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Kearney L, Nguyen T, Steiling K. Disparities across the continuum of lung cancer care: a review of recent literature. Curr Opin Pulm Med 2024; 30:359-367. [PMID: 38411202 DOI: 10.1097/mcp.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
PURPOSE OF REVIEW Lung cancer remains the leading cause of cancer mortality worldwide. Health disparities have long been noted in lung cancer incidence and survival and persist across the continuum of care. Understanding the gaps in care that arise from disparities in lung cancer risk, screening, treatment, and survivorship are essential to guiding efforts to achieve equitable care. RECENT FINDINGS Recent literature continues to show that Black people, women, and people who experience socioeconomic disadvantage or live in rural areas experience disparities throughout the spectrum of lung cancer care. Contributing factors include structural racism, lower education level and health literacy, insurance type, healthcare facility accessibility, inhaled carcinogen exposure, and unmet social needs. Promising strategies to improve lung cancer care equity include policy to reduce exposure to tobacco smoke and harmful pollutants, more inclusive lung cancer screening eligibility criteria, improved access and patient navigation in lung cancer screening, diagnosis and treatment, more deliberate offering of appropriate surgical and medical treatments, and improved availability of survivorship and palliative care. SUMMARY Given ongoing disparities in lung cancer care, research to determine best practices for narrowing these gaps and to guide policy change are an essential focus of future lung cancer research.
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Affiliation(s)
- Lauren Kearney
- Section of Pulmonary, Allergy, and Critical Care Medicine. Boston University Chobanian and Avedisian School of Medicine
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System
| | - Tatyana Nguyen
- Department of Medicine. Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Katrina Steiling
- Section of Pulmonary, Allergy, and Critical Care Medicine. Boston University Chobanian and Avedisian School of Medicine
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Zhu L, Liu J, Zeng L, Moonindranath S, An P, Chen H, Xiang Q, Wang Z. Thoracic high resolution computed tomography evaluation of imaging abnormalities of 108 lung cancer patients with different pulmonary function. Cancer Imaging 2024; 24:78. [PMID: 38910260 PMCID: PMC11194896 DOI: 10.1186/s40644-024-00720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 06/10/2024] [Indexed: 06/25/2024] Open
Abstract
PURPOSE Preserved ratio impaired spirometry (PRISm) and chronic obstructive pulmonary disease (COPD) belong to lung function injury. PRISm is a precursor to COPD. We compared and evaluated the different basic information, imaging findings and survival curves of 108 lung cancer patients with different pulmonary function based on high resolution computed tomography (HRCT). METHODS This retrospective study was performed on 108 lung cancer patients who did pulmonary function test (PFT) and thoracic HRCT. The basic information was evaluated: gender, age, body mass index (BMI), smoke, smoking index (SI). The following pulmonary function findings were evaluated: forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio. The following computed tomography (CT) findings were evaluated: appearance (bronchiectasis, pneumonectasis, atelectasis, ground-glass opacities [GGO], interstitial inflammation, thickened bronchial wall), diameter (aortic diameter, pulmonary artery diameter, MPAD/AD ratio, inferior vena cava diameter [IVCD]), tumor (volume, classification, distribution, staging [I, II, III, IV]). Mortality rates were calculated and survival curves were estimated using the Kaplan-Meier method. RESULTS Compared with normal pulmonary function group, PRISm group and COPD group were predominantly male, older, smoked more, poorer lung function and had shorter survival time after diagnosis. There were more abnormal images in PRISm group and COPD group than in normal lung function group (N-C group). In PRISm group and COPD group, lung cancer was found late, and the tumor volume was larger, mainly central squamous carcinoma. But the opposite was true for the N-C group. The PRISm group and COPD group had significant poor survival probability compared with the normal lung function group. CONCLUSIONS Considerable differences regarding basic information, pulmonary function, imaging findings and survival curves are found between normal lung function group and lung function injury group. Lung function injury (PRISm and COPD) should be taken into account in future lung cancer screening studies.
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Affiliation(s)
- Li Zhu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, China
| | - Jiali Liu
- School of Public Health, Southeast University, No. 2 Sipai Lou, Nanjing, 210096, China
| | - Liang Zeng
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, China
| | | | - Peng An
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, China
| | - Hu Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, China
| | - Quanyong Xiang
- School of Public Health, Southeast University, No. 2 Sipai Lou, Nanjing, 210096, China.
- Department of Chronic Non-communicable Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Nanjing, 210009, China.
| | - Zhongqiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, China.
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Pegues JN, Isenberg EE, Fendrick AM. The Cost to Breathe: Eliminating Cost Sharing Associated with Lung Cancer Screening. Ann Am Thorac Soc 2024; 21:849-851. [PMID: 38578799 PMCID: PMC11160123 DOI: 10.1513/annalsats.202401-064vp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/04/2024] [Indexed: 04/07/2024] Open
Affiliation(s)
- J’undra N. Pegues
- Department of Cardiac Surgery
- Department of General Surgery, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Erin E. Isenberg
- Department of Surgery, and
- National Clinician Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Triplette M, Kross EK, Snidarich M, Shahrir S, Hippe DS, Crothers K. An alternating-intervention pilot trial on the impact of an informational handout on patient-reported outcomes and follow-up after lung cancer screening. PLoS One 2024; 19:e0300352. [PMID: 38598511 PMCID: PMC11006146 DOI: 10.1371/journal.pone.0300352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 02/20/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Lung cancer screening (LCS) can reduce lung cancer mortality; however, poor understanding of results may impact patient experience and follow-up. We sought to determine whether an informational handout accompanying LCS results can improve patient-reported outcomes and adherence to follow-up. STUDY DESIGN This was a prospective alternating intervention pilot trial of a handout to accompany LCS results delivery. SETTING/PARTICIPANTS Patients undergoing LCS in a multisite program over a 6-month period received a mailing containing either: 1) a standardized form letter of LCS results (control) or 2) the LCS results letter and the handout (intervention). INTERVENTION A two-sided informational handout on commonly asked questions after LCS created through iterative mixed-methods evaluation with both LCS patients and providers. OUTCOME MEASURES The primary outcomes of 1)patient understanding of LCS results, 2)correct identification of next steps in screening, and 3)patient distress were measured through survey. Adherence to recommended follow-up after LCS was determined through chart review. Outcomes were compared between the intervention and control group using generalized estimating equations. RESULTS 389 patients were eligible and enrolled with survey responses from 230 participants (59% response rate). We found no differences in understanding of results, identification of next steps in follow-up or distress but did find higher levels of knowledge and understanding on questions assessing individual components of LCS in the intervention group. Follow-up adherence was overall similar between the two arms, though was higher in the intervention group among those with positive findings (p = 0.007). CONCLUSIONS There were no differences in self-reported outcomes between the groups or overall follow-up adherence. Those receiving the intervention did report greater understanding and knowledge of key LCS components, and those with positive results had a higher rate of follow-up. This may represent a feasible component of a multi-level intervention to address knowledge and follow-up for LCS. TRIAL REGISTRATION ClinicalTrials.gov NCT05265897.
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Affiliation(s)
- Matthew Triplette
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Erin K. Kross
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA, United States of America
| | - Madison Snidarich
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Shahida Shahrir
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Daniel S. Hippe
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Kristina Crothers
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States of America
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Slatore CG, Hooker ER, Shull S, Golden SE, Melzer AC. Association of patient and health care organization factors with incidental nodule guidelines adherence: A multi-system observational study. Lung Cancer 2024; 190:107526. [PMID: 38452601 PMCID: PMC10999337 DOI: 10.1016/j.lungcan.2024.107526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/01/2024] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Health care organizations are increasingly developing systems to ensure patients with pulmonary nodules receive guideline-adherent care. Our goal was to determine patient and organization factors that are associated with radiologist adherence as well as clinician and patient concordance to 2005 Fleischner Society guidelines for incidental pulmonary nodule follow-up. MATERIALS Trained researchers abstracted data from the electronic health record from two Veterans Affairs health care systems for patients with incidental pulmonary nodules as identified by interpreting radiologists from 2008 to 2016. METHODS We classified radiology reports and patient follow-up into two categories. Radiologist-Fleischner Adherence was the agreement between the radiologist's recommendation in the computed tomography report and the 2005 Fleischner Society guidelines. Clinician/Patient-Fleischner Concordance was agreement between patient follow-up and the guidelines. We calculated multivariable-adjusted predicted probabilities for factors associated with Radiologist-Fleischner Adherence and Clinician/Patient-Fleischner Concordance. RESULTS Among 3150 patients, 69% of radiologist recommendations were adherent to 2005 Fleischner guidelines, 4% were more aggressive, and 27% recommended less aggressive follow-up. Overall, only 48% of patients underwent follow-up concordant with 2005 Fleischner Society guidelines, 37% had less aggressive follow-up, and 15% had more aggressive follow-up. Radiologist-Fleischner Adherence was associated with Clinician/Patient-Fleischner Concordance with evidence for effect modification by health care system. CONCLUSION Clinicians and patients seem to follow radiologists' recommendations but often do not obtain concordant follow-up, likely due to downstream differential processes in each health care system. Health care organizations need to develop comprehensive and rigorous tools to ensure high levels of appropriate follow-up for patients with pulmonary nodules.
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Affiliation(s)
- Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA; Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA; Division of Pulmonary & Critical Care Medicine, Department of Medicine, and Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Elizabeth R Hooker
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA
| | - Sarah Shull
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA
| | - Anne C Melzer
- Section of Pulmonary & Critical Care Medicine, VA Minneapolis Health Care System, 1 Veterans Dr, Minneapolis, MN 55417, USA
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Sadeghi JK, Reza JA, Miller C, Cooke DT, Erkmen C. Death by a thousand delays. JTCVS OPEN 2024; 18:353-359. [PMID: 38690410 PMCID: PMC11056460 DOI: 10.1016/j.xjon.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/25/2023] [Accepted: 12/04/2023] [Indexed: 05/02/2024]
Affiliation(s)
- John K. Sadeghi
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pa
| | - Joseph A. Reza
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pa
| | - Claire Miller
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pa
| | - David T. Cooke
- Division of General Thoracic Surgery, University of California, Davis, Davis, Calif
| | - Cherie Erkmen
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pa
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Kearney L, Bolton RE, Núñez ER, Boudreau JH, Sliwinski S, Herbst AN, Caverly TJ, Wiener RS. Tackling Guideline Non-concordance: Primary Care Barriers to Incorporating Life Expectancy into Lung Cancer Screening Decision-Making-A Qualitative Study. J Gen Intern Med 2024:10.1007/s11606-024-08705-x. [PMID: 38459413 DOI: 10.1007/s11606-024-08705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Primary care providers (PCPs) are often the first point of contact for discussing lung cancer screening (LCS) with patients. While guidelines recommend against screening people with limited life expectancy (LLE) who are less likely to benefit, these patients are regularly referred for LCS. OBJECTIVE We sought to understand barriers PCPs face to incorporating life expectancy into LCS decision-making for patients who otherwise meet eligibility criteria, and how a hypothetical point-of-care tool could support patient selection. DESIGN Qualitative study based on semi-structured telephone interviews. PARTICIPANTS Thirty-one PCPs who refer patients for LCS, from six Veterans Health Administration facilities. APPROACH We thematically analyzed interviews to understand how PCPs incorporated life expectancy into LCS decision-making and PCPs' receptivity to a point-of-care tool to support patient selection. Final themes were organized according to the Cabana et al. framework Why Don't Physicians Follow Clinical Practice Guidelines, capturing the influence of clinician knowledge, attitudes, and behavior on LCS appropriateness determinations. KEY RESULTS PCP referrals to LCS for patients with LLE were influenced by limited knowledge of the life expectancy threshold at which patients are less likely to benefit from LCS, discomfort estimating life expectancy, fear of missing cancer at the point of early detection, and prioritization of factors such as quality of life, patient values, clinician-patient relationship, and family support. PCPs were receptive to a decision support tool to inform and communicate LCS appropriateness decisions if easy to use and integrated into clinical workflows. CONCLUSIONS Our study suggests knowledge gaps and attitudes may drive decisions to offer screening despite LLE, a behavior counter to guideline recommendations. Integrating a LCS decision support tool that incorporates life expectancy within the electronic medical record and existing clinical workflows may be one acceptable solution to improve guideline concordance and increase confidence in selecting high benefit patients for LCS.
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Affiliation(s)
- Lauren Kearney
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA.
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
| | - Rendelle E Bolton
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Eduardo R Núñez
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | - Jacqueline H Boudreau
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
| | - Samantha Sliwinski
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
| | - Abigail N Herbst
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
| | - Tanner J Caverly
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA
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Adams SJ, Flores EJ, Little BP, Sharma A, Lennes IT, Shepard JAO, Fintelmann FJ. RadioGraphics Update: The 10 Pillars of Lung Cancer Screening-Rationale and Logistics of a Lung Cancer Screening Program. Radiographics 2024; 44:e230057. [PMID: 38329900 PMCID: PMC10878164 DOI: 10.1148/rg.230057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
Editor's Note.-RadioGraphics Update articles supplement or update information found in full-length articles previously published in RadioGraphics. These updates, written by at least one author of the previous article, provide a brief synopsis that emphasizes important new information such as technological advances, revised imaging protocols, new clinical guidelines involving imaging, or updated classification schemes.
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Affiliation(s)
- Scott J Adams
- From the Departments of Radiology (S.J.A., E.J.F., A.S., J.O.S., F.J.F.) and Medicine (I.T.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02111; and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
| | - Efren J Flores
- From the Departments of Radiology (S.J.A., E.J.F., A.S., J.O.S., F.J.F.) and Medicine (I.T.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02111; and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
| | - Brent P Little
- From the Departments of Radiology (S.J.A., E.J.F., A.S., J.O.S., F.J.F.) and Medicine (I.T.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02111; and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
| | - Amita Sharma
- From the Departments of Radiology (S.J.A., E.J.F., A.S., J.O.S., F.J.F.) and Medicine (I.T.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02111; and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
| | - Inga T Lennes
- From the Departments of Radiology (S.J.A., E.J.F., A.S., J.O.S., F.J.F.) and Medicine (I.T.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02111; and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
| | - Jo-Anne O Shepard
- From the Departments of Radiology (S.J.A., E.J.F., A.S., J.O.S., F.J.F.) and Medicine (I.T.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02111; and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
| | - Florian J Fintelmann
- From the Departments of Radiology (S.J.A., E.J.F., A.S., J.O.S., F.J.F.) and Medicine (I.T.L.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02111; and Department of Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.P.L.)
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Núñez ER, Zhang S, Glickman ME, Qian SX, Boudreau JH, Lindenauer PK, Slatore CG, Miller DR, Caverly TJ, Wiener RS. What Goes into Patient Selection for Lung Cancer Screening? Factors Associated with Clinician Judgments of Suitability for Screening. Am J Respir Crit Care Med 2024; 209:197-205. [PMID: 37819144 PMCID: PMC10806423 DOI: 10.1164/rccm.202301-0155oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023] Open
Abstract
Rationale: Achieving the net benefit of lung cancer screening (LCS) depends on optimizing patient selection. Objective: To identify factors associated with clinician assessments that a patient was unlikely to benefit from LCS ("LCS-inappropriate") because of comorbidities or limited life expectancy. Methods: Retrospective analysis of patients assessed for LCS at 30 Veterans Health Administration facilities from January 1, 2015 to February 1, 2021. We conducted hierarchical mixed-effects logistic regression analyses to determine factors associated with clinicians' designations of LCS inappropriateness (primary outcome), accounting for 3-year predicted probability (i.e., competing risk) of non-lung cancer death. Measurements and Main Results: Among 38,487 LCS-eligible patients, 1,671 (4.3%) were deemed LCS-inappropriate by clinicians, whereas 4,383 (11.4%) had an estimated 3-year competing risk of non-lung cancer death greater than 20%. Patients with higher competing risks of non-lung cancer death were more likely to be deemed LCS-inappropriate (odds ratio [OR], 2.66; 95% confidence interval [CI], 2.32-3.05). Older patients (ages 75-80; OR, 1.45; 95% CI, 1.18-1.78) and those with interstitial lung disease (OR, 1.98; 95% CI, 1.51-2.59) were more likely to be deemed LCS-inappropriate than would be explained by competing risk of non-lung cancer death, whereas patients currently smoking (OR, 0.65; 95% CI, 0.58-0.73) were less likely to be deemed LCS-inappropriate, suggesting that clinicians over- or underweighted these factors. The probability of being deemed LCS-inappropriate varied from 0.4% to 74%, depending on the clinician making the assessment (median OR, 3.07; 95% CI, 2.89-3.25). Conclusion: Concerningly, the likelihood that a patient is deemed LCS-inappropriate is more strongly associated with the clinician making the assessment than with patient characteristics. Patient selection may be optimized by providing decision support to help clinicians assess net LCS benefit.
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Affiliation(s)
- Eduardo R. Núñez
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- The Pulmonary Center, School of Medicine, Boston University, Boston, Massachusetts
- Department of Healthcare Delivery and Population Sciences, Chan Medical School-Baystate, University of Massachusetts, Springfield, Massachusetts
| | - Sanqian Zhang
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Mark E. Glickman
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Shirley X. Qian
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Jacqueline H. Boudreau
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences, Chan Medical School-Baystate, University of Massachusetts, Springfield, Massachusetts
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland Oregon
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon
| | - Donald R. Miller
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Massachusetts
| | - Tanner J. Caverly
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan; and
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- The Pulmonary Center, School of Medicine, Boston University, Boston, Massachusetts
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
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Lee G, Hill LP, Schroeder MC, Kraus SJ, El-Abiad KMB, Hoffman RM. Adherence to Annual Lung Cancer Screening in a Centralized Academic Program. Clin Lung Cancer 2024; 25:e18-e25. [PMID: 37925362 DOI: 10.1016/j.cllc.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/23/2023] [Accepted: 10/09/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Adherence to lung cancer screening (LCS) protocols is critical for achieving mortality reductions. However, adherence rates, particularly for recommended annual screening among patients with low-risk findings, are often sub-optimal. We evaluated annual LCS adherence for patients with low-risk findings participating in a centralized screening program at a tertiary academic center. PATIENTS AND METHODS We conducted a retrospective, observational cohort study of a centralized lung cancer screening program launched in July 2018. We performed electronic medical review of 337 patients who underwent low-dose CT (LDCT) screening before February 1, 2021 (to ensure ≥ 15 months follow up) and had a low-risk Lung-RADS score of 1 or 2. Captured data included patient characteristics (smoking history, Fagerstrom score, environmental exposures, lung cancer risk score), LDCT imaging dates, and Lung-RADS results. The primary outcome measure was adherence to annual screening. We used multivariable logistic regression models to identify factors associated with adherence. RESULTS Overall, 337 patients had an initial Lung-RADS result of 1 (n = 189) or 2 (n = 148). Among this cohort, 139 (73.5%) of Lung-RADS 1 and 111 (75.0%) of Lung-RADS 2 patients completed the annual repeat LDCT within 15 months, respectively. The only patient characteristic associated with adherence was having Medicaid coverage; compared to having private insurance, Medicaid patients were less adherent (adjusted OR = 0.37, 95% CI = 0.15-0.92). No other patient characteristic was associated with adherence. CONCLUSION Our centralized screening program achieved a high initial annual adherence rate. Although LCS has first-dollar insurance coverage, other socioeconomic concerns may present barriers to annual screening for Medicaid recipients.
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Affiliation(s)
- Grace Lee
- University of Iowa Carver College of Medicine, Iowa City, IA.
| | - Laura P Hill
- Internal Medicine Primary Care, Mercy Hospital, St. Louis, MO
| | - Mary C Schroeder
- Division of Health Services Research, University of Iowa College of Pharmacy, Iowa City, IA
| | - Sara J Kraus
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - Richard M Hoffman
- Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, IA; Holden Comprehensive Cancer Center, University of Iowa Carver College of Medicine, Iowa City, IA
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Thakore NL, Russo R, Hang T, Moore WH, Chen Y, Kang SK. Evaluation of Socioeconomic Disparities in Follow-Up Completion for Incidental Pulmonary Nodules. J Am Coll Radiol 2023; 20:1215-1224. [PMID: 37473854 DOI: 10.1016/j.jacr.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/08/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE The aim of this study was to evaluate the association between census tract-level measures of social vulnerability and residential segregation and incidental pulmonary nodule (IPN) follow-up. METHODS This retrospective cohort study included patients with IPNs ≥6 mm in size or multiple subsolid or ground-glass IPNs <6 mm (with nonoptional follow-up recommendations) diagnosed between January 1, 2018, and December 30, 2019, at a large urban tertiary center and followed for ≥2 years. Geographic sociodemographic context was characterized by the 2018 Centers for Disease Control and Prevention Social Vulnerability Index (SVI) and the index of concentration at the extremes (ICE), categorized in quartiles. Multivariable binomial regression models were used, with a primary outcome of inappropriate IPN follow-up (late or no follow-up). Models were also stratified by nodule risk. RESULTS The study consisted of 2,492 patients (mean age, 65.6 ± 12.6 years; 1,361 women). Top-quartile SVI patients were more likely to have inappropriate follow-up (risk ratio [RR], 1.24; 95% confidence interval [CI], 1.12-1.36) compared with the bottom quartile; risk was also elevated in top-quartile SVI subcategories of socioeconomic status (RR, 1.23; 95% CI, 1.13-1.34), Minority status and language (RR, 1.24; 95% CI, 1.03-1.48), housing and transportation (RR, 1.13; 95% CI, 1.02-1.26), and ICE (RR, 1.20; 95% CI, 1.11-1.30). Furthermore, top-quartile ICE was associated with greater risk for inappropriate follow-up among high-risk versus lower risk IPNs (RR, 1.33 [95% CI, 1.18-1.50] versus 1.13 [95% CI, 1.02-1.25]), respectively; P for interaction = .017). CONCLUSIONS Local social vulnerability and residential segregation are associated with inappropriate IPN follow-up and may inform policy or interventions tailored for neighborhoods.
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Affiliation(s)
| | - Rienna Russo
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Tianchu Hang
- Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - William H Moore
- Section Chief, Thoracic Imaging, and Vice Chair, Clinical informatics, Department of Radiology, NYU Grossman School of Medicine, New York, New York
| | - Yu Chen
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Stella K Kang
- Associate Chair, Population Health Imaging & Outcomes, Department of Radiology and Department of Population Health, NYU Grossman School of Medicine, New York, New York.
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12
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Marshall DC, Carney LM, Hsieh K, Dickstein DR, Downes M, Chaudhari A, McVorran S, Montgomery GH, Schnur JB. Effects of trauma history on cancer-related screening, diagnosis, and treatment. Lancet Oncol 2023; 24:e426-e437. [PMID: 37922933 PMCID: PMC10754479 DOI: 10.1016/s1470-2045(23)00438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/30/2023] [Accepted: 08/22/2023] [Indexed: 11/07/2023]
Abstract
Trauma has substantial effects on human health and is recognised as a potential barrier to seeking or receiving cancer care. The evidence that exists regarding the effect of trauma on seeking cancer screening, diagnosis, and treatment and the gaps therein can define this emerging research area and guide the development of interventions intended to improve the cancer care continuum for trauma survivors. This Review summarises current literature on the effects of trauma history on screening, diagnosis, and treatment among adult patients at risk for or diagnosed with cancer. We discuss a complex relationship between trauma history and seeking cancer-related services, the nature of which is influenced by the necessity of care, perceived or measured health status, and potential triggers associated with the similarity of cancer care to the original trauma. Collaborative scientific investigations by multidisciplinary teams are needed to generate further clinical evidence and develop mitigation strategies to provide trauma-informed cancer care for this patient population.
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Affiliation(s)
- Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Lauren M Carney
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Shauna McVorran
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Dartmouth Cancer Center, Hanover, NH, USA
| | - Guy H Montgomery
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julie B Schnur
- Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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13
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Islam JY, Yang S, Schabath M, Vadaparampil ST, Lou X, Wu Y, Bian J, Guo Y. Lung cancer screening adherence among people living with and without HIV: An analysis of an integrated health system in Florida, United States (2012-2021). Prev Med Rep 2023; 35:102334. [PMID: 37546581 PMCID: PMC10403735 DOI: 10.1016/j.pmedr.2023.102334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023] Open
Abstract
Although lung cancer is a leading cause of death among people living with HIV (PLWH), limited research exists characterizing real-world lung cancer screening adherence among PLWH. Our objective was to compare low-dose computed tomography (LDCT) adherence among PLWH to those without HIV treated at one integrated health system. Using the University of Florida's Health Integrated Data Repository (01/01/2012-10/31/2021), we identified PLWH with at least one LDCT procedure, using Current Procedural Terminology codes(S8032/G0297/71271). Lung cancer screening adherence was defined as a second LDCT based on the Lung Imaging Reporting and Data System (Lung-RADS®). Lung-RADS categories were extracted from radiology reports using a natural language processing system. PLWH were matched with 4 randomly selected HIV-negative patients based on (+/- 1 year) age, Lung-RADS category, and calendar year. Seventy-three PLWH and 292 matched HIV-negative adults with at least one LDCT were identified. PLWH were more likely to be male (66% vs.52%,p < 0.04), non-Hispanic Black (53% vs.23%,p < 0.001), and live in an area of high poverty (45% vs.31%,p < 0.001). PLWH were more likely to be diagnosed with lung cancer after first LDCT (8% vs.0%,p < 0.001). Seventeen percent of HIV-negative and 12% of PLWH were adherent to LDCT screenings. Only 25% of PLWH diagnosed with category 4A were adherent compared to 44% of HIV-negative. On multivariable analyses, those with older age (66-80 vs.50-64 years) and with either Medicaid, charity-based, or other government insurance (vs. Medicare) were less likely to be adherent to LDCT screenings. PLWH may have poorer adherence to LDCT compared to their HIV-negative counterparts.
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Affiliation(s)
- Jessica Y. Islam
- Cancer Epidemiology Program, Center for Immunization and Infection in Cancer Research, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Shuang Yang
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Matthew Schabath
- Cancer Epidemiology Program, Center for Immunization and Infection in Cancer Research, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Susan T. Vadaparampil
- Health Outcomes and Behavior, The Office of Community Outreach, Engagement, and Equity (COEE), H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Xiwei Lou
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
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14
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Núñez ER, Gould MK, Wiener RS. Time to Update Lung-RADS v1.1? Incorporating evidence from recent observational studies. J Am Coll Radiol 2023; 20:915-918. [PMID: 35970258 PMCID: PMC10612120 DOI: 10.1016/j.jacr.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Eduardo R Núñez
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts; Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; and VA Bedford Healthcare System, Bedford, Massachusetts.
| | - Michael K Gould
- Professor of Medicine and Director of Research Programs, Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Renda Soylemez Wiener
- Professor of Medicine, The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts; Associate Director, VA Boston Healthcare System, Boston, Massachusetts; VA Bedford Healthcare System, Bedford, Massachusetts; and Lung Cancer Screening Appropriateness Committee, ACR
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15
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Rivera MP, Gudina AT, Cartujano-Barrera F, Cupertino P. Disparities Across the Continuum of Lung Cancer Care. Clin Chest Med 2023; 44:531-542. [PMID: 37517833 DOI: 10.1016/j.ccm.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Despite the overall decline in lung cancer incidence and mortality, minority populations continue to bear a higher disease burden. Lung cancer remains the leading cause of cancer-related death in the United States and disproportionately impacts minority populations. Social determinants of health-including low-socioeconomic status, lack of health insurance, and access to health care- disproportionately impact racial, ethnic, and rural populations resulting in direct consequences on lung cancer disparities.
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Affiliation(s)
- M Patricia Rivera
- University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY 14642, USA.
| | - Abdi T Gudina
- University of Rochester Medical Center, 265 Crittenden Boulevard, Rm 2-223, Rochester, NY 14642, USA
| | | | - Paula Cupertino
- University of Rochester Medical Center, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA
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16
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Kee D, Sigel KM, Wisnivesky JP, Kale MS. Timely adherence to follow-up after high-risk lung cancer screenings. J Med Screen 2023; 30:150-155. [PMID: 36916158 DOI: 10.1177/09691413231162507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To achieve the lung cancer screening (LCS) mortality benefit in clinical trials, timely, real-world follow-up of abnormal test results is necessary. Presently, annual LCS rates are lower than in trials, and adherence to follow-up after suspicious findings has not been well studied. This study examined timely adherence to follow-up recommendations after positive low-dose computed tomography (LDCT) screenings. METHODS This retrospective study included individuals from two academic primary care practices in New York City who met United States Preventative Services Task Force LCS eligibility and had a positive LDCT scan between 2013 and 2020. They were recommended for shorter interval follow-up repeat computed tomography (CT), CT biopsy, or positron emission tomography/CT. Adherence was completion of the prescribed imaging by 15 days after the recommended 7-, 30-, and 90-day follow-up and by 30 days after the 180-day recommended follow-up. RESULTS Among 106 individuals with a positive LDCT scan, 64 (60%) were adherent to follow-up recommendations. Adherence was 72%, 63%, and 42% for recommended follow-ups of 30, 90, and 180 days, respectively. Being male was a predictor of a lower adherence rate. Among 23 individuals newly diagnosed with lung cancer after a positive LDCT scan, 83% were adherent to follow-up testing and 82% of cancers were Stage 1A or limited stage. CONCLUSIONS There was variable adherence to the LCS follow-up recommendations despite positive screening CT, suggesting that even in a well-established screening program there may not be an efficient, systematic approach for follow-up. The delays in repeat testing potentially undermine the benefits of early detection.
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Affiliation(s)
- Dustin Kee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Keith M Sigel
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Minal S Kale
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Philipson TJ, Durie T, Cong Z, Fendrick AM. The aggregate value of cancer screenings in the United States: full potential value and value considering adherence. BMC Health Serv Res 2023; 23:829. [PMID: 37550686 PMCID: PMC10405449 DOI: 10.1186/s12913-023-09738-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/22/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Although cancer mortality has been decreasing since 1991, many cancers are still not detected until later stages with poorer outcomes. Screening for early-stage cancer can save lives because treatments are generally more effective at earlier than later stages of disease. Evidence of the aggregate benefits of guideline-recommended single-site cancer screenings has been limited. This article assesses the benefits in terms of life-years gained and associated value from major cancer screening technologies in the United States. METHODS A mathematical model was built to estimate the aggregate benefits of screenings for breast, colorectal, cervical, and lung cancer over time since the start of US Preventive Services Task Force (USPSTF) recommendations. For each type, the full potential benefits under perfect adherence and the benefits considering reported adherence rates were estimated. The effectiveness of each screening technology was abstracted from published literature on the life-years gained per screened individual. The number of individuals eligible for screening per year was estimated using US Census data matched to the USPSTF recommendations, which changed over time. Adherence rates to screening protocols were based on the National Health Interview Survey results with extrapolation. RESULTS Since initial USPSTF recommendations, up to 417 million people were eligible for cancer screening. Assuming perfect adherence to screening recommendations, the life-years gained from screenings are estimated to be 15.5-21.3 million (2.2-4.9, 1.4-3.6, 11.4-12.3, and 0.5 million for breast, colorectal, cervical, and lung cancer, respectively). At reported adherence rates, combined screening has saved 12.2-16.2 million life-years since the introduction of USPSTF recommendations, ~ 75% of potential with perfect adherence. These benefits translate into a value of $8.2-$11.3 trillion at full potential and $6.5-$8.6 trillion considering current adherence. Therefore, single-site screening could have saved an additional 3.2-5.1 million life-years, equating to $1.7-$2.7 trillion, with perfect adherence. CONCLUSIONS Although gaps persist between the full potential benefit and benefits considering adherence, existing cancer screening technologies have offered significant value to the US population. Technologies and policy interventions that can improve adherence and/or expand the number of cancer types tested will provide significantly more value and save significantly more patient lives.
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Affiliation(s)
| | | | - Ze Cong
- GRAIL, LLC, a subsidiary of Illumina, Inc., currently held separate from Illumina Inc., under the terms of the Interim Measures Order of the European Commission dated 29 October 2021, Menlo Park, CA, USA.
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18
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Rivera MP, Henderson LM, Sakoda LC. Delays in Follow-up after a Positive Lung Cancer Screening Exam: Is the Benefit of Screening Compromised? Ann Am Thorac Soc 2023; 20:1102-1104. [PMID: 37311217 PMCID: PMC10405616 DOI: 10.1513/annalsats.202305-440ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Affiliation(s)
- M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, New York
- Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | - Louise M Henderson
- Department of Radiology, and
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, California; and
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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19
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Smyth R, Sears CR. Lung Cancer Screening: Millions of Promises and More Challenges. Chest 2023; 164:18-20. [PMID: 37423692 DOI: 10.1016/j.chest.2023.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Robert Smyth
- Department of Pulmonary and Critical Care Medicine, Section of Computational Biomedicine, Boston University, Boston, MA
| | - Catherine R Sears
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Richard L. Roudebush VA Medical Center and Indiana University, Indianapolis, IN.
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20
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Silvestri GA, Goldman L, Tanner NT, Burleson J, Gould M, Kazerooni EA, Mazzone PJ, Rivera MP, Doria-Rose VP, Rosenthal LS, Simanowith M, Smith RA, Fedewa S. Outcomes From More Than 1 Million People Screened for Lung Cancer With Low-Dose CT Imaging. Chest 2023; 164:241-251. [PMID: 36773935 PMCID: PMC10331628 DOI: 10.1016/j.chest.2023.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Lung cancer screening (LCS) with low-dose CT (LDCT) imaging was recommended in 2013, making approximately 8 million Americans eligible for LCS. The demographic characteristics and outcomes of individuals screened in the United States have not been reported at the population level. RESEARCH QUESTION What are the outcomes among people screened and entered in the American College of Radiology's Lung Cancer Screening Registry compared with those of trial participants? STUDY DESIGN AND METHODS This was a cohort study of individuals undergoing baseline LDCT imaging for LCS between 2015 and 2019. Predictors of adherence to annual screening were computed. LDCT scan interpretations by Lung Imaging Reporting and Data System (Lung-RADS) score, cancer detection rates (CDRs), and stage at diagnosis were compared with National Lung Cancer Screening Trial data. RESULTS Adherence was 22.3%, and predictors of poor adherence included current smoking status and Hispanic or Black race. On baseline screening, 83% of patients showed negative results and 17% showed positive screening results. The overall CDR was 0.56%. The percentage of people with cancer detected at baseline was higher in the positive Lung-RADS categories at 0.4% for Lung-RADS category 3, 2.6% for Lung-RADS category 4A, 11.1% for Lung-RADS category 4B, and 19.9% for Lung-RADS category 4X. The cancer stage distribution was similar to that observed in the National Lung Cancer Screening Trial, with 53.5% of patients receiving a diagnosis of stage I cancer and 14.3% with stage IV cancer. Underreporting into the registry may have occurred. INTERPRETATION This study revealed both the positive aspects of CT scan screening for lung cancer and the challenges that remain. Findings on CT imaging were correlated accurately with lung cancer detection using the Lung-RADS system. A significant stage shift toward early-stage lung cancer was present. Adherence to LCS was poor and likely contributes to the lower than expected cancer detection rate, all of which will impact the outcomes of patients undergoing screening for lung cancer.
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Affiliation(s)
- Gerard A Silvestri
- Division of Pulmonary Medicine, Thoracic Oncology Research Group, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.
| | | | - Nichole T Tanner
- Division of Pulmonary Medicine, Thoracic Oncology Research Group, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | | | - Michael Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Ella A Kazerooni
- Departments of Radiology and Internal Medicine, University of Michigan/Michigan Medicine, Ann Arbor, MI
| | | | - M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | | | | | | | - Stacey Fedewa
- Intramural Research Department, American Cancer Society, Atlanta, GA
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21
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Rustagi AS, Byers AL, Brown JK, Purcell N, Slatore CG, Keyhani S. Lung Cancer Screening Among U.S. Military Veterans by Health Status and Race and Ethnicity, 2017-2020: A Cross-Sectional Population-Based Study. AJPM FOCUS 2023; 2:100084. [PMID: 37790642 PMCID: PMC10546514 DOI: 10.1016/j.focus.2023.100084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Veterans are at high risk for lung cancer and are an important group for lung cancer screening. Previous research suggests that lung cancer screening may not be reaching healthier and/or non-White individuals, who stand to benefit most from lung cancer screening. We sought to test whether lung cancer screening is associated with poor health and/or race and ethnicity among veterans. Methods This cross-sectional, population-based study included veterans eligible for lung cancer screening (aged 55-79 years, ≥30 pack-year smoking history, current smokers or quit within 15 years, no previous lung cancer) in the 2017-2020 Behavioral Risk Factor Surveillance System surveys. Exposures were (1) poor health, defined as fair/poor health status and difficulty walking or climbing stairs, aligning with eligibility criteria for a pivotal lung cancer screening trial, and (2) race/ethnicity. The outcome was a receipt of lung cancer screening. All variables were self-reported. Results Of 3,376 lung cancer screening-eligible veterans representing an underlying population of 866,000 individuals, 20.3% (95% CI=17.3, 23.6) had poor health, and 13.7% (95% CI=10.6, 17.5) identified as non-White. Poor health was strongly associated with lung cancer screening (adjusted RR=1.64, 95% CI=1.06, 2.27); one third of veterans screened for lung cancer would not qualify for a pivotal lung cancer screening trial in terms of health. Marked racial disparities were observed among veterans: after adjustment, non-White veterans were 67% less likely to report lung cancer screening than White veterans (adjusted RR=0.33, 95% CI=0.11, 0.66). Conclusions Lung cancer screening is correlated with poorer health and White race/ethnicity among veterans, which may undermine its population-level effectiveness. These results highlight the need to promote lung cancer screening, especially for healthier and/or non-White veterans, an important group of Americans for lung cancer screening.
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Affiliation(s)
- Alison S. Rustagi
- Division of General Internal Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Medicine, University of California, San Francisco, California
| | - Amy L. Byers
- Department of Medicine, University of California, San Francisco, California
- Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California
- Weill Institute for Neurosciences, University of California, San Francisco, California
| | - James K. Brown
- Department of Medicine, University of California, San Francisco, California
- Division of Pulmonary, Critical Care, and Sleep Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Natalie Purcell
- Integrative Health, San Francisco Veterans Affairs Health Care System, San Francisco, California
- Social Behavioral Health Sciences, School of Nursing, University of California, San Francisco, California
| | - Christopher G. Slatore
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, District of Columbia
- Division of Pulmonary and Critical Care Medicine, VA Portland Health Care System, Portland, Oregon
- Division of Pulmonary & Critical Care Medicine, Department of Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Salomeh Keyhani
- Division of General Internal Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Medicine, University of California, San Francisco, California
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22
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Kearney LE, Butler C, Nunez ER, Qian S, Slatore CG, Spalluto L, Wiener RS. Highly variable reporting of incidental findings in a national cohort of US veterans screened for lung cancer. Clin Imaging 2023; 100:21-23. [PMID: 37146522 DOI: 10.1016/j.clinimag.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Lauren E Kearney
- Center for Healthcare Organizations & Implementation Research, VA Boston Healthcare System, Boston, MA, United States of America; Department of Pulmonary and Critical Care Medicine, Boston University Medical Center, Boston, MA, United States of America; VA Bedford Healthcare System, Bedford, MA, United States of America.
| | - Caitlin Butler
- Department of Pulmonary and Critical Care Medicine, Brown Medicine, Providence, RI, United States of America
| | - Eduardo R Nunez
- Center for Healthcare Organizations & Implementation Research, VA Boston Healthcare System, Boston, MA, United States of America; Department of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, MA, United States of America; VA Bedford Healthcare System, Bedford, MA, United States of America
| | - Shirley Qian
- Center for Healthcare Organizations & Implementation Research, VA Boston Healthcare System, Boston, MA, United States of America; VA Bedford Healthcare System, Bedford, MA, United States of America
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, United States of America; National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, United States of America; Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, United States of America
| | - Lucy Spalluto
- Veterans' Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center, Nashville, TN, United States of America; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Renda Soylemez Wiener
- Center for Healthcare Organizations & Implementation Research, VA Boston Healthcare System, Boston, MA, United States of America; Department of Pulmonary and Critical Care Medicine, Boston University Medical Center, Boston, MA, United States of America; National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, United States of America; VA Bedford Healthcare System, Bedford, MA, United States of America
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23
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Mikhael PG, Wohlwend J, Yala A, Karstens L, Xiang J, Takigami AK, Bourgouin PP, Chan P, Mrah S, Amayri W, Juan YH, Yang CT, Wan YL, Lin G, Sequist LV, Fintelmann FJ, Barzilay R. Sybil: A Validated Deep Learning Model to Predict Future Lung Cancer Risk From a Single Low-Dose Chest Computed Tomography. J Clin Oncol 2023; 41:2191-2200. [PMID: 36634294 PMCID: PMC10419602 DOI: 10.1200/jco.22.01345] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 10/10/2022] [Accepted: 11/29/2022] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Low-dose computed tomography (LDCT) for lung cancer screening is effective, although most eligible people are not being screened. Tools that provide personalized future cancer risk assessment could focus approaches toward those most likely to benefit. We hypothesized that a deep learning model assessing the entire volumetric LDCT data could be built to predict individual risk without requiring additional demographic or clinical data. METHODS We developed a model called Sybil using LDCTs from the National Lung Screening Trial (NLST). Sybil requires only one LDCT and does not require clinical data or radiologist annotations; it can run in real time in the background on a radiology reading station. Sybil was validated on three independent data sets: a heldout set of 6,282 LDCTs from NLST participants, 8,821 LDCTs from Massachusetts General Hospital (MGH), and 12,280 LDCTs from Chang Gung Memorial Hospital (CGMH, which included people with a range of smoking history including nonsmokers). RESULTS Sybil achieved area under the receiver-operator curves for lung cancer prediction at 1 year of 0.92 (95% CI, 0.88 to 0.95) on NLST, 0.86 (95% CI, 0.82 to 0.90) on MGH, and 0.94 (95% CI, 0.91 to 1.00) on CGMH external validation sets. Concordance indices over 6 years were 0.75 (95% CI, 0.72 to 0.78), 0.81 (95% CI, 0.77 to 0.85), and 0.80 (95% CI, 0.75 to 0.86) for NLST, MGH, and CGMH, respectively. CONCLUSION Sybil can accurately predict an individual's future lung cancer risk from a single LDCT scan to further enable personalized screening. Future study is required to understand Sybil's clinical applications. Our model and annotations are publicly available. [Media: see text].
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Affiliation(s)
- Peter G. Mikhael
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA
- Jameel Clinic, Massachusetts Institute of Technology, Cambridge, MA
| | - Jeremy Wohlwend
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA
- Jameel Clinic, Massachusetts Institute of Technology, Cambridge, MA
| | - Adam Yala
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA
- Jameel Clinic, Massachusetts Institute of Technology, Cambridge, MA
| | - Ludvig Karstens
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA
- Jameel Clinic, Massachusetts Institute of Technology, Cambridge, MA
| | - Justin Xiang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA
- Jameel Clinic, Massachusetts Institute of Technology, Cambridge, MA
| | - Angelo K. Takigami
- Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Patrick P. Bourgouin
- Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - PuiYee Chan
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Sofiane Mrah
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Wael Amayri
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Yu-Hsiang Juan
- Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Ta Yang
- Chang Gung University, Taoyuan, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yung-Liang Wan
- Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Gigin Lin
- Chang Gung University, Taoyuan, Taiwan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Lecia V. Sequist
- Harvard Medical School, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Florian J. Fintelmann
- Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Regina Barzilay
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA
- Jameel Clinic, Massachusetts Institute of Technology, Cambridge, MA
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Contrera KJ, Tam S, Pytynia K, Diaz EM, Hessel AC, Goepfert RP, Lango M, Su SY, Myers JN, Weber RS, Eguia A, Pisters PWT, Adair DK, Nair AS, Rosenthal DI, Mayo L, Chronowski GM, Zafereo ME, Shah SJ. Impact of Cancer Care Regionalization on Patient Volume. Ann Surg Oncol 2023; 30:2331-2338. [PMID: 36581726 DOI: 10.1245/s10434-022-13029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cancer centers are regionalizing care to expand patient access, but the effects on patient volume are unknown. This study aimed to compare patient volumes before and after the establishment of head and neck regional care centers (HNRCCs). METHODS This study analyzed 35,394 unique new patient visits at MD Anderson Cancer Center (MDACC) before and after the creation of HNRCCs. Univariate regression estimated the rate of increase in new patient appointments. Geospatial analysis evaluated patient origin and distribution. RESULTS The mean new patients per year in 2006-2011 versus 2012-2017 was 2735 ± 156 patients versus 3155 ± 207 patients, including 464 ± 78 patients at HNRCCs, reflecting a 38.4 % increase in overall patient volumes. The rate of increase in new patient appointments did not differ significantly before and after HNRCCs (121.9 vs 95.8 patients/year; P = 0.519). The patients from counties near HNRCCs, showed a 210.8 % increase in appointments overall, 33.8 % of which were at an HNRCC. At the main campus exclusively, the shift in regional patients to HNRCCs coincided with a lower rate of increase in patients from the MDACC service area (33.7 vs. 11.0 patients/year; P = 0.035), but the trend was toward a greater increase in out-of-state patients (25.7 vs. 40.3 patients/year; P = 0.299). CONCLUSIONS The creation of HNRCCs coincided with stable increases in new patient volume, and a sizeable minority of patients sought care at regional centers. Regional patients shifted to the HNRCCs, and out-of-state patient volume increased at the main campus, optimizing access for both local and out-of-state patients.
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Affiliation(s)
- Kevin J Contrera
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samantha Tam
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Kristen Pytynia
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo M Diaz
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C Hessel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Miriam Lango
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arturo Eguia
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | | | - Deborah K Adair
- Department of Global Business Development, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ajith S Nair
- Department of Global Business Development, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren Mayo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory M Chronowski
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Shalin J Shah
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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25
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Kim RY, Rendle KA, Mitra N, Saia CA, Neslund-Dudas C, Greenlee RT, Burnett-Hartman AN, Honda SA, Simoff MJ, Schapira MM, Croswell JM, Meza R, Ritzwoller DP, Vachani A. Socioeconomic Status as a Mediator of Racial Disparity in Annual Lung Cancer Screening Adherence. Am J Respir Crit Care Med 2023; 207:777-780. [PMID: 36306485 PMCID: PMC10037473 DOI: 10.1164/rccm.202208-1590le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Roger Y. Kim
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine
| | - Katharine A. Rendle
- Department of Family Medicine and Community Health
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | - Stacey A. Honda
- Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Oahu, Hawaii
- Hawaii Permanente Medical Group, Oahu, Hawaii
| | - Michael J. Simoff
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Marilyn M. Schapira
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia, Pennsylvania
| | - Jennifer M. Croswell
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, Maryland
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | | | - Anil Vachani
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine
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26
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Steiling K, Kathuria H, Echieh CP, Ost DE, Rivera MP, Begnaud A, Celedón JC, Charlot M, Dietrick F, Duma N, Fong KM, Ford JG, Gould MK, Holguin F, Pérez-Stable EJ, Tanner NT, Thomson CC, Wiener RS, Wisnivesky J. Research Priorities for Interventions to Address Health Disparities in Lung Nodule Management: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2023; 207:e31-e46. [PMID: 36920066 PMCID: PMC10037482 DOI: 10.1164/rccm.202212-2216st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background: Lung nodules are common incidental findings, and timely evaluation is critical to ensure diagnosis of localized-stage and potentially curable lung cancers. Rates of guideline-concordant lung nodule evaluation are low, and the risk of delayed evaluation is higher for minoritized groups. Objectives: To summarize the existing evidence, identify knowledge gaps, and prioritize research questions related to interventions to reduce disparities in lung nodule evaluation. Methods: A multidisciplinary committee was convened to review the evidence and identify key knowledge gaps in four domains: 1) research methodology, 2) patient-level interventions, 3) clinician-level interventions, and 4) health system-level interventions. A modified Delphi approach was used to identify research priorities. Results: Key knowledge gaps included 1) a lack of standardized approaches to identify factors associated with lung nodule management disparities, 2) limited data evaluating the role of social determinants of health on disparities in lung nodule management, 3) a lack of certainty regarding the optimal strategy to improve patient-clinician communication and information transmission and/or retention, and 4) a paucity of information on the impact of patient navigators and culturally trained multidisciplinary teams. Conclusions: This statement outlines a research agenda intended to stimulate high-impact studies of interventions to mitigate disparities in lung nodule evaluation. Research questions were prioritized around the following domains: 1) need for methodologic guidelines for conducting research related to disparities in nodule management, 2) evaluating how social determinants of health influence lung nodule evaluation, 3) studying approaches to improve patient-clinician communication, and 4) evaluating the utility of patient navigators and culturally enriched multidisciplinary teams to reduce disparities.
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27
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Espinoza‐Gutarra MR, Rawl SM, Maupome G, O'Leary HA, Valenzuela RE, Malloy C, Golzarri‐Arroyo L, Parker E, Haunert L, Haggstrom DA. Cancer-related knowledge, beliefs, and behaviors among Hispanic/Latino residents of Indiana. Cancer Med 2023; 12:7470-7484. [PMID: 36683200 PMCID: PMC10067073 DOI: 10.1002/cam4.5466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/28/2022] [Accepted: 11/11/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Cancer is the leading cause of death for Hispanics in the USA. Screening and prevention reduce cancer morbidity and mortality. METHODS This study administered a cross-sectional web-based survey to self-identified Hispanic residents in the state of Indiana to assess their cancer-related knowledge, beliefs, and behaviors, as well as to identify what factors might be associated with cancer screening and prevention. Chi-square and Fisher's exact test were used to compare associations and logistic regression used to develop both univariate and multivariate regression models. RESULTS A total of 1520 surveys were completed, median age of respondents was 53, 52% identified as men, 50.9% completed the survey in Spanish, and 60.4% identified the USA as their country of birth. Most were not able to accurately identify ages to begin screening for breast, colorectal, or lung cancer, and there were significant differences in cancer knowledge by education level. US-born individuals with higher income and education more often believed they were likely to develop cancer and worry about getting cancer. Sixty eight percent of respondents were up-to-date with colorectal, 44% with breast, and 61% with cervical cancer screening. Multivariate models showed that higher education, lack of fatalism, older age, lower household income, and unmarried status were associated with cervical cancer screening adherence. CONCLUSIONS Among a Hispanic population in the state of Indiana, factors associated with cervical cancer screening adherence were similar to the general population, with the exceptions of income and marital status. Younger Hispanic individuals were more likely to be adherent with breast and colorectal cancer screening, and given the higher incidence of cancer among older individuals, these results should guide future research and targeted outreach.
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Affiliation(s)
- Manuel R. Espinoza‐Gutarra
- Division of Hematology and Oncology, Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Susan M. Rawl
- Indiana University Melvin and Bren Simon Comprehensive Cancer CenterIndianapolisIndianaUSA
- Indiana University School of NursingIndianapolisIndianaUSA
| | - Gerardo Maupome
- Indiana University Purdue University Indianapolis, Richard M. Fairbanks School of Public HealthIndianapolisIndianaUSA
| | | | | | - Caeli Malloy
- Indiana University School of NursingIndianapolisIndianaUSA
| | | | - Erik Parker
- School of Public HealthIndiana University BloomingtonBloomingtonIndianaUSA
| | - Laura Haunert
- Indiana University School of NursingIndianapolisIndianaUSA
- Indiana University School of MedicineIndianapolisIndianaUSA
| | - David A. Haggstrom
- Center for Health Services ResearchRegenstrief InstituteIndianapolisIndianaUSA
- VA HSR&D Center for Health Information and CommunicationRichard L. Roudebush Veterans Affairs Medical CenterIndianapolisIndianaUSA
- Division of General Internal Medicine and GeriatricsIndiana University School of MedicineIndianapolisIndianaUSA
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28
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Adams SJ, Stone E, Baldwin DR, Vliegenthart R, Lee P, Fintelmann FJ. Lung cancer screening. Lancet 2023; 401:390-408. [PMID: 36563698 DOI: 10.1016/s0140-6736(22)01694-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 81.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/26/2022] [Accepted: 08/25/2022] [Indexed: 12/24/2022]
Abstract
Randomised controlled trials, including the National Lung Screening Trial (NLST) and the NELSON trial, have shown reduced mortality with lung cancer screening with low-dose CT compared with chest radiography or no screening. Although research has provided clarity on key issues of lung cancer screening, uncertainty remains about aspects that might be critical to optimise clinical effectiveness and cost-effectiveness. This Review brings together current evidence on lung cancer screening, including an overview of clinical trials, considerations regarding the identification of individuals who benefit from lung cancer screening, management of screen-detected findings, smoking cessation interventions, cost-effectiveness, the role of artificial intelligence and biomarkers, and current challenges, solutions, and opportunities surrounding the implementation of lung cancer screening programmes from an international perspective. Further research into risk models for patient selection, personalised screening intervals, novel biomarkers, integrated cardiovascular disease and chronic obstructive pulmonary disease assessments, smoking cessation interventions, and artificial intelligence for lung nodule detection and risk stratification are key opportunities to increase the efficiency of lung cancer screening and ensure equity of access.
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Affiliation(s)
- Scott J Adams
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emily Stone
- Faculty of Medicine, University of New South Wales and Department of Lung Transplantation and Thoracic Medicine, St Vincent's Hospital, Sydney, NSW, Australia
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Pyng Lee
- Division of Respiratory and Critical Care Medicine, National University Hospital and National University of Singapore, Singapore
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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29
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Nam J, Krishnan G, Shofer S, Navuluri N. Interventions to improve lung cancer screening among racially and ethnically minoritized groups: A scoping review. Lung Cancer 2023; 176:46-55. [PMID: 36610272 DOI: 10.1016/j.lungcan.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
Lung cancer screening (LCS) decreases lung cancer related mortality among high-risk people who smoke cigarettes and has been endorsed by the US Preventive Services Task Force (USPSTF) since 2013. However, adoption of LCS has been limited, and disparities in LCS among racially and ethnically minoritized groups have become apparent. While recommendations to improve disparities in LCS have been made, there is a lack of information on how these recommendations have been implemented and their relative effectiveness in improving screening disparities. This scoping review addresses this knowledge gap by examining interventions that have been implemented to improve LCS among racially and ethnically minoritized groups in the United States. A comprehensive search of MEDLINE (via PubMed), EMBASE (via Elsevier), CINAHL Complete (via EBSCO), and Scopus (via Elsevier), for articles from the period 1 January 2010 through 22 October 2021 was completed. Out of 17,045 references screened, only 11 studies describing an intervention to improve disparities in LCS were identified, underscoring the dearth of data on established interventions. The interventions discussed could be categorized into three groups -- patient level (n = 3), clinic/institution level (n = 3), and community level (n = 5) interventions. Of those studies reporting effectiveness data (n = 8), there was substantial heterogeneity in the outcomes measured and their relative effectiveness. We found that interventions which streamlined the LCS process at the level of a single clinic or institution were the most effective in improving LCS. Community-level interventions that focused on engagement and education had the greatest potential to target racially and ethnically minoritized groups. Our study underscores the need for more robust research on addressing barriers to LCS by identifying effective patient, clinic, and community-level interventions to improve LCS disparities and the need for potential standardization of intervention effectiveness outcomes.
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Affiliation(s)
- Jason Nam
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| | - Govind Krishnan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Scott Shofer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Durham Veterans Affairs Medical Center, Durham, NC 27710, USA
| | - Neelima Navuluri
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC 27710, USA; Durham Veterans Affairs Medical Center, Durham, NC 27710, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
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30
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Jin GY. [Lung Imaging Reporting and Data System (Lung-RADS) in Radiology: Strengths, Weaknesses and Improvement]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:34-50. [PMID: 36818696 PMCID: PMC9935959 DOI: 10.3348/jksr.2022.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/05/2022] [Accepted: 12/27/2022] [Indexed: 06/18/2023]
Abstract
In 2019, the American College of Radiology announced Lung CT Screening Reporting & Data System (Lung-RADS) 1.1 to reduce lung cancer false positivity compared to that of Lung-RADS 1.0 for effective national lung cancer screening, and in December 2022, announced the new Lung-RADS 1.1, Lung-RADS® 2022 improvement. The Lung-RADS® 2022 measures the nodule size to the first decimal place compared to that of the Lung-RADS 1.0, to category 2 until the juxtapleural nodule size is < 10 mm, increases the size criterion of the ground glass nodule to 30 mm in category 2, and changes categories 4B and 4X to extremely suspicious. The category was divided according to the airway nodules location and shape or wall thickness of atypical pulmonary cysts. Herein, to help radiologists understand the Lung-RADS® 2022, this review will describe its advantages, disadvantages, and future improvements.
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31
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Hinojos M, Li X, Mikesell S, Studden S, Odean M, Boylan MJ, Arvold DS, Bachelder VD, Gowda N, Arvold ND. Impact of Low-dose Chest CT Screening on the Association Between Rurality and Lung Cancer Outcomes. Am J Clin Oncol 2022; 45:519-525. [PMID: 36326127 DOI: 10.1097/coc.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Lung cancer mortality is higher among rural United States populations compared with nonrural ones. Little is known about screening low-dose chest computed tomography (LDCT) outcomes in rural settings. MATERIALS AND METHODS This retrospective cohort study examined all patients (n=1805) who underwent screening LDCT in a prospective registry from March 1, 2015, through December 31, 2019, in a majority-rural health care system. We assessed the proportion of early-stage lung cancers (American Joint Committee on Cancer stage I-II) diagnosed among LDCT-screened patients, and analyzed overall survival after early-stage lung cancer diagnosis according to residency location. RESULTS The screening cohort had a median age of 63 and median 40-pack-year smoking history; 62.4% had a rural residence, 51.2% were female, and 62.7% completed only 1 LDCT scan. Thirty-eight patients were diagnosed with lung cancer (2.1% of the cohort), of which 65.8% were early-stage. On multivariable analysis, rural (vs nonrural) residency was not associated with a lung cancer diagnosis (adjusted hazard ratio 1.59; 95% CI, 0.74-3.40; P =0.24). At a median follow-up of 37.1 months (range, 3.3 to 67.2 months), 88.2% of rural versus 87.5% of nonrural patients with screen-diagnosed early-stage lung cancer were alive ( P =0.93). CONCLUSIONS In a majority-rural United States population undergoing LDCT, most screen-detected lung cancers were early-stage. There were no significant differences observed between rural and nonrural patients in lung cancer diagnosis rate or early-stage lung cancer survival. Increased implementation of LDCT might blunt the historical association between rural United States populations and worse lung cancer outcomes.
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Affiliation(s)
| | - Xuan Li
- Department of Mathematics and Statistics, University of Minnesota Duluth
| | | | | | - Marilyn Odean
- University of Minnesota Medical School
- Whiteside Institute for Clinical Research, Duluth MN
| | | | | | | | | | - Nils D Arvold
- University of Minnesota Medical School
- Radiation Oncology, St. Luke's Hospital
- Whiteside Institute for Clinical Research, Duluth MN
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32
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Rivera MP, Durham DD, Long JM, Perera P, Lane L, Lamb D, Metwally E, Henderson LM. Receipt of Recommended Follow-up Care After a Positive Lung Cancer Screening Examination. JAMA Netw Open 2022; 5:e2240403. [PMID: 36326760 PMCID: PMC9634495 DOI: 10.1001/jamanetworkopen.2022.40403] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Importance Maximizing benefits of lung cancer screening requires timely follow-up after a positive screening test. The American College of Radiology (ACR) Lung CT Screening Reporting and Data System (Lung-RADS) recommends testing and follow-up timing based on the screening result. Objective To determine rates of and factors associated with recommended follow-up after a positive lung cancer screening examination by Lung-RADS category. Design, Setting, and Participants This prospective cohort study of lung cancer screening examinations performed from January 1, 2015, through July 31, 2020, with follow-up through July 31, 2021, was conducted at 5 academic and community lung cancer screening sites in North Carolina. Participants included 685 adults with a positive screening examination, Lung-RADS categories 3, 4A, 4B, or 4X. Statistical analysis was performed from December 2020 to March 2022. Exposures Individual age, race, sex, smoking exposure, year of lung cancer screening examination, chronic obstructive pulmonary disease, body mass index, referring clinician specialty, rural or urban residence. Main Outcomes and Measures Adherence, defined as receipt of recommended follow-up test or procedure after the positive screen per ACR Lung-RADS timeframes: 6 months for Lung-RADS 3 and 3 months for Lung-RADS 4A. For Lung-RADS 4B or 4X, adherence was defined as follow-up care within 4 weeks, as ACR Lung-RADS does not specify a timeframe. Results Among the 685 individuals included in this study who underwent lung cancer screening with low-dose computed tomography, 416 (60.7%) were aged at least 65 years, 123 (18.0%) were Black, 562 (82.0%) were White, and 352 (51.4%) were male. Overall adherence to recommended follow-up was 42.6% (292 of 685) and varied by Lung-RADS category: Lung-RADS 3 = 30.0% (109 of 363), Lung-RADS 4A = 49.5% (96 of 194), Lung-RADS 4B or 4X = 68.0% (87 of 128). Extending the follow-up time increased adherence: Lung-RADS 3 = 68.6% (249 of 363) within 9 months, Lung-RADS 4A = 77.3% (150 of 194) within 5 months, and Lung-RADS 4B or 4X = 80.5% (103 of 128) within 62 days. For Lung-RADS 3, recommended follow-up was less likely among those currently smoking vs those who quit (adjusted odds ratio [aOR], 0.48; 95% CI, 0.29-0.78). In Lung-RADS 4A, recommended follow-up was less likely in Black individuals vs White individuals (aOR, 0.35; 95% CI, 0.15-0.86). For Lung-RADS 4B or 4X, recommended follow-up was more likely in female individuals vs male individuals (aOR, 2.82; 95% CI, 1.09-7.28) and less likely in those currently smoking vs those who quit (aOR, 0.31; 95% CI, 0.12-0.80). Conclusions and Relevance In this cohort study, adherence to recommended follow-up after a positive screening examination was low but improved among nodules with a higher suspicion of cancer and after extending the follow-up timeline. However, the association of extending the follow-up time of screen-detected nodules with outcomes at the population level, outside of a clinical trial, is unknown. These findings suggest that studies to understand why recommended follow-up is lower in Black individuals, male individuals, and individuals currently smoking are needed to develop strategies to improve adherence.
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Affiliation(s)
- M. Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Rochester University Medical Center, Rochester, New York
- Wilmot Cancer Institute, University of Rochester, Rochester, New York
| | | | - Jason M. Long
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina, Chapel Hill
| | - Pasangi Perera
- Department of Radiology, The University of North Carolina, Chapel Hill
| | - Lindsay Lane
- Department of Radiology, The University of North Carolina, Chapel Hill
| | - Derek Lamb
- Department of Radiology, The University of North Carolina, Chapel Hill
| | - Eman Metwally
- Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill
| | - Louise M. Henderson
- Department of Radiology, The University of North Carolina, Chapel Hill
- Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill
- Department of Epidemiology, The University of North Carolina, Chapel Hill
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Kim RY, Rendle KA, Mitra N, Saia CA, Neslund-Dudas C, Greenlee RT, Burnett-Hartman AN, Honda SA, Simoff MJ, Schapira MM, Croswell JM, Meza R, Ritzwoller DP, Vachani A. Racial Disparities in Adherence to Annual Lung Cancer Screening and Recommended Follow-Up Care: A Multicenter Cohort Study. Ann Am Thorac Soc 2022; 19:1561-1569. [PMID: 35167781 PMCID: PMC9447384 DOI: 10.1513/annalsats.202111-1253oc] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/14/2022] [Indexed: 11/20/2022] Open
Abstract
Rationale: Black patients receive recommended lung cancer screening (LCS) follow-up care less frequently than White patients, but it is unknown if this racial disparity persists across both decentralized and centralized LCS programs. Objectives: To determine adherence to American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS) recommendations among individuals undergoing LCS at either decentralized or centralized programs and to evaluate the association of race with LCS adherence. Methods: We performed a multicenter retrospective cohort study of patients receiving LCS at five heterogeneous U.S. healthcare systems. We calculated adherence to annual LCS among patients with a negative baseline screen (Lung-RADS 1 or 2) and recommended follow-up care among those with a positive baseline screen (Lung-RADS 3, 4A, 4B, or 4X) stratified by type of LCS program and evaluated the association between race and adherence using multivariable modified Poisson regression. Results: Of the 6,134 total individuals receiving LCS, 5,142 (83.8%) had negative baseline screens, and 992 (16.2%) had positive baseline screens. Adherence to both annual LCS (34.8% vs. 76.1%; P < 0.001) and recommended follow-up care (63.9% vs. 74.6%; P < 0.001) was lower at decentralized compared with centralized programs. Among individuals with negative baseline screens, a racial disparity in adherence was observed only at decentralized screening programs (interaction term, P < 0.001). At decentralized programs, Black race was associated with 27% reduced adherence to annual LCS (adjusted relative risk [aRR], 0.73; 95% confidence interval [CI], 0.63-0.84), whereas at centralized programs, no effect by race was observed (aRR, 0.98; 95% CI, 0.91-1.05). In contrast, among those with positive baseline screens, there was no significant difference by race for adherence to recommended follow-up care by type of LCS program (decentralized aRR, 0.95; 95% CI, 0.81-1.11; centralized aRR, 0.81; 95% CI, 0.71-0.93; interaction term, P = 0.176). Conclusions: In this large multicenter study of individuals screened for lung cancer, adherence to both annual LCS and recommended follow-up care was greater at centralized screening programs. Black patients were less likely to receive annual LCS than White patients at decentralized compared with centralized LCS programs. Our results highlight the need for further study of healthcare system-level mechanisms to optimize longitudinal LCS care.
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Affiliation(s)
- Roger Y. Kim
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine
| | - Katharine A. Rendle
- Department of Family Medicine and Community Health
- Department of Biostatistics, Epidemiology, and Informatics, and
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, and
| | | | | | | | | | - Stacey A. Honda
- Center for Health Research, Kaiser Permanente Hawaii, Oahu, Hawaii
| | - Michael J. Simoff
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Marilyn M. Schapira
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer M. Croswell
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, Maryland; and
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | | | - Anil Vachani
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine
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Addressing Lung Cancer Screening Disparities: What Does It Mean to Be Centralized? Ann Am Thorac Soc 2022; 19:1457-1458. [PMID: 36048121 PMCID: PMC9447398 DOI: 10.1513/annalsats.202206-495ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Núñez ER, Caverly TJ, Zhang S, Glickman ME, Qian SX, Boudreau JH, Miller DR, Wiener RS. Invasive Procedures and Associated Complications After Initial Lung Cancer Screening in a National Cohort of Veterans. Chest 2022; 162:475-484. [PMID: 35231480 PMCID: PMC9424329 DOI: 10.1016/j.chest.2022.02.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/21/2022] [Accepted: 02/13/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Little is known about rates of invasive procedures and associated complications after lung cancer screening (LCS) in nontrial settings. RESEARCH QUESTION What are the frequency of invasive procedures, complication rates, and factors associated with complications in a national sample of veterans screened for lung cancer? STUDY DESIGN AND METHODS We conducted a retrospective cohort analysis of veterans who underwent LCS in any Veterans Health Administration (VA) facility between 2013 and 2019 and identified veterans who underwent invasive procedures within 10 months of initial LCS. The primary outcome was presence of a complication within 10 days after an invasive procedure. We conducted hierarchical mixed-effects logistic regression analyses to determine patient- and facility-level factors associated with complications resulting from an invasive procedure. RESULTS Our cohort of 82,641 veterans who underwent LCS was older, more racially diverse, and had more comorbidities than National Lung Screening Trial (NLST) participants. Overall, 1,741 veterans (2.1%) underwent an invasive procedure after initial screening, including 856 (42.3%) bronchoscopies, 490 (24.2%) transthoracic needle biopsies, and 423 (20.9%) thoracic surgeries. Among veterans who underwent procedures, 151 (8.7%) experienced a major complication (eg, respiratory failure, prolonged hospitalization) and an additional 203 (11.7%) experienced an intermediate complication (eg, pneumothorax, pleural effusion). Veterans who underwent thoracic surgery (OR, 7.70; 95% CI, 5.48-10.81), underwent multiple nonsurgical procedures (OR, 1.49; 95% CI, 1.15-1.92), or carried a dementia diagnosis (OR, 3.91; 95% CI, 1.79-8.52) were more likely to experience complications. Invasive procedures were performed less often than in the NLST (2.1% vs 4.2%), but veterans were more likely to experience complications after each type of procedure. INTERPRETATION These findings may reflect a higher threshold to perform procedures in veteran populations with multiple comorbidities and higher risks of complications. Future work should focus on optimizing the identification of patients whose chance of benefit likely outweighs the complication risks.
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Núñez ER, Caverly TJ, Zhang S, Glickman ME, Qian SX, Boudreau JH, Miller DR, Slatore CG, Wiener RS. Factors Associated With Declining Lung Cancer Screening After Discussion With a Physician in a Cohort of US Veterans. JAMA Netw Open 2022; 5:e2227126. [PMID: 35972738 PMCID: PMC9382440 DOI: 10.1001/jamanetworkopen.2022.27126] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Lung cancer screening (LCS) is underused in the US, particularly in underserved populations, and little is known about factors associated with declining LCS. Guidelines call for shared decision-making when LCS is offered to ensure informed, patient-centered decisions. OBJECTIVE To assess how frequently veterans decline LCS and examine factors associated with declining LCS. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included LCS-eligible US veterans who were offered LCS between January 1, 2013, and February 1, 2021, by a physician at 1 of 30 Veterans Health Administration (VHA) facilities that routinely used electronic health record clinical reminders documenting LCS eligibility and veterans' decisions to accept or decline LCS. Data were obtained from the Veterans Affairs (VA) Corporate Data Warehouse or Medicare claims files from the VA Information Resource Center. MAIN OUTCOMES AND MEASURES The main outcome was documentation, in clinical reminders, that veterans declined LCS after a discussion with a physician. Logistic regression analyses with physicians and facilities as random effects were used to assess factors associated with declining LCS compared with agreeing to LCS. RESULTS Of 43 257 LCS-eligible veterans who were offered LCS (mean [SD] age, 64.7 [5.8] years), 95.9% were male, 84.2% were White, and 37.1% lived in a rural zip code; 32.0% declined screening. Veterans were less likely to decline LCS if they were younger (age 55-59 years: odds ratio [OR], 0.69; 95% CI, 0.64-0.74; age 60-64 years: OR, 0.80; 95% CI, 0.75-0.85), were Black (OR, 0.80; 95% CI, 0.73-0.87), were Hispanic (OR, 0.62; 95% CI, 0.49-0.78), did not have to make co-payments (OR, 0.92; 95% CI, 0.85-0.99), or had more frequent VHA health care utilization (outpatient: OR, 0.70; 95% CI, 0.67-0.72; emergency department: OR, 0.86; 95% CI, 0.80-0.92). Veterans were more likely to decline LCS if they were older (age 70-74 years: OR, 1.27; 95% CI, 1.19-1.37; age 75-80 years: OR, 1.93; 95% CI, 1.73-2.17), lived farther from a VHA screening facility (OR, 1.06; 95% CI, 1.03-1.08), had spent more days in long-term care (OR, 1.13; 95% CI, 1.07-1.19), had a higher Elixhauser Comorbidity Index score (OR, 1.04; 95% CI, 1.03-1.05), or had specific cardiovascular or mental health conditions (congestive heart failure: OR, 1.25; 95% CI, 1.12-1.39; stroke: OR, 1.14; 95% CI, 1.01-1.28; schizophrenia: OR, 1.87; 95% CI, 1.60-2.19). The physician and facility offering LCS accounted for 19% and 36% of the variation in declining LCS, respectively. CONCLUSIONS AND RELEVANCE In this cohort study, older veterans with serious comorbidities were more likely to decline LCS and Black and Hispanic veterans were more likely to accept it. Variation in LCS decisions was accounted for more by the facility and physician offering LCS than by patient factors. These findings suggest that shared decision-making conversations in which patients play a central role in guiding care may enhance patient-centered care and address disparities in LCS.
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Affiliation(s)
- Eduardo R. Núñez
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Tanner J. Caverly
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Michigan Medical School, Ann Arbor
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
| | - Sanqian Zhang
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Mark E. Glickman
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
| | - Shirley X. Qian
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
| | - Jacqueline H. Boudreau
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Donald R. Miller
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Christopher G. Slatore
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
- Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
- The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
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Bernstein E, Bade BC, Akgün KM, Rose MG, Cain HC. Barriers and facilitators to lung cancer screening and follow-up. Semin Oncol 2022; 49:S0093-7754(22)00058-6. [PMID: 35927099 DOI: 10.1053/j.seminoncol.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022]
Abstract
Two randomized trials have shown that lung cancer screening (LCS) with low dose computed tomography (LDCT) reduces lung cancer mortality in patients at high-risk for lung malignancy by identifying early-stage cancers, when local cure and control is achievable. The implementation of LCS in the United States has revealed multiple barriers to preventive cancer care. Rates of LCS are disappointingly low with estimates between 5%-18% of eligible patients screened. Equally concerning, follow-up after baseline screening is far lower than that of clinical trials (44-66% v >90%). To optimize the benefits of LCS, programs must identify and address factors related to LCS participation and follow-up while concurrently recognizing and mitigating barriers. As a relatively new screening test, the most effective processes for LCS are uncertain. Therefore, LCS programs have adopted a wide range of approaches without clearly established best practices to guide them, particularly in rural and resource-limited settings. In this narrative review, we identify barriers and facilitators to LCS, focusing on those studies in non-clinical trial settings - reflecting "real world" challenges. Our goal is to identify effective and scalable LCS practices that will increase LCS participation, improve adherence to follow-up, inform strategies for quality improvement, and support new research approaches.
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Affiliation(s)
- Ethan Bernstein
- Veterans Administration (VA) Connecticut Healthcare System, Section of Pulmonary, Critical Care, and Sleep Medicine, West Haven, CT, USA; Yale School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA
| | - Brett C Bade
- Veterans Administration (VA) Connecticut Healthcare System, Section of Pulmonary, Critical Care, and Sleep Medicine, West Haven, CT, USA; Yale School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA; Veterans Administration (VA) Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities, and Education Center, West Haven, CT, USA
| | - Kathleen M Akgün
- Veterans Administration (VA) Connecticut Healthcare System, Section of Pulmonary, Critical Care, and Sleep Medicine, West Haven, CT, USA; Yale School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA; Veterans Administration (VA) Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities, and Education Center, West Haven, CT, USA
| | - Michal G Rose
- Veterans Administration (VA) Connecticut Healthcare System, Section of Hematology/Oncology, West Haven, CT, USA; Yale School of Medicine, Section of Medical Oncology, New Haven, CT, USA
| | - Hilary C Cain
- Veterans Administration (VA) Connecticut Healthcare System, Section of Pulmonary, Critical Care, and Sleep Medicine, West Haven, CT, USA; Yale School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA.
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Bade B, Gwin M, Triplette M, Wiener RS, Crothers K. Comorbidity and life expectancy in shared decision making for lung cancer screening. Semin Oncol 2022; 49:S0093-7754(22)00057-4. [PMID: 35940959 DOI: 10.1053/j.seminoncol.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 11/11/2022]
Abstract
Shared decision making (SDM) is an important part of lung cancer screening (LCS) that includes discussing the risks and benefits of screening, potential outcomes, patient eligibility and willingness to participate, tobacco cessation, and tailoring a strategy to an individual patient. More than other cancer screening tests, eligibility for LCS is nuanced, incorporating the patient's age as well as tobacco use history and overall health status. Since comorbidities and multimorbidity (ie, 2 or more comorbidities) impact the risks and benefits of LCS, these topics are a fundamental part of decision-making. However, there is currently little evidence available to guide clinicians in addressing comorbidities and an individual's "appropriateness" for LCS during SDM visits. Therefore, this literature review investigates the impact of comorbidities and multimorbidity among patients undergoing LCS. Based on available evidence and guideline recommendations, we identify comorbidities that should be considered during SDM conversations and review best practices for navigating SDM conversations in the context of LCS. Three conditions are highlighted since they concomitantly portend higher risk of developing lung cancer, potentially increase risk of screening-related evaluation and treatment complications and can be associated with limited life expectancy: chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and human immunodeficiency virus infection.
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Affiliation(s)
- Brett Bade
- Veterans Affairs (VA) Connecticut Healthcare System, Section of Pulmonary, Critical Care, and Sleep Medicine, West Haven, CT, United States of America (USA); Yale University School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA.
| | - Mary Gwin
- University of Washington School of Medicine, Seattle, WA, USA
| | - Matthew Triplette
- University of Washington School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA, USA; Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research and Medical Service, VA Boston Healthcare System, Boston, MA, USA; The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Kristina Crothers
- University of Washington School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA, USA; VA Puget Sound Health Care System, Section of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA, USA
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Alghanim F, Li KZ, An M, Verceles AC, Grier WR, Abbas H, Deepak J. Exploring the effects of racial and socioeconomic factors on timeliness of lung cancer diagnosis and treatment in Baltimore Veterans. Semin Oncol 2022; 49:S0093-7754(22)00055-0. [PMID: 35927100 DOI: 10.1053/j.seminoncol.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To characterize the effect of racial and socioeconomic factors on the timeliness of lung cancer diagnosis and treatment in a single-center Veterans Affair Medical Center (VAMC) pulmonary nodule clinic. METHODS We conducted a single-center retrospective review of all patients seen at the Baltimore VAMC pulmonary nodule clinic between 2013 and 2019 to identify key demographic factors, measures of neighborhood socioeconomic disadvantage, cancer staging and histopathologic information, and time elapsed between diagnosis and treatment. We excluded patients with pulmonary nodules undergoing active surveillance, prior history of lung cancer, metastases of a different primary origin, insufficient followup, or who had received care outside the VHA system. RESULTS Median times to diagnosis and treatment of lung cancer were 28 and 73 days. There were no statistically significant differences in overall timeliness of diagnosis and treatment when stratified by race or measures of neighborhood socioeconomic disadvantage. CONCLUSIONS The authors found no differences in timeliness of lung cancer care by race and socioeconomic status within the system. Despite general adherence to national standards in timeliness of care, there continues to be a need for improvements in the operational workflows to reduce time to diagnosis and treatment for all Veterans.
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Affiliation(s)
- Fahid Alghanim
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kevin Z Li
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Max An
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Avelino C Verceles
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William R Grier
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hatoon Abbas
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Janaki Deepak
- Veterans Affairs Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
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Maurice NM, Tanner NT. Lung cancer screening at the VA: Past, present and future. Semin Oncol 2022; 49:S0093-7754(22)00041-0. [PMID: 35831214 DOI: 10.1053/j.seminoncol.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 06/04/2022] [Indexed: 11/11/2022]
Abstract
Lung cancer is responsible for more deaths annually in the United States than breast, prostate and colon cancers combined. Lung cancer screening with annual low-dose computed tomography reduces lung cancer mortality in high-risk patients through early detection. The incidence of lung cancer is higher in the veteran population compared to the general population due, in part, to the prevalence of tobacco use. Early detection of lung cancer is therefore an important goal of the Veterans Health Administration (VHA), the largest integrated health care system in the United States. The following will review previous and current initiatives undertaken by the VHA to implement and expand access to lung cancer screening and will highlight target areas of interest to improve uptake and quality of lung cancer screening. Through these initiatives and programs, the VHA aims to provide high quality and equitable access to lung cancer screening for all Veterans that incorporates research that will improve outcomes and potentially inform and optimize the practice of Lung cancer screening across the United States.
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Affiliation(s)
- Nicholas M Maurice
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, U.S.A.; Atlanta Veterans Affairs Health Care System, Decatur, GA.
| | - Nichole T Tanner
- Ralph H. Johnson Veterans Affairs Hospital, Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston, SC, U.S.A.; Medical University of South Carolina, Thoracic Oncology Research Group, Division of Pulmonary and Critical Care, Charleston, SC, U.S.A
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Stone E, Leong TL. Contemporary Concise Review 2021: Pulmonary nodules from detection to intervention. Respirology 2022; 27:776-785. [PMID: 35581532 DOI: 10.1111/resp.14296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 12/11/2022]
Abstract
The US Preventive Task Force (USPSTF) has updated screening criteria by expanding age range and reducing smoking history required for eligibility; the International Lung Screen Trial (ILST) data have shown that PLCOM2012 performs better for eligibility than USPSTF criteria. Screening adherence is low (4%-6% of potential eligible candidates in the United States) and depends upon multiple system and patient/candidate-related factors. Smoking cessation in lung cancer improves survival (past prospective trial data, updated meta-analysis data); smoking cessation is an essential component of lung cancer screening. Circulating biomarkers are emerging to optimize screening and early diagnosis. COVID-19 continues to affect lung cancer treatment and screening through delays and disruptions; specific operational challenges need to be met. Over 70% of suspected malignant lesions develop in the periphery of the lungs. Bronchoscopic navigational techniques have been steadily improving to allow greater accuracy with target lesion approximation and therefore diagnostic yield. Fibre-based imaging techniques provide real-time microscopic tumour visualization, with potential diagnostic benefits. With significant advances in peripheral lung cancer localization, bronchoscopically delivered ablative therapies are an emerging field in limited stage primary and oligometastatic disease. In advanced stage lung cancer, small-volume samples acquired through bronchoscopic techniques yield material of sufficient quantity and quality to support clinically relevant biomarker assessment.
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Affiliation(s)
- Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.,School of Clinical Medicine, UNSW, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tracy L Leong
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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HIGH RISK DISEASE AND POOR FOLLOWUP: THE IMPORTANCE OF RENAL MASS BIOPSY IN A COHORT OF VETERANS. Urology 2022; 167:152-157. [PMID: 35588788 DOI: 10.1016/j.urology.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the clinical utility of RMB in our multi-state system. Renal mass biopsy (RMB) is useful in the management of masses ≤ 4 cm (T1a), but evaluation of RMB in the uniquely vulnerable Veteran population is lacking. METHODS 136 RMB in 130 patients performed between 06/2015 and 11/2020 were identified in this Quality Improvement analysis. Demographics, size, pathology, treatment, and biopsy complications were analyzed. Of 101 T1a masses, 89 were either diagnostic or not decompressed cysts and 77 met inclusion criteria for follow-up imaging compliance analysis. RESULTS The median age was 66 years. The diagnostic rate was 94.1% (128/136) for all masses and 94.1% (95/101) for T1a renal masses, with a complication rate of 2.2%. Among solid T1a masses, unexpectedly aggressive lesions (Fuhrman Grade 4, Type 2 papillary or sarcomatoid features) were identified in 8/89 (9.0%). 57 (64%) patients were treated with cryoablation or surgery and 32 (36%) patients elected active surveillance (AS). A neoplastic finding (oncocytoma or RCC) was present in 16 patients choosing AS (50%) compared to 52 patients choosing treatment (91%). Compliance with NCCN-recommended imaging was 50% and 47% for AS and treatment groups, respectively. CONCLUSIONS In this VA cohort, we found a significant incidence of high-risk lesions and poor compliance with follow-up imaging. Aggressive biopsy protocols with high consideration of treatment may be appropriate to limit risk in those lost to follow-up. Given that 9% of our small renal masses were highly aggressive, biopsy may be critical in the selection of AS candidates.
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Osarogiagbon RU, Liao W, Faris NR, Meadows-Taylor M, Fehnel C, Lane J, Williams SC, Patel AA, Akinbobola OA, Pacheco A, Epperson A, Luttrell J, McCoy D, McHugh L, Signore R, Bishop AM, Tonkin K, Optican R, Wright J, Robbins T, Ray MA, Smeltzer MP. Lung Cancer Diagnosed Through Screening, Lung Nodule, and Neither Program: A Prospective Observational Study of the Detecting Early Lung Cancer (DELUGE) in the Mississippi Delta Cohort. J Clin Oncol 2022; 40:2094-2105. [PMID: 35258994 PMCID: PMC9242408 DOI: 10.1200/jco.21.02496] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Lung cancer screening saves lives, but implementation is challenging. We evaluated two approaches to early lung cancer detection-low-dose computed tomography screening (LDCT) and program-based management of incidentally detected lung nodules. METHODS A prospective observational study enrolled patients in the early detection programs. For context, we compared them with patients managed in a Multidisciplinary Care Program. We compared clinical stage distribution, surgical resection rates, 3- and 5-year survival rates, and eligibility for LDCT screening of patients diagnosed with lung cancer. RESULTS From 2015 to May 2021, 22,886 patients were enrolled: 5,659 in LDCT, 15,461 in Lung Nodule, and 1,766 in Multidisciplinary Care. Of 150, 698, and 1,010 patients diagnosed with lung cancer in the respective programs, 61%, 60%, and 44% were diagnosed at clinical stage I or II, whereas 19%, 20%, and 29% were stage IV (P = .0005); 47%, 42%, and 32% had curative-intent surgery (P < .0001); aggregate 3-year overall survival rates were 80% (95% CI, 73 to 88) versus 64% (60 to 68) versus 49% (46 to 53); 5-year overall survival rates were 76% (67 to 87) versus 60% (56 to 65) versus 44% (40 to 48), respectively. Only 46% of 1,858 patients with lung cancer would have been deemed eligible for LDCT by US Preventive Services Task Force (USPSTF) 2013 criteria, and 54% by 2021 criteria. Even if all eligible patients by USPSTF 2021 criteria had been enrolled into LDCT, the Nodule Program would have detected 20% of the stage I-II lung cancer in the entire cohort. CONCLUSION LDCT and Lung Nodule Programs are complementary, expanding access to early lung cancer detection and curative treatment to different-risk populations. Implementing Lung Nodule Programs may alleviate emerging disparities in access to early lung cancer detection.
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Affiliation(s)
| | - Wei Liao
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | | | - Carrie Fehnel
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Jordan Lane
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Sara C Williams
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Anita A Patel
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | | | - Alicia Pacheco
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Amanda Epperson
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Joy Luttrell
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Denise McCoy
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Laura McHugh
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Raymond Signore
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Anna M Bishop
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Keith Tonkin
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.,Mid-South Imaging and Therapeutics, Memphis, TN
| | - Robert Optican
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.,Mid-South Imaging and Therapeutics, Memphis, TN
| | - Jeffrey Wright
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN.,Memphis Lung Physicians, Memphis, TN
| | - Todd Robbins
- Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN
| | - Meredith A Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN
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Beyond the AJR: Disparities in Lung Cancer Screening Adherence Persist in the Veterans Health Administration. AJR Am J Roentgenol 2022:1. [PMID: 35234498 DOI: 10.2214/ajr.21.26852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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46
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Barta JA. Variation in Adherence to Lung Cancer Screening Among Vulnerable Populations. Chest 2022; 161:16-17. [DOI: 10.1016/j.chest.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/26/2021] [Indexed: 10/19/2022] Open
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