◽  
Lung Cancer Screening ◽  
Shared Decision ◽  
Factors Associated ◽  
Coverage Policy ◽  
Privately Insured

Introduction. The Centers for Medicare & Medicaid Services requires a written order of shared decision making (SDM) visit in its coverage policy for low-dose computed tomography (LDCT) for lung cancer screening (LCS). With screening eligibility starting at age 55, private insurance plans will likely adopt this coverage policy. This study examined the implementation of SDM in the context of LCS among the privately insured. Methods. We constructed two study cohorts from MarketScan Commercial Claims and Encounters database 2016-2017: a LDCT cohort who received LDCT for LCS and an SDM cohort who had an LCS-related SDM visit. For the LDCT cohort, we examined the trend and factors associated with the receipt of SDM within 3 months prior to LDCT. For the SDM cohort, we studied the trend and factors associated with LDCT within 3 months after an SDM visit. Results. For privately insured adults aged <64, 93% (19,681/21,084) of the LDCT cohort did not have a billing claim indicating SDM, although the uptake of SDM increased from 3.1% in 1Q2016 to 8.2% in 4Q2017 ( P < 0.0001). For the SDM cohort, 46% (948/2048) did not have a claim for an LDCT for lung cancer screening in the 3 months after the SDM visit; this percentage increased from 29.5% in 1Q2016 to 61.8% in 3Q2017 ( P < 0.0001). Limitations. Findings cannot be generalized to other nonelderly adults without private insurance. Additionally, the rate of SDM identified from claims may be underreported. Conclusions. We found a growing but low uptake of SDM among privately insured individuals who underwent LDCT. The higher rate of LDCT in the SDM cohort than the rate reported in national studies emphasized the importance of patient awareness.

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.

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