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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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2
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Black GB, van Os S, Whitaker KL, Hawkins GS, Quaife SL. What are the similarities and differences in lung cancer symptom appraisal and help-seeking according to smoking status? A qualitative study with lung cancer patients. Psychooncology 2022; 31:2094-2103. [PMID: 36131549 PMCID: PMC10099562 DOI: 10.1002/pon.6041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/25/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Lung cancer in never-smokers represents a growing proportion of patients. The relationship between smoking status, symptom appraisal and help-seeking behaviour is complex. Little is known about cancer symptom-related health behaviours according to smoking status. The aim of the study was to explore lung cancer patients' experiences of a lung cancer diagnosis, identifying differences by smoking history. METHOD This was a qualitative study involving telephone interviews with 40 lung cancer patients (20 never smokers, 11 former smokers and 9 current smokers). We used framework analysis to analyse the data using the Common Sense Model of Illness Self-Regulation as a theoretical framework, developed after initial analysis. RESULTS All patients were likely to delay seeking help for symptoms in primary care regardless of smoking history, but for different reasons. Smoking history was instrumental to how individuals perceived and responded to early symptoms of lung cancer. Differences in interpretation and coping responses to new symptoms seemed to be caused by the higher presence of comorbidities due to smoking, and perceptions of the current state of health. Individuals with a smoking history reported acting with urgency in seeking help and follow up, whereas patients who experienced low levels of concern were more easily reassured by clinicians, resulting in delays. CONCLUSIONS Never and former smokers perceive, interpret, and respond to symptoms of lung cancer differently to smokers. However, few people attribute their lung symptoms to cancer initially, even with a smoking history. Interventions that drive increased urgency and vigilance in never smokers may be effective.
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Affiliation(s)
- Georgia B. Black
- Department of Applied Health ResearchUniversity College LondonLondonUK
- Centre for PreventionDetection and DiagnosisWolfson Institute of Population HealthBarts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Sandra van Os
- Department of Applied Health ResearchUniversity College LondonLondonUK
| | | | | | - Samantha L. Quaife
- Centre for PreventionDetection and DiagnosisWolfson Institute of Population HealthBarts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
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Lin YA, Hong YT, Lin XJ, Lin JL, Xiao HM, Huang FF. Barriers and facilitators to uptake of lung cancer screening: A mixed methods systematic review. Lung Cancer 2022; 172:9-18. [PMID: 35963208 DOI: 10.1016/j.lungcan.2022.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/02/2022] [Accepted: 07/27/2022] [Indexed: 11/29/2022]
Abstract
Numerous factors contribute to the low adherence to lung cancer screening (LCS) programs. A theory-informed approach to identifying the obstacles and facilitators to LCS uptake is required. This study aimed to identify, assess, and synthesize the available literature at the individual and healthcare provider (HCP) levels based on a social-ecological model and identify gaps to improve practice and policy decision-making. Systematic searches were conducted in nine electronic databases from inception to December 31, 2020. We also searched Google Scholar and manually examined the reference lists of systematic reviews to include relevant articles. Primary studies were scored for quality assessment. Among 3938 potentially relevant articles, 36 studies, including 25 quantitative and 11 qualitative studies, were identified for inclusion in the review. Fifteen common factors were extracted from 34 studies, including nine barriers and six facilitators. The barriers included individual factors (n = 5), health system factors (n = 3), and social/environmental factors (n = 1). The facilitators included only individual factors (n = 6). However, two factors, age and screening harm, remain mixed. This systematic review identified and combined barriers and facilitators to LCS uptake at the individual and HCP levels. The interaction mechanisms among these factors should be further explored, which will allow the construction of tailored LCS recommendations or interventions for the Chinese context.
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Affiliation(s)
- Yu-An Lin
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Yu Ting Hong
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiu Jing Lin
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Jia Ling Lin
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Hui Min Xiao
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Fei Fei Huang
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China.
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Williams RM, Eyestone E, Smith L, Philips JG, Whealan J, Webster M, Li T, Luta G, Taylor KL. Engaging Patients in Smoking Cessation Treatment within the Lung Cancer Screening Setting: Lessons Learned from an NCI SCALE Trial. Curr Oncol 2022; 29:2211-2224. [PMID: 35448154 PMCID: PMC9027703 DOI: 10.3390/curroncol29040180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 11/16/2022] Open
Abstract
Offering smoking cessation treatment at lung cancer screening (LCS) will maximize mortality reduction associated with screening, but predictors of treatment engagement are not well understood. We examined participant characteristics of engagement in an NCI SCALE cessation trial. Eligible LCS patients (N = 818) were randomized to the Intensive arm (8 phone counseling sessions +8 weeks of nicotine replacement therapy (NRT)) vs. Minimal arm (3 sessions + 2 weeks of NRT). Engagement was measured by number of sessions completed (none, some, or all) and NRT mailed (none vs. any) in each arm. In the Intensive arm, those with ≥some college (OR = 2.1, 95% CI = 1.1, 4.0) and undergoing an annual scan (OR = 2.1, 95% CI = 1.1, 4.2) engaged in some counseling vs. none. Individuals with higher nicotine dependence were more likely (OR = 2.8, 95% CI = 1.3, 6.2) to request NRT. In the Minimal arm, those with higher education (OR = 2.1, 95% CI = 1.1, 3.9) and undergoing an annual scan (OR = 2.0, 95% CI = 1.04, 3.8) completed some sessions vs. none. Requesting NRT was associated with more pack-years (OR = 1.9, 95% CI = 1.1, 3.5). Regardless of treatment intensity, additional strategies are needed to engage those with lower education, less intensive smoking histories, and undergoing a first scan. These efforts will be important given the broader 2021 LCS guidelines.
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Affiliation(s)
- Randi M. Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
| | - Ellie Eyestone
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
| | - Laney Smith
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
| | - Joanna G. Philips
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
| | - Julia Whealan
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
| | - Marguerite Webster
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC 20007, USA; (T.L.); (G.L.)
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, DC 20007, USA; (T.L.); (G.L.)
| | - Kathryn L. Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA; (E.E.); (L.S.); (J.G.P.); (J.W.); (M.W.); (K.L.T.)
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5
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Williams RM, Cordon M, Eyestone E, Smith L, Luta G, McKee BJ, Regis SM, Abrams DB, Niaura RS, Stanton CA, Parikh V, Taylor KL. Improved motivation and readiness to quit shortly after lung cancer screening: Evidence for a teachable moment. Cancer 2022; 128:1976-1986. [PMID: 35143041 PMCID: PMC9038674 DOI: 10.1002/cncr.34133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND For patients at high risk for lung cancer, screening using low-dose computed tomography (lung cancer screening [LCS]) is recommended. The purpose of this study was to examine whether screening may serve as a teachable moment for smoking-related outcomes. METHODS In a smoking-cessation trial, participants (N = 843) completed 2 phone interviews before randomization: before LCS (T0) and after LCS (T1). By using logistic and linear regression, the authors examined teachable moment variables (perceived risk, lung cancer worry) and outcomes (readiness, motivation, and cigarettes per day [CPD]). RESULTS Participants were a mean ± SD age of 63.7 ± 5.9 years, had 47.8 ± 7.1 pack-years of smoking, 35.2% had a high school diploma or General Educational Development (high school equivalency) degree or less, and 42.3% were undergoing their first scan. Between T0 and T1, 25.7% of participants increased readiness to quit, 9.6% decreased readiness, and 64.7% reported no change (P < .001). Motivation to quit increased (P < .05) and CPD decreased between assessments (P < .001), but only 1.3% self-reported quitting. Compared with individuals who reported no lung cancer worry/little worry, extreme worry was associated with readiness to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.1-3.0) and with higher motivation (b = 0.83; P < .001) at T1. Individuals undergoing a baseline (vs annual) scan were more ready to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.3-2.5). CONCLUSIONS During the brief window between registering for LCS and receiving the results, the authors observed that very few participants quit smoking, but a significant proportion improved on readiness and motivation to quit, particularly among individuals who were undergoing their first scan and those who were extremely worried about lung cancer. These results indicate that providing evidence-based tobacco treatment can build upon this teachable moment.
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Affiliation(s)
- Randi M Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Marisa Cordon
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Ellie Eyestone
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Laney Smith
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, District of Columbia
| | - Brady J McKee
- Division of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Shawn M Regis
- Division of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David B Abrams
- New York University School of Global Public Health, New York, New York
| | - Raymond S Niaura
- New York University School of Global Public Health, New York, New York
| | | | - Vicky Parikh
- Department of Population Health, MedStar Shah Medical Group, Hollywood, Maryland
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
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Deros DE, Hagerman CJ, Kramer JA, Anderson ED, Regis S, McKee AB, McKee BJ, Stanton CA, Niaura R, Abrams DB, Ramsaier M, Fallon S, Harper H, Taylor KL. Change in amount smoked and readiness to quit among patients undergoing lung cancer screening. J Thorac Dis 2021; 13:4947-4955. [PMID: 34527333 PMCID: PMC8411192 DOI: 10.21037/jtd-20-3267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
Background There is mixed evidence regarding whether undergoing computed tomography lung cancer screening (LCS) can serve as a "teachable moment" that impacts smoking behavior and attitudes. The study aim was to assess whether the standard procedures of undergoing LCS and receiving free and low-cost evidence-based cessation resources impacted short-term smoking-related outcomes. Methods Participants were smokers (N=87) who were registered to undergo lung screening and were enrolled in a cessation intervention trial. We conducted two phone interviews, both preceding trial randomization: the first interview was conducted prior to lung screening, and the second interview followed lung screening (median =12.5 days post-screening) and participants' receipt of their screening results. The interviews assessed demographic characteristics, interest in evidence-based cessation intervention methods, and tobacco-related characteristics, including cigarettes per day and readiness to quit. Participants received minimal evidence-based cessation resources following the pre-lung screening interview. Results Participants were 60.3 years old, 56.3% female, and reported a median of 40 pack-years. Participants were interested in using several evidence-based strategies, including counseling from a healthcare provider (76.7%) and receiving nicotine replacement therapy (69.8%). Pre-lung screening, 25.3% smoked ≤10 cigarettes per day, and 29.9% were ready to quit in the next 30 days. We conducted two McNemar binomial distribution tests to assess change from pre- to post-screening. At the post-lung screening assessment, approximately three-quarters reported no change on these variables. However, 23.3% reported smoking fewer cigarettes per day, whereas 4.7% reported smoking more cigarettes per day (McNemar P=0.002), and 17.2% reported increased readiness to quit, whereas 6.9% reported decreased readiness to quit (McNemar P=0.078). Conclusions Following receipt of cessation resources and completion of lung screening, most participants reported no change in smoking outcomes. However, there was a significant reduction in cigarettes per day, and there was a trend for increased readiness to quit. This setting may provide a potential "teachable moment" and an opportunity to assist smokers with quitting. However, more proactive and intensive interventions will be necessary to capitalize on these changes and to support abstinence in the long-term.
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Affiliation(s)
- Danielle E Deros
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Charlotte J Hagerman
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jenna A Kramer
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | - Eric D Anderson
- Medstar Georgetown University Medical Center, Washington, DC, USA
| | - Shawn Regis
- Sophia Gordon Cancer Center, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Andrea B McKee
- Sophia Gordon Cancer Center, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Brady J McKee
- Sophia Gordon Cancer Center, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Cassandra A Stanton
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Westat, Inc. Rockville, MD, USA
| | - Ray Niaura
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
| | - David B Abrams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
| | - Michael Ramsaier
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Shelby Fallon
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Harry Harper
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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Flores EJ, Neil JM, Tiersma KM, Pappano CR, Mulligan C, Van Alphen MU, Park ER, Irwin KE. Feasibility and Acceptability of a Collaborative Lung Cancer Screening Educational Intervention Tailored for Individuals With Serious Mental Illness. J Am Coll Radiol 2021; 18:1624-1634. [PMID: 34375628 DOI: 10.1016/j.jacr.2021.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Individuals with serious mental illness (SMI) experience disparities in lung cancer mortality. Using a two-phase, mixed-methods approach, we developed a person-centered lung cancer screening (LCS) educational intervention (phase 1) for individuals with SMI (schizophrenia and bipolar disorder) and evaluated acceptability, feasibility, and changes in attitudes toward LCS (phase 2). METHODS Phase 1: We conducted three focus groups with mental health, primary care, and radiology clinicians and utilized rapid qualitative analysis to adapt the LCS intervention (LCS walk-through video and smoking cessation handouts) tailored for individuals with SMI. Phase 2: We enrolled LCS-eligible patients with SMI (n = 15) and assessed the feasibility (>50% enrollment; >75% completion) and acceptability (>75% overall satisfaction) of an LCS educational intervention delivered by a radiologist and a mental health clinician at a community mental health clinic. We explored changes in participant attitudes about lung cancer, LCS, and smoking before and after the intervention. RESULTS Phase 1: Focus groups with primary care (n = 5), radiologists (n = 9), and mental health clinicians (n = 6) recommended person-centered language and adapting a video demonstrating the process of LCS to address concerns specific to SMI, including paranoia and concrete thinking. Phase 2: Fifty percent (15 of 30) of eligible patients enrolled in the LCS intervention, 100% (15 of 15) completed the intervention, and 93% (14 of 15) were satisfied with the intervention. Participants reported a significantly greater worry about developing lung cancer postintervention, but there were no other significant differences. CONCLUSIONS Radiologists can partner with primary care and community mental health clinics to lead LCS equity among individuals with SMI.
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Affiliation(s)
- Efrén J Flores
- Officer of Radiology, Community, and Health Equity, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Assistant Professor of Radiology, Harvard Medical School, Boston, Massachusetts; The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts.
| | - Jordan M Neil
- Assistant Professor, Department of Family and Preventive Medicine, TSET Health Promotion Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Keenae M Tiersma
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; North Suffolk Mental Health Association, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Catherine R Pappano
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Caitlin Mulligan
- North Suffolk Mental Health Association, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Manjola U Van Alphen
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Chief Medical Officer, Medical Director, Division of Ambulatory Services, North Suffolk Mental Health Association, Boston, Massachusetts
| | - Elyse R Park
- Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts; Associate Director, Survivorship Research and Psychosocial Services for the MGH Cancer Center, Director of Behavioral Sciences, MGH Tobacco Treatment & Research Center, the Mongan Institute, The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts; Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Director of Behavioral Research, MGH Benson-Henry Institute for Mind Body Medicine, Boston, Massachusetts
| | - Kelly E Irwin
- The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts; Assistant Professor of Psychiatry, Harvard Medical School, Harvard Medical School, Boston, Massachusetts; Director, Collaborative Care and Community Engagement Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Maki KG, Liao K, Lowenstein LM, Lopez-Olivo MA, Volk RJ. Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke. MDM Policy Pract 2021; 6:23814683211067810. [PMID: 34993342 PMCID: PMC8725001 DOI: 10.1177/23814683211067810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022] Open
Abstract
Background. Screening with low-dose computed tomography scans can reduce lung cancer deaths but uptake remains low. This study examines psychosocial factors associated with obtaining lung cancer screening (LCS) among individuals. Methods. This is a secondary analysis of a randomized clinical trial conducted with 13 state quitlines’ clients. Participants who met age and smoking history criteria were enrolled and followed-up for 6 months. Only participants randomized to the intervention group (a patient decision aid) were included in this analysis. A logistic regression was performed to identify determinants of obtaining LCS 6 months after the intervention. Results. There were 204 participants included in this study. Regarding individual attitudes, high and moderate levels of concern about overdiagnosis were associated with a decreased likelihood of obtaining LCS compared with lower levels of concern (high levels of concern, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04–0.65; moderate levels of concern, OR 0.15, 95% CI 0.05–0.53). In contrast, higher levels of anticipated regret about not obtaining LCS and later being diagnosed with lung cancer were associated with an increased likelihood of being screened compared with lower levels of anticipated regret (OR 5.59, 95% CI 1.72–18.10). Other potential harms related to LCS were not significant. Limitations. Follow-up may not have been long enough for all individuals who wished to be screened to complete the scan. Additionally, participants may have been more health motivated due to recruitment via tobacco quitlines. Conclusions. Anticipated regret about not obtaining screening is associated with screening behavior, whereas concern about overdiagnosis is associated with decreased likelihood of LCS. Implications. Decision support research may benefit from further examining anticipated regret in screening decisions. Additional training and information may be helpful to address concerns regarding overdiagnosis.
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Affiliation(s)
| | | | | | | | - Robert J. Volk
- Robert J. Volk, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1444, Houston, TX 77030, USA; Telephone: (713) 745-4516 ()
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9
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Lam V, Scott R, Billings P, Cabebe E, Young R. Utility of incorporating a gene-based lung cancer risk test on uptake and adherence in a community-based lung cancer screening pilot study. Prev Med Rep 2021; 23:101397. [PMID: 34040933 PMCID: PMC8142278 DOI: 10.1016/j.pmedr.2021.101397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/31/2021] [Accepted: 05/08/2021] [Indexed: 11/24/2022] Open
Abstract
Based on the results of randomized control trials, screening for lung cancer using computed tomography (CT) is now widely recommended. However, adherence to screening remains an issue outside the clinical trial setting. This study examines the utility of biomarker-based risk assessment on uptake and subsequent adherence in a community screening study. In a single arm pilot study, current or former smokers > 50 years old with 20 + pack year history were recruited following local advertising. One hundred and fifty seven participants volunteered to participate in the study that offered an optional gene-based lung cancer risk assessment followed by low-dose CT according to a standardised screening protocol. All 157 volunteers who attended visit 1 underwent the gene-based risk assessment comprising of a clinical questionnaire and buccal swab. Of this group, 154 subsequently attended for CT screening (98%) and were followed prospectively for a median of 2.7 years. A participant’s adherence to screening was influenced by their baseline lung cancer risk category, with overall adherence in those with a positive scan being significantly greater in the “very high” risk group compared to “moderate” and “high” risk categories (71% vs 52%, Odds ratio = 2.27, 95% confidence interval of 1.02–5.05, P = 0.047). Those in the “moderate” risk group were not different to those in the “high” risk group (52% and 52%, P > 0.05). In this proof-of-concept study, personalised gene-based lung cancer risk assessment was well accepted, associated with a 98% uptake for screening and increased adherence for those in the highest risk group.
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Affiliation(s)
- V.K. Lam
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- El Camino Hospital, Mountain View, CA, USA
| | - R.J. Scott
- Department of Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland Hospital, New Zealand
- Corresponding author at: Medicine and Molecular Genetics, P. O. Box 26161 Epsom, Auckland 1344, New Zealand.
| | | | - E. Cabebe
- El Camino Hospital, Mountain View, CA, USA
| | - R.P. Young
- Department of Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland Hospital, New Zealand
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Kim E, Williams RM, Eyestone E, Cordon M, Smith L, Davis K, Luta G, Anderson ED, McKee B, Batlle J, Ramsaier M, Howell J, Parikh V, Geronimo M, Stanton C, Niaura R, Abrams D, Taylor KL. Predictors of attrition in a smoking cessation trial conducted in the lung cancer screening setting. Contemp Clin Trials 2021; 106:106429. [PMID: 33964415 DOI: 10.1016/j.cct.2021.106429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 01/01/2023]
Abstract
SIGNIFICANCE Although it is a requirement that tobacco treatment is offered to cigarette smokers undergoing low-dose computed tomographic lung cancer screening (LCS), not all smokers engage in treatment. To understand the barriers to tobacco treatment in this setting, we evaluated predictors of attrition in a smoking cessation trial among individuals undergoing LCS. METHODS Prior to LCS, 926 participants, 50-80 years old, completed the baseline (T0) phone assessment, including demographic, clinical, tobacco, and psychological characteristics. Following LCS and receipt of the results, participants completed the pre-randomization (T1) assessment. RESULTS At the T1 assessment, 735 (79%) participants were retained and 191 (21%) dropped out. In multivariable analyses, attrition was higher among those who: smoked >1 pack per day (OR = 1.44, CI 1.01, 2.06) or had undergone their first (vs. annual) LCS scan (OR = 1.70, CI 1.20, 2.42). Attrition was lower among those with: more education (associates (OR = 0.67, CI = 0.46, 0.98) or bachelor's degree (OR = 0.56, CI 0.35, 0.91) vs. high school/GED), some (vs. none/a little) worry about lung cancer (OR = 0.60, CI 0.39, 0.92), or a screening result that was benign (OR = 0.57, CI 0.39, 0.82) or probably benign (OR = 0.38, CI 0.16, 0.90) vs. negative. CONCLUSIONS This study illuminated several LCS-related factors that contributed to trial attrition. Increasing tobacco treatment in this setting will require targeted strategies for those who report little lung cancer worry, are undergoing their first LCS exam, and/or who have a negative LCS result. Addressing attrition and reducing barriers to tobacco treatment will increase the likelihood of cessation, thereby reducing the risk of developing lung cancer.
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Affiliation(s)
- Emily Kim
- Georgetown University Medical Center, D.C., USA
| | | | | | | | - Laney Smith
- Georgetown University Medical Center, D.C., USA
| | | | - George Luta
- Georgetown University Medical Center, D.C., USA
| | | | - Brady McKee
- Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Juan Batlle
- Baptist Health South Florida, Miami, FL, USA
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11
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Ahmed HG, El Hag AB, Binsaleh NK, Elhussein GEMO, Hussain MA, Bealy MABI, Abboh EAA, Sherfi H. The Utility of Nucleolar Organizer Regions Quantitation in Early Prediction of Lung Neoplastic Transformation. Cureus 2020; 12:e11738. [PMID: 33269177 PMCID: PMC7707122 DOI: 10.7759/cureus.11738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Cancer burden can be reduced by early detection of early neoplastic changes applying suitable screening methods. This study aimed to assess the utility of nucleolar organizer regions (NORs) quantitation in early prediction of lung neoplastic transformation. Methodology: This study investigated 200 apparently healthy individuals categorized into two groups; smoking exposed individuals (N=100), and were categorized as cases, and smoking nonexposed (N=100), and were ascertained as controls. Sputum specimen was attained from each participant (paying all indispensable safety precautions and sample adequacy processes). Results: Out of the 200 volunteers assessed in the present study, mean NORs counts of >2.00 were identified in 16/200(8%) of the study subjects. All 16/16(100%) cases were found with lung epithelial metaplasia (squamous metaplasia). Out of the 100 cases, mean NORs counts of >2.00 were identified in 16/100(16%), hence, all the controls were identified with mean NORs counts of <2.00. The risk of lung cellular proliferative changes associated with smoking exposure are odds ratio (OR) (95% confidence interval, CI) = 39.2485 (2.3199-664.0052), p = 0.0110, z statistic = 2.543. Conclusion: NORs count is a simple, specific, cost-effective, and reliable method that can give a quantitative measurement for the risk of lung neoplastic transformation. For at risk-population (tobacco users), it is recommended to perform the argyrophilic NORs (AgNORs) method beside sputum cytology.
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Affiliation(s)
- Hussain G Ahmed
- Pathology, College of Medicine, University of Ha'il, Ha'il, SAU
| | - Amel B El Hag
- Pathology, College of Medicine, University of Ha'il, Ha'il, SAU
| | - Naif K Binsaleh
- Clinical Laboratory, College of Applied Medical Science, University of Ha'il, Ha'il, SAU
| | | | | | | | | | - Hisham Sherfi
- Medicine, College of Medicine, University of Ha'il, Ha'il, SAU
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12
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Understanding the Associations between Smoking-Related Risk Perception, Interest in Quitting Smoking, and Interest in Lung Cancer Screening among Homeless Adult Smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238817. [PMID: 33260975 PMCID: PMC7729438 DOI: 10.3390/ijerph17238817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022]
Abstract
Individuals experiencing homelessness smoke cigarettes at high rates, suffer a disproportionate incidence of lung cancer, but are unlikely to be screened to enhance early detection. Understanding correlates of lung cancer screening (LCS) interest within this vulnerable group may lend insight into prevention and treatment efforts and reduce their smoking-related morbidity and mortality. This study sought to understand how risk perception and interest in quitting smoking relate to LCS interest among homeless adults. Participants comprised a convenience sample of CO-verified current smokers (N = 310; 72.6% men, Mage = 43 + 11.7) from a homeless shelter in Dallas, TX. Participants self-reported risk perception, interest in quitting smoking, and interest in LCS. The average risk perception was 6.7 + 3.2 (range 0-10), 74.8% (n = 232) agreed or strongly agreed with interest in LCS, and 65.8% (n = 204) were interested in quitting smoking. Greater interest in quitting smoking, but not greater risk perception, was associated with greater interest in LCS (adjusted OR: 1.968, (95% CI: 1.213, 3.191), p = 0.006). Risk perception and interest in quitting smoking did not interact in their association with interest in LCS. Results suggest that homeless smokers with an interest in quitting may be receptive to LCS: a diagnostic tool by which cancers can be caught at earlier stages and prior to metastasis. However, few in the current sample would be eligible for LCS based on current guidelines; results have implications for altered screening practices among chronic smokers experiencing homelessness.
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13
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Peiffer G, Underner M, Perriot J, Ruppert AM, Tiotiu A. [Smoking cessation and lung cancer screening]. Rev Mal Respir 2020; 37:722-734. [PMID: 33129612 DOI: 10.1016/j.rmr.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
Several studies have shown that lung cancer screening, using annual low-dose computed tomography (CT) scan in a targeted population of smokers and ex-smokers reduces overall and lung cancer specific mortality rates. This form of screening strategy is not currently established for use in France by the French High Authority for Health. Quitting smoking is the most important measure in reducing mortality from lung cancer. The maximum benefit in reducing mortality from lung cancer should be seen through an effective combination of smoking cessation intervention and chest CT screening to identify early, curable disease. However, current data to guide clinicians in the choice of smoking cessation interventions in this specific context are limited due to the small number of randomized studies that have been carried out. The optimal approach to smoking cessation during lung cancer screening needs to be clarified by new studies comparing different motivation strategies, establishing the ideal moment to propose stopping smoking and the most effective therapies to use.
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Affiliation(s)
- G Peiffer
- Service de pneumologie, CHR de Metz-Thionville, 1, allée du Château, 57085 Metz, France.
| | - M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France
| | - J Perriot
- CLAT 63, dispensaire Emile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - A-M Ruppert
- Unité de tabacologie, service de pneumologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - A Tiotiu
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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14
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Hahn EJ, Wiggins AT, Rademacher K, Butler KM, Huntington-Moskos L, Rayens MK. FRESH: Long-Term Outcomes of a Randomized Trial to Reduce Radon and Tobacco Smoke in the Home. Prev Chronic Dis 2019; 16:E127. [PMID: 31517597 PMCID: PMC6745895 DOI: 10.5888/pcd16.180634] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Introduction Tobacco smoke and radon are the leading causes of lung cancer. The FRESH intervention was a randomized controlled trial of 515 homeowners to promote stage of action to reduce radon and air nicotine levels. Methods We studied 515 participants, 257 in a treatment group and 258 in a control group. Treatment participants received free radon and air nicotine test kits, report back, and telephone support, and those participants whose homes had high radon levels received a voucher for $600 toward mitigation. Both groups were asked to retest 15 months post intervention. We examined differences in stage of action to test for and mitigate radon and adopt a smoke-free–home policy and in observed radon and air nicotine values by study group over time. Results Homeowners in the treatment group scored higher on stage of action to test for radon and air nicotine and to mitigate for radon during follow-up than those in the control group at 3 months and 9 months, but the effect of the intervention diminished after 9 months. We saw no difference between groups or over time in observed radon or air nicotine values. Of homeowners in the treatment group with high radon levels at baseline, 17% mitigated, and 80% of them used the voucher we provided. Conclusion The null finding of no significant change in observed radon or air nicotine values from baseline to 15 months may reflect the low proportion of radon mitigation systems installed and the decline in stage of action to adopt a smoke-free home policy. Including a booster session at 9 months post intervention may improve the remediation rate.
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Affiliation(s)
- Ellen J Hahn
- University of Kentucky Colleges of Nursing and Public Health, 2265 Harrodsburg Road, Lexington, KY 40504.
| | | | | | - Karen M Butler
- University of Kentucky College of Nursing, Lexington, Kentucky
| | | | - Mary Kay Rayens
- University of Kentucky Colleges of Nursing and Public Health, Lexington, Kentucky
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15
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Tonge JE, Atack M, Crosbie PA, Barber PV, Booton R, Colligan D. "To know or not to know…?" Push and pull in ever smokers lung screening uptake decision-making intentions. Health Expect 2019; 22:162-172. [PMID: 30289583 PMCID: PMC6433322 DOI: 10.1111/hex.12838] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the United States, lung cancer screening aims to detect cancer early in nonsymptomatic current and former smokers. A lung screening pilot service in an area of high lung cancer incidence in the United Kingdom has been designed based on United States trial evidence. However, our understanding of acceptability and reasons for lung screening uptake or decline in a United Kingdom nontrial context are currently limited. OBJECTIVE To explore with ever smokers the acceptability of targeted lung screening and uptake decision-making intentions. DESIGN Qualitative study using semistructured focus groups and inductive thematic analysis to explore acceptability and uptake decision-making intentions with people of similar characteristics to lung screening eligible individuals. SETTING AND PARTICIPANTS Thirty-three participants (22 ex-smokers; 11 smokers) men and women, smokers and ex-smokers, aged 50-80 were recruited purposively from community and health settings in Manchester, England. RESULTS Lung screening was widely acceptable to participants. It was seen as offering reassurance about lung health or opportunity for early detection and treatment. Participant's desire to know about their lung health via screening was impacted by perceived benefits; emotions such as worry about a diagnosis and screening tests; practicalities such as accessibility; and smoking-related issues including perceptions of individual risk and smoking stigma. DISCUSSION Decision making was multifaceted with indications that current smokers faced higher participation barriers than ex-smokers. Reducing participation barriers through careful service design and provision of decision support information will be important in lung screening programmes to support informed consent and equitable uptake.
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Affiliation(s)
- Janet E. Tonge
- Macmillan Cancer Improvement PartnershipParkway Business CentreManchester Health and Care CommissioningManchesterUK
- Present address:
Leeds Institute of Health SciencesUniversity of LeedsUK
| | - Melanie Atack
- Macmillan Cancer Improvement PartnershipParkway Business CentreManchester Health and Care CommissioningManchesterUK
- Present address:
The Christie NHS Foundation TrustManchesterUK
| | - Phil A. Crosbie
- North West Lung Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - Phil V. Barber
- North West Lung Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - Richard Booton
- North West Lung Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - Denis Colligan
- Macmillan Cancer Improvement PartnershipParkway Business CentreManchester Health and Care CommissioningManchesterUK
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16
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Young B, Vedhara K, Kendrick D, Littleford R, Robertson JFR, Sullivan FM, Schembri S, das Nair R. Determinants of motivation to quit in smokers screened for the early detection of lung cancer: a qualitative study. BMC Public Health 2018; 18:1276. [PMID: 30453929 PMCID: PMC6245764 DOI: 10.1186/s12889-018-6211-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 11/08/2018] [Indexed: 12/05/2022] Open
Abstract
Background The promotion of smoking cessation within lung cancer screening could lead to benefits for smoking-related disease and improve cost-effectiveness of screening. Little is known about how smokers respond to lung cancer screening and how this impacts smoking behaviour. We aimed to understand how lung cancer screening influences individual motivations about smoking, including in those who have stopped smoking since screening. Methods Thirty one long-term smokers aged 51–74 took part in semi-structured interviews about smoking. They had been screened with the EarlyCDT-Lung Test (13 positive result; 18 negative) as part of the Early Cancer Detection Test Lung Cancer Scotland Study. They were purposively sampled for interview based on their self-reported post-screening smoking behaviour. Eleven participants had stopped smoking since screening. Verbatim interview transcripts were analysed using thematic analysis. Results Two key overarching themes were interpretations of screening test results and emotional responses to those interpretations. Participants’ understanding of the risk implied by their test result was often inaccurate, for example a negative result interpreted as an ‘all-clear’ from lung cancer and a positive result as meaning lung cancer would definitely develop. Those interpretations led to emotional responses (fear, shock, worry, relief, indifference) influencing motivations about smoking. Other themes included a wake-up call causing changes in perceived risk of smoking-related disease, a feeling that now is the time to stop smoking and family influences. There was no clear pattern in smoking motivations in those who received positive or negative test results. Of those who had stopped smoking, some cited screening experiences as the sole motivation, some cited screening along with other coinciding factors, and others cited non-screening reasons. Cues to change were experienced at different stages of the screening process. Some participants indicated they underwent screening to try and stop smoking, while others expressed little or no desire to stop. Conclusions We observed complex and individualised motivations about smoking following lung cancer screening. To be most effective, smoking cessation support in this context should explore understanding of screening test results and may need to be highly tailored to individual emotional responses to screening. Electronic supplementary material The online version of this article (10.1186/s12889-018-6211-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ben Young
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Kavita Vedhara
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Denise Kendrick
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | - John F R Robertson
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK
| | | | | | - Roshan das Nair
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, UK
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17
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Hahn EJ, Huntington-Moskos L, Mundy M, Rademacher K, Wiggins AT, Rayens MK, Studts JL, Butler KM. A Randomized Trial to Test Personalized Environmental Report Back to Reduce Lung Cancer Risk. HEALTH EDUCATION & BEHAVIOR 2018; 46:165-175. [PMID: 30078335 DOI: 10.1177/1090198118788602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND More radon-related lung cancers occur among those exposed to tobacco smoke. OBJECTIVES To test the effects of a personalized environmental report back intervention on change in stage of action for air nicotine testing and adopting a smoke-free home and radon testing and mitigation from baseline to 3 months postintervention. METHODS The study design used a two-arm parallel groups randomized controlled trial with stratified quota sampling. The treatment group received free air nicotine and radon home test kits and a brief problem-solving phone intervention; the control group received a coupon for free test kits. A sample of 515 homeowners were enrolled; 319 completed the 3-month follow-up. Stage of action to test and remediate the home was measured consistent with the precaution adoption process model. Linear mixed modeling assessed whether the main and interaction effects of treatment and time were associated with the testing and remediation outcomes; multiple covariates were included in the models. RESULTS The models for the four stages of action outcomes (testing and remediating for radon and secondhand smoke) each had a significant treatment-by-time effect. The general pattern was an increase in stage of action from baseline to 3 months. The degree of change was generally larger among the treatment group participants relative to the controls, indicating that those in the treatment group were more ready to take action. For all the models, participants with higher self-efficacy for radon/air nicotine testing and radon/secondhand smoke remediation were more ready to take action to test and remediate. Synergistic risk perception was associated with stage of action for radon mitigation. CONCLUSIONS Homeowners who were provided free radon and air nicotine test kits, given their results, and engaged in a brief telephonic problem-solving consultation tended to show a greater increase in readiness to take action to test and remediate by 3 months compared with those who received standard public health practice. Both groups showed an increase in stage of action for all four outcomes over time.
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18
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Carter-Harris L, Davis LL, Rawl SM. Lung Cancer Screening Participation: Developing a Conceptual Model to Guide Research. Res Theory Nurs Pract 2018; 30:333-352. [PMID: 28304262 DOI: 10.1891/1541-6577.30.4.333] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To describe the development of a conceptual model to guide research focused on lung cancer screening participation from the perspective of the individual in the decision-making process. METHODS Based on a comprehensive review of empirical and theoretical literature, a conceptual model was developed linking key psychological variables (stigma, medical mistrust, fatalism, worry, and fear) to the health belief model and precaution adoption process model. RESULTS Proposed model concepts have been examined in prior research of either lung or other cancer screening behavior. To date, a few studies have explored a limited number of variables that influence screening behavior in lung cancer specifically. Therefore, relationships among concepts in the model have been proposed and future research directions presented. CONCLUSION This proposed model is an initial step to support theoretically based research. As lung cancer screening becomes more widely implemented, it is critical to theoretically guide research to understand variables that may be associated with lung cancer screening participation. Findings from future research guided by the proposed conceptual model can be used to refine the model and inform tailored intervention development.
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19
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Joseph AM, Rothman AJ, Almirall D, Begnaud A, Chiles C, Cinciripini PM, Fu SS, Graham AL, Lindgren BR, Melzer AC, Ostroff JS, Seaman EL, Taylor KL, Toll BA, Zeliadt SB, Vock DM. Lung Cancer Screening and Smoking Cessation Clinical Trials. SCALE (Smoking Cessation within the Context of Lung Cancer Screening) Collaboration. Am J Respir Crit Care Med 2018; 197:172-182. [PMID: 28977754 PMCID: PMC5768904 DOI: 10.1164/rccm.201705-0909ci] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/02/2017] [Indexed: 12/17/2022] Open
Abstract
National recommendations for lung cancer screening for former and current smokers aged 55-80 years with a 30-pack-year smoking history create demand to implement efficient and effective systems to offer smoking cessation on a large scale. These older, high-risk smokers differ from participants in past clinical trials of behavioral and pharmacologic interventions for tobacco dependence. There is a gap in knowledge about how best to design systems to extend reach and treatments to maximize smoking cessation in the context of lung cancer screening. Eight clinical trials, seven funded by the National Cancer Institute and one by the Veterans Health Administration, address this gap and form the SCALE (Smoking Cessation within the Context of Lung Cancer Screening) collaboration. This paper describes methodological issues related to the design of these clinical trials: clinical workflow, participant eligibility criteria, screening indication (baseline or annual repeat screen), assessment content, interest in stopping smoking, and treatment delivery method and dose, all of which will affect tobacco treatment outcomes. Tobacco interventions consider the "teachable moment" offered by lung cancer screening, how to incorporate positive and negative screening results, and coordination of smoking cessation treatment with clinical events associated with lung cancer screening. Unique data elements, such as perceived risk of lung cancer and costs of tobacco treatment, are of interest. Lung cancer screening presents a new and promising opportunity to reduce morbidity and mortality resulting from lung cancer that can be amplified by effective smoking cessation treatment. SCALE teamwork and collaboration promise to maximize knowledge gained from the clinical trials.
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Affiliation(s)
| | | | - Daniel Almirall
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | | | - Caroline Chiles
- Department of Radiology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | - Paul M. Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Amanda L. Graham
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | | | | | - Jamie S. Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth L. Seaman
- Tobacco Control Research Branch, National Cancer Institute, Rockville, Maryland
| | - Kathryn L. Taylor
- Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Benjamin A. Toll
- Department of Public Health Sciences and Psychiatry, Medical University of South Carolina, Charleston, South Carolina; and
| | - Steven B. Zeliadt
- VA Center of Innovation for Veteran-Centered and Value-Driven Care, School of Public Health, University of Washington, Seattle, Washington
| | - David M. Vock
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
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20
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Butler KM, Rayens MK, Wiggins AT, Rademacher KB, Hahn EJ. Association of Smoking in the Home With Lung Cancer Worry, Perceived Risk, and Synergistic Risk. Oncol Nurs Forum 2018; 44:E55-E63. [PMID: 28222077 DOI: 10.1188/17.onf.e55-e63] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the association of smoking in the home with lung cancer worry, perceived risk, and synergistic risk, controlling for sociodemographics, family history of lung cancer, and health-related self-concept. The hypothesis is that participants with smoking in the home would have higher scores for lung cancer worry, perceived risk, and synergistic risk.
. DESIGN Cross-sectional baseline survey.
. SETTING Participants recruited from an outpatient clinic and pharmacy at University of Kentucky HealthCare, an academic medical center.
. SAMPLE 515 homeowners from a larger randomized, controlled trial aimed at reducing exposure to radon and secondhand smoke (SHS).
. METHODS Homeowners were selected via quota sampling so that about half would have a smoker or smokers in the home.
. MAIN RESEARCH VARIABLES Lung cancer worry and perceived risk; perception of synergistic risk of radon and SHS exposure; demographics.
. FINDINGS Participants with smoking in the home had higher rates of lung cancer worry and perceived risk. In addition, those with less education and a family history of lung cancer and who were current smokers had higher lung cancer worry and perceived lung cancer risk scores. Predictors of perception of synergistic risk were marital status and health-related self-concept.
. CONCLUSIONS Homeowners with smoking in the home, less education, and a family history of lung cancer had greater lung cancer worry and perceived lung cancer risk. Lung cancer risk reduction interventions with vulnerable populations are needed.
. IMPLICATIONS FOR NURSING Nurses are in a unique position to target high-risk populations and identify opportunities to create teachable moments to reduce environmental risks of radon and tobacco smoke exposure.
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21
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Chen LS, Kaphingst KA, Tseng TS, Zhao S. How are lung cancer risk perceptions and cigarette smoking related?-testing an accuracy hypothesis. Transl Cancer Res 2016; 5:S964-S971. [PMID: 29147644 DOI: 10.21037/tcr.2016.10.75] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Subjective risk perception is an important theoretical construct in the field of cancer prevention and control. Although the relationship between subjective risk perception and health behaviors has been widely studied in many health contexts, the causalities and associations between the risk perception of developing lung cancer and cigarette smoking have been inconsistently reported among studies. Such inconsistency may be from discrepancies between study designs (cross-sectional versus longitudinal designs) and the three hypotheses (i.e., the behavior motivation hypothesis, the risk reappraisals hypothesis, and the accuracy hypothesis) testing different underlying associations between risk perception and cigarette-smoking behaviors. To clarify this issue, as an initial step, we examined the association between absolute and relative risk perceptions of developing lung cancer and cigarette-smoking behaviors among a large, national representative sample of 1,680 U.S. adults by testing an accuracy hypothesis (i.e., people who smoke accurately perceived a higher risk of developing lung cancer). Methods Data from the U.S. Health Information National Trends Survey (HINTS) were analyzed using logistic regression and multivariate linear regression to examine the associations between risk perception and cigarette-smoking behaviors among 1,680 U.S. adults. Results Findings from this cross-sectional survey suggest that absolute and relative risk perceptions were positively and significantly correlated with having smoked >100 cigarettes during lifetime and the frequency of cigarette smoking. Only absolute risk perception was significantly associated with the number of cigarettes smoked per day among current smokers. Conclusions Because both absolute and relative risk perceptions are positively related to most cigarette-smoking behaviors, this study supports the accuracy hypothesis. Moreover, absolute risk perception might be a more sensitive measurement than relative risk perception for perceived lung cancer risk. Longitudinal research is needed in the future to investigate other types of risk perception-risk behavior hypotheses-the behavior motivation and the risk reappraisals hypotheses-among nationally representative samples to further examine the causations between risk perception of obtaining lung cancer and smoking behaviors.
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Affiliation(s)
- Lei-Shih Chen
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, Salt Lake City, UT, USA.,Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Tung-Sung Tseng
- Department of Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Shixi Zhao
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
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Fucito LM, Czabafy S, Hendricks PS, Kotsen C, Richardson D, Toll BA. Pairing smoking-cessation services with lung cancer screening: A clinical guideline from the Association for the Treatment of Tobacco Use and Dependence and the Society for Research on Nicotine and Tobacco. Cancer 2016; 122:1150-9. [PMID: 26916412 PMCID: PMC4828323 DOI: 10.1002/cncr.29926] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/12/2016] [Accepted: 01/21/2016] [Indexed: 12/17/2022]
Abstract
Smoking cessation is crucial for reducing cancer risk and premature mortality. The US Preventive Services Task Force (USPSTF) has recommended annual lung cancer screening with low-dose computed tomography (LDCT), and the Center for Medicare and Medicaid Services recently approved lung screening as a benefit for patients ages 55 to 77 years who have a 30 pack-year history. The Society for Research on Nicotine and Tobacco (SRNT) and the Association for the Treatment of Tobacco Use and Dependence (ATTUD) developed the guideline described in this commentary based on an illustrative literature review to present the evidence for smoking-cessation health benefits in this high-risk group and to provide clinical recommendations for integrating evidence-based smoking-cessation treatment with lung cancer screening. Unfortunately, extant data on lung cancer screening participants were scarce at the time this guideline was written. However, in this review, the authors summarize the sufficient evidence on the benefits of smoking cessation and the efficacy of smoking-cessation interventions for smokers ages 55 to 77 years to provide smoking-cessation interventions for smokers who seek lung cancer screening. It is concluded that smokers who present for lung cancer screening should be encouraged to quit smoking at each visit. Access to evidence-based smoking-cessation interventions should be provided to all smokers regardless of scan results, and motivation to quit should not be a necessary precondition for treatment. Follow-up contacts to support smoking-cessation efforts should be arranged for smokers. Evidence-based behavioral strategies should be used at each visit to motivate smokers who are unwilling to try quitting/reducing smoking or to try evidence-based treatments that may lead to eventual cessation.
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Affiliation(s)
- Lisa M. Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Smilow Cancer Hospital at Yale-New Haven, New Haven, Connecticut
- Yale Cancer Center, New Haven, Connecticut
| | - Sharon Czabafy
- Wellspan Ephrata Community Hospital Wellness Center, Stevens, Pennsylvania
| | - Peter S. Hendricks
- Department of Human Behavior, School of Public Health, University of Alabama, Birmingham, Alabama
| | - Chris Kotsen
- Tobacco Quitcenter, Lung Cancer Institute, Steeplechase Cancer Center, Robert Wood Johnson University Hospital, Somerville, New Jersey
| | - Donna Richardson
- Tobacco Dependence Program, Cancer Institute of New Jersey, School of Public Health, Robert Wood Johnson Medical School at Rutgers, New Brunswick, New Jersey
| | - Benjamin A. Toll
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
- Hollings Cancer Center, Charleston, South Carolina
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Manners D, Emery J, Brims FJ, Pettigrew S. Lung cancer screening - practical challenges of confining participation to those who might benefit. Aust N Z J Public Health 2016; 40:205-6. [PMID: 27028577 DOI: 10.1111/1753-6405.12516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- David Manners
- Department of General Medicine, St John of God Midland Public and Private Hospitals, Western Australia
| | - Jon Emery
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Victoria
| | - Fraser J Brims
- Department of General Medicine, St John of God Midland Public and Private Hospitals, Western Australia
| | - Simone Pettigrew
- School of Psychology and Speech Pathology, Curtin University, Western Australia
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Ostroff JS, Copeland A, Borderud SP, Li Y, Shelley DR, Henschke CI. Readiness of Lung Cancer Screening Sites to Deliver Smoking Cessation Treatment: Current Practices, Organizational Priority, and Perceived Barriers. Nicotine Tob Res 2015; 18:1067-75. [PMID: 26346948 DOI: 10.1093/ntr/ntv177] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 08/07/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Lung cancer screening represents an opportunity to deliver smoking cessation advice and assistance to current smokers. However, the current tobacco treatment practices of lung cancer screening sites are unknown. The purpose of this study was to describe organizational priority, current practice patterns, and barriers for delivery of evidence-based tobacco use treatment across lung cancer screening sites within the United States. METHODS Guided by prior work examining readiness of health care providers to deliver tobacco use treatment, we administered a brief online survey to a purposive national sample of site coordinators from 93 lung cancer screening sites. RESULTS Organizational priority for promoting smoking cessation among lung cancer screening enrollees was high. Most sites reported that, at the initial visit, patients are routinely asked about their current smoking status (98.9%) and current smokers are advised to quit (91.4%). Fewer (57%) sites provide cessation counseling or refer smokers to a quitline (60.2%) and even fewer (36.6%) routinely recommend cessation medications. During follow-up screening visits, respondents reported less attention to smoking cessation advice and treatment. Lack of patient motivation and resistance to cessation advice and treatment, lack of staff training, and lack of reimbursement were the most frequently cited barriers for delivering smoking cessation treatment. CONCLUSIONS Although encouraging that lung cancer screening sites endorsed the importance of smoking cessation interventions, greater attention to identifying and addressing barriers for tobacco treatment delivery is needed in order to maximize the potential benefit of integrating smoking cessation into lung cancer screening protocols. IMPLICATIONS This study is the first to describe practice patterns, organizational priority, and barriers for delivery of smoking cessation treatment in a national sample of lung cancer screening sites.
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Affiliation(s)
| | | | | | - Yuelin Li
- Memorial Sloan Kettering Cancer Center, New York, NY
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Ali N, Lifford KJ, Carter B, McRonald F, Yadegarfar G, Baldwin DR, Weller D, Hansell DM, Duffy SW, Field JK, Brain K. Barriers to uptake among high-risk individuals declining participation in lung cancer screening: a mixed methods analysis of the UK Lung Cancer Screening (UKLS) trial. BMJ Open 2015; 5:e008254. [PMID: 26173719 PMCID: PMC4513485 DOI: 10.1136/bmjopen-2015-008254] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The current study aimed to identify the barriers to participation among high-risk individuals in the UK Lung Cancer Screening (UKLS) pilot trial. SETTING The UKLS pilot trial is a randomised controlled trial of low-dose CT (LDCT) screening that has recruited high-risk people using a population approach in the Cambridge and Liverpool areas. PARTICIPANTS High-risk individuals aged 50-75 years were invited to participate in UKLS. Individuals were excluded if a LDCT scan was performed within the last year, if they were unable to provide consent, or if LDCT screening was unable to be carried out due to coexisting comorbidities. OUTCOME MEASURES Statistical associations between individual characteristics and UKLS uptake were examined using multivariable regression modelling. In those who completed a non-participation questionnaire (NPQ), thematic analysis of free-text data was undertaken to identify reasons for not taking part, with subsequent exploratory linkage of key themes to risk factors for non-uptake. RESULTS Comparative data were available from 4061 high-risk individuals who consented to participate in the trial and 2756 who declined participation. Of those declining participation, 748 (27.1%) completed a NPQ. Factors associated with non-uptake included: female gender (OR=0.64, p<0.001), older age (OR=0.73, p<0.001), current smoking (OR=0.70, p<0.001), lower socioeconomic group (OR=0.56, p<0.001) and higher affective risk perception (OR=0.52, p<0.001). Among non-participants who provided a reason, two main themes emerged reflecting practical and emotional barriers. Smokers were more likely to report emotional barriers to participation. CONCLUSIONS A profile of risk factors for non-participation in lung screening has emerged, with underlying reasons largely relating to practical and emotional barriers. Strategies for engaging high-risk, hard-to-reach groups are critical for the equitable uptake of a potential future lung cancer screening programme. TRIAL REGISTRATION NUMBER The UKLS trial was registered with the International Standard Randomised Controlled Trial Register under the reference 78513845.
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Affiliation(s)
- Noor Ali
- Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, UK
| | - Kate J Lifford
- Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, UK
| | - Ben Carter
- Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, UK
| | - Fiona McRonald
- Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, UK
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, The University of Liverpool Cancer Research Centre, Liverpool, UK
| | - Ghasem Yadegarfar
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, The University of Liverpool Cancer Research Centre, Liverpool, UK
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Centre, Nottingham University Hospitals, Nottingham, UK
| | - David Weller
- Centre for Population Health Sciences, Medical School, Edinburgh, UK
| | | | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, London, UK
| | - John K Field
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, The University of Liverpool Cancer Research Centre, Liverpool, UK
| | - Kate Brain
- Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff, UK
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Gomez MM, LoBiondo-Wood G. Lung Cancer Screening With Low-Dose CT: Its Effect on Smoking Behavior. J Adv Pract Oncol 2014; 4:405-14. [PMID: 25032020 PMCID: PMC4093451 DOI: 10.6004/jadpro.2013.4.6.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lung cancer screening provides an opportunity for smoking cessation interventions. A review of the literature found that smokers who participated in lung cancer screening had a higher smoking cessation rate compared with smokers in the general population. However, the randomized controlled trials included in the review did not identify any difference in smoking cessation rates between the individuals who had a CT scan to screen for lung cancer and unscreened control groups. Multiple studies observed participants for lengths of time ranging from 1 to 36 months and concluded that individuals who received abnormal CT results had a higher smoking cessation rate compared with participants with normal CT results. A single study that observed participants for 6 years initially found similar increased cessation rates among those with abnormal CT results, but at the conclusion of the study the difference in cessation rates had dissipated. Lung cancer screening produces a teachable moment when individuals may be more receptive to smoking cessation interventions. Advanced practitioners should take an active role in promoting smoking cessation interventions and fostering this teachable moment created by lung cancer screening.
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Persky S, Kaphingst KA, Allen VC, Senay I. Effects of patient-provider race concordance and smoking status on lung cancer risk perception accuracy among African-Americans. Ann Behav Med 2013; 45:308-17. [PMID: 23389688 DOI: 10.1007/s12160-013-9475-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Communication of lung cancer risk information between providers and African-American patients occurs in a context marked by race-based health disparities. PURPOSE A controlled experiment assessed whether perceived physician race influenced African-American patients' (n = 127) risk perception accuracy following the provision of objective lung cancer risk information. METHODS Participants interacted with a virtual reality-based, simulated physician who provided personalized cancer risk information. RESULTS Participants who interacted with a racially discordant virtual doctor were less accurate in their risk perceptions at post-test than those who interacted with a concordant virtual doctor, F(1,94) = 4.02, p = .048. This effect was amplified among current smokers. Effects were not mediated by trust in the provider, engagement with the health care system, or attention during the encounter. CONCLUSIONS The current study demonstrates that African-American patients' perceptions of a doctor's race are sufficient to independently impact their processing of lung cancer risk information.
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Affiliation(s)
- Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, 31 Center Drive, Bethesda, MD 20892, USA.
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Toll BA, Brandon TH, Gritz ER, Warren GW, Herbst RS. Assessing tobacco use by cancer patients and facilitating cessation: an American Association for Cancer Research policy statement. Clin Cancer Res 2013; 19:1941-8. [PMID: 23570694 DOI: 10.1158/1078-0432.ccr-13-0666] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
When diagnosed with cancer, patients can immediately make a meaningful positive impact on their health by stopping their tobacco use. Scientific evidence clearly shows that tobacco use in patients with cancer leads to poorer outcomes. The specific biological processes driving tobacco consumption's interference in cancer therapy are the subject of continuing research, but the evidence is clear that tobacco use in patients with cancer leads to decreased treatment efficacy and safety, decreased survival, decreased quality of life, increased treatment-related toxicity, and increased risk of cancer recurrence and second primary tumors. Data suggest that tobacco cessation can improve outcomes and survival in patients with cancer, yet full execution of evidence-based cessation interventions is infrequent in oncology settings. Therefore, both improved provision of cessation assistance to all patients with cancer who use tobacco or have recently quit and further study of the deleterious effects of tobacco use and benefits of tobacco cessation on cancer progression and treatment are needed and recommended by the American Association for Cancer Research. Progress on both fronts begins with universal assessment and documentation of tobacco use as a standard of quality cancer care regardless of treatment setting and will be further facilitated through the development of reliable, valid, and standard measures of tobacco use, incorporation of evidence-based procedures into quality and accreditation procedures, and the development of appropriate training, clinical infrastructure, and incentives for delivery of tobacco cessation interventions.
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Affiliation(s)
- Benjamin A Toll
- Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
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Park ER, Gareen IF, Jain A, Ostroff JS, Duan F, Sicks JD, Rakowski W, Diefenbach M, Rigotti NA. Examining whether lung screening changes risk perceptions: National Lung Screening Trial participants at 1-year follow-up. Cancer 2013; 119:1306-13. [PMID: 23280348 PMCID: PMC3604047 DOI: 10.1002/cncr.27925] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 10/24/2012] [Accepted: 10/30/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND The National Lung Screening Trial (NLST) research team reported reduced lung cancer mortality among current and former smokers with a minimum 30 pack-year history who were screened with spiral computed tomography scans compared with chest x-rays. The objectives of the current study were to examine, at 1-year follow-up: 1) risk perceptions of lung cancer and smoking-related diseases and behavior change determinants, 2) whether changes in risk perceptions differed by baseline screening result; and 3) whether changes in risk perceptions affected smoking behavior. METHODS A 25-item risk perception questionnaire was administered to a subset of participants at 8 American College of Radiology Imaging Network/NLST sites before initial and 1-year follow-up screens. Items assessed risk perceptions of lung cancer and smoking-related diseases, cognitive and emotional determinants of behavior change, and knowledge of smoking risks. RESULTS Among 430 NLST participants (mean age, 61.0 years; 55.6% men; 91.9% white), half were current smokers at baseline. Overall, risk perceptions and associated cognitive and emotional determinants of behavior change did not change significantly from prescreen trial enrollment to 1-year follow-up and did not differ significantly by screening test result. Changes in risk perceptions were not associated with changes in smoking status (9.7% of participants quit, and 6.6% relapsed) at 1-year follow-up. CONCLUSIONS Lung screening did not change participants' risk perceptions of lung cancer or smoking-related disease. A negative screening test, which was the most common screening result, did not appear to decrease risk perceptions nor provide false reassurance to smokers.
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Affiliation(s)
- Elyse R Park
- Mongan Institute for Health Policy, Harvard Medical School, Boston, MA 02114, USA.
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Overwhelming support among urban Irish COPD patients for lung cancer screening by low-dose CT scan. Lung 2012; 190:621-8. [PMID: 23064487 DOI: 10.1007/s00408-012-9421-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The National Lung Screening Trial (NLST) has renewed interest in low-dose computed tomography (LDCT) screening for lung cancer. Smokers may be less receptive toward LDCT screening, however, compared with never smokers. The views of patients with COPD, a particularly high-risk group, toward LDCT screening for lung cancer are currently unknown. We therefore evaluated attitudes of patients with COPD toward LDCT screening for lung cancer. METHODS Interviews with Irish patients with COPD who satisfied NLST eligibility criteria were conducted in clinical settings using a questionnaire based on that of a comparable study of U.S. current/former smokers of unspecified disease status. RESULTS A total of 142 subjects had a mean age of 65.09 ± 6.07 years (46.4 % were male, mean pack years 54.5 ± 33.3, mean FEV1 59.16 ± 23 %); 97.8 % had an identifiable usual source of healthcare. Compared with data from a U.S. cohort of current/former smokers, a higher proportion of Irish COPD smokers: believed that they were at risk for lung cancer (63.6 vs. 15.7 %); believed that early detection improved chances of survival (90 vs. 51.2 ); were willing to consider LDCT screening (97.9 vs. 78.6 %); were willing to pay for a LDCT scan (68.6 vs. 36.2 %); and were willing to accept treatment recommendations arising (95.7 vs. 56.2 %; p < 0.0001 for all comparisons). CONCLUSIONS Urban Irish smokers with COPD who would be eligible for LDCT screening are almost universally in favor of being screened and treated for screening-detected lung cancers. This readily accessible high-risk population should be actively targeted in future screening programs.
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Ferketich AK, Otterson GA, King M, Hall N, Browning KK, Wewers ME. A pilot test of a combined tobacco dependence treatment and lung cancer screening program. Lung Cancer 2011; 76:211-5. [PMID: 22088938 DOI: 10.1016/j.lungcan.2011.10.011] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 10/11/2011] [Accepted: 10/16/2011] [Indexed: 12/14/2022]
Abstract
Lung cancer screening with computed tomography has demonstrated a significant reduction in mortality. While these findings are important for the lung cancer research field, the most important risk factor for lung cancer, i.e. smoking, should not be ignored. We performed a pilot study to examine the feasibility of delivering a program that included both tobacco dependence treatment and lung cancer screening. The objectives of this study were to: (1) estimate the proportion of smokers who complied with a 12-week treatment protocol that included both tobacco dependence treatment and lung cancer screening, (2) obtain preliminary estimates of abstinence and quit attempts at 4 and 6 months, and (3) obtain preliminary estimates of the cognitive social health information processing (C-SHIP) constructs and how they change following the intervention. In this randomized pilot study, 18 volunteers completed a 12-week protocol: half received the tobacco dependence treatment program before a CT scan (BCT) and the other received the CT scan first, followed by the treatment program (ACT). The treatment protocol included both nurse-delivered telephone counseling and either nicotine replacement therapy or varenicline. Only one person did not complete all follow-up evaluations. At 4 months post enrollment, the carbon monoxide confirmed quit rates were 33.3% in the BCT arm and 22.2% in the ACT arm (27.8% overall), and all but one had made a 24-h attempt to quit. At 6 months the confirmed abstinence decreased to 22.1% in the BCT arm and 11.1% in the ACT arm (16.7% overall), and 72.2% of participants had made a 24-h quit attempt. These preliminary results suggest that it might be better to deliver treatment before the screening test. Future randomized trials with a larger sample size are needed to confirm these findings.
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Affiliation(s)
- Amy K Ferketich
- The Ohio State University College of Public Health, Columbus, OH 43210, USA.
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Paris C, Maurel M, Luc A, Stoufflet A, Pairon JC, Letourneux M. CT scan screening is associated with increased distress among subjects of the APExS. BMC Public Health 2010; 10:647. [PMID: 20977751 PMCID: PMC2988732 DOI: 10.1186/1471-2458-10-647] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 10/26/2010] [Indexed: 12/21/2022] Open
Abstract
Background The aim of this study was to assess the psychological consequences of HRCT scan screening in retired asbestos-exposed workers. Methods A HRCT-scan screening program for asbestos-related diseases was carried out in four regions of France. At baseline (T1), subjects filled in self-administered occupational questionnaires. In two of the regions, subjects also received a validated psychological scale, namely the psychological consequences questionnaire (PCQ). The physician was required to provide the subject with the results of the HRCT scan at a final visit. A second assessment of psychological consequences was performed 6 months after the HRCT-scan examination (T2). PCQ scores were compared quantitatively (t-test, general linear model) and qualitatively (chi²-test, logistic regression) to screening results. Multivariate analyses were adjusted for gender, age, smoking, asbestos exposure and counseling. Results Among the 832 subjects included in this psychological impact study, HRCT-scan screening was associated with a significant increase of the psychological score 6 months after the examination relative to baseline values (8.31 to 10.08, p < 0.0001, t-test). This increase concerned patients with an abnormal HRCT-scan result, regardless of the abnormalities, but also patients with normal HRCT-scans after adjustment for age, gender, smoking status, asbestos exposure and counseling visit. The greatest increase was observed for pleural plaques (+3.60; 95%CI [+2.15;+5.06]), which are benign lesions. Detection of isolated pulmonary nodules was also associated with a less marked but nevertheless significant increase of distress (+1.88; 95%CI [+0.34;+3.42]). However, analyses based on logistic regressions only showed a close to significant increase of the proportion of subjects with abnormal PCQ scores at T2 for patients with asbestosis (OR = 1.92; 95%CI [0.97-3.81]) or with two or more diseases (OR = 2.04; 95%CI [0.95-4.37]). Conclusion This study suggests that HRCT-scan screening may be associated with increased distress in asbestos-exposed subjects. If confirmed, these results may have consequences for HRCT-scan screening recommendations.
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Sinicrope PS, Rabe KG, Brockman TA, Patten CA, Petersen WO, Slusser J, Yang P, Swensen SJ, Edell ES, de Andrade M, Petersen GM. Perceptions of lung cancer risk and beliefs in screening accuracy of spiral computed tomography among high-risk lung cancer family members. Acad Radiol 2010; 17:1012-25. [PMID: 20599157 DOI: 10.1016/j.acra.2010.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 03/24/2010] [Accepted: 04/08/2010] [Indexed: 10/19/2022]
Abstract
RATIONALE AND OBJECTIVES Spiral computed tomography (SCT) is being evaluated as a screening tool for lung cancer. Our objective was to describe the effect of participation in SCT screening on participants' risk perceptions, worry, and expectations regarding the accuracy of the screening result. MATERIALS AND METHODS We surveyed 60 individuals with lung cancer family history who were participating in an SCT study for the primary purpose of improving genetic linkage analysis at baseline, and then 1 and 6 months post-SCT. RESULTS Of the 60 participants, 40 received normal results, 19 received non-negative results requiring follow-up, and 1 was diagnosed with lung cancer. At baseline, participants reported high levels of perceived lung cancer risk (64%), were concerned about developing lung cancer (94%), and the majority (84%) were not OK with receiving a non-negative SCT result when they really didn't have cancer. At 1 month post-SCT, those with a non-negative screen (n = 19) had lowered their expectations of test accuracy regarding non-negative results (54%) and reported increased levels in worry/concern (100%) and perceived risk (75%), but these effects diminished over time and returned almost to baseline levels at 6 months. CONCLUSIONS Persons at very high empiric risk for lung cancer expect their SCT screening test to be accurate and present with high levels of lung cancer risk perception and worry/concern overall. Our findings suggest a need for risk counseling and discussion on the limitations of screening tests to accurately detect lung cancer.
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Self-Selection Effects in Smokers Attending Lung Cancer Screening: A 9.5-Year Population-Based Cohort Study in Varese, Italy. J Thorac Oncol 2010; 5:428-35. [DOI: 10.1097/jto.0b013e3181d2efc7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Psychological impact of computed tomography screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers. Eur J Cancer Prev 2009; 18:203-6. [PMID: 19728402 DOI: 10.1097/cej.0b013e328329d800] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to investigate the psychological impact of screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers. Altogether, 633 workers were screened with chest computed tomography (627 men, 6 women, mean age 64.5 years). Participants' views on the necessity of screening,awareness of asbestos-exposure risks, their perceived lung cancer risk, trial adherence intention, health anxiety,and worry about lung cancer were assessed. Health anxiety was reduced significantly after screening (P < 0.001). After 1 year, no significant long-term psychological differences were found between those who immediately received clear results and those who were submitted to additional examinations because of positive findings. In conclusion,computed tomography screening of pulmonary disease was well accepted and did not produce excessive long-term anxiety or other negative psychological effects,which could prevent the participation in the future screening programs.
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Park ER, Ostroff JS, Rakowski W, Gareen IF, Diefenbach MA, Feibelmann S, Rigotti NA. Risk perceptions among participants undergoing lung cancer screening: baseline results from the National Lung Screening Trial. Ann Behav Med 2009; 37:268-79. [PMID: 19711141 DOI: 10.1007/s12160-009-9112-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lung cancer screening could present a "teachable moment" for promoting smoking cessation and relapse prevention. Understanding the risk perceptions of older individuals who undergo screening will guide these efforts. PURPOSE This paper examines National Lung Screening Trial (NLST) participants' perceptions of risk for lung cancer and other smoking-related diseases. We investigated (1) whether risk perceptions of lung cancer screening participants differed between current and former smokers and (2) which factors (sociodemographic, smoking and medical history, cognitive, emotional, and knowledge) were associated with these risk perceptions. METHODS We analyzed baseline data collected from 630 NLST participants prior to their initial screen. Participants were older (55-74 years), heavy (minimum 30 pack years) current or former smokers. A ten-item risk perception measure was developed to assess perceived lifetime risk of lung cancer and other smoking-related diseases. RESULTS The risk perception measure had excellent internal consistency (alpha = 0.93). Former smokers had lower risk perceptions compared to current smokers. Factors independently associated with high risk perceptions among current smokers included having a personal history of a smoking-related disease, higher lifetime maximum number of cigarettes smoked daily, having lived with a smoker, high worry, high perceived severity of lung cancer and smoking-related diseases, and accurate knowledge of tenfold increased risk of lung cancer for a one pack per day smoker. Factors independently associated with high risk perceptions among former smokers included being White, past history of smoking within 30 min of waking, high worry, and accurate knowledge of tenfold increased risk of lung cancer for a one pack per day smoker. CONCLUSIONS Using a comprehensive risk perception measurement, we found that current and former smokers held different risk perceptions. Former and current smokers' smoking and medical history, race, emotional concerns, behavior change cognitions, and knowledge should be considered during a prescreening risk communication session. We highlight the theoretical and risk communication implications for former and current smokers undergoing lung cancer screening.
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Affiliation(s)
- Elyse R Park
- Massachusetts General Hospital/Harvard Medical School, 50 Staniford Street, 9th Floor, Boston, MA 02114, USA.
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Ortendahl M, Näsman P. Judgments of Risk for Consequences of Continuing or Quitting Smoking—A Study of Pregnant and Nonpregnant Women Intending and Not Intending to Quit. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 34:225-33. [DOI: 10.1080/00952990701877169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bunge EM, van den Bergh KAM, Essink-Bot ML, van Klaveren RJ, de Koning HJ. High affective risk perception is associated with more lung cancer-specific distress in CT screening for lung cancer. Lung Cancer 2008; 62:385-90. [PMID: 18468717 DOI: 10.1016/j.lungcan.2008.03.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 03/14/2008] [Accepted: 03/29/2008] [Indexed: 11/26/2022]
Abstract
Screening for cancer can cause distress. People who perceive their risk of cancer as high may be more vulnerable to distress. This study evaluated whether participants of a lung cancer Computed Tomography (CT) screening trial with a high affective risk perception of developing lung cancer had a higher level of lung cancer-specific distress during CT screening. Furthermore, we evaluated whether participants perceived their risk of developing lung cancer differently 6 months after screening compared with 1 day before screening. A total of 351 subsequent participants of the NELSON-trial (Dutch-Belgian randomized controlled trial for lung cancer screening in high-risk subjects), who were randomized to the screen arm, were asked to fill in questionnaires 1 day before and 6 months after screening. Lung cancer-specific distress (Impact of Event Scale (IES)), generic health-related quality of life (SF-12) and affective risk perception were assessed. One day before screening, the participants with a high affective risk perception (n=47/321, 14.6%) had significantly higher (i.e., worse) median IES scores than participants with a low affective risk perception (11.5 vs. 2.0, p<0.01). Although median IES scores were significantly lower 6 months after screening than 1 day before screening, participants with a high affective risk perception still showed significantly higher IES scores than participants with a low affective risk perception (6.5 vs. 1.0, p<0.01). Six months after screening, significantly less participants (10.5%) felt that their risk of developing lung cancer was high than 1 day before screening (14.5%) (p<0.01). Levels of distress were not severe, but were elevated compared to participants with a low affective risk perception, and therefore, attention for this group is recommended.
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Affiliation(s)
- Eveline M Bunge
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Whynes DK. Could CT screening for lung cancer ever be cost effective in the United Kingdom? COST EFFECTIVENESS AND RESOURCE ALLOCATION 2008; 6:5. [PMID: 18302756 PMCID: PMC2292150 DOI: 10.1186/1478-7547-6-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 02/26/2008] [Indexed: 02/04/2023] Open
Abstract
Background The absence of trial evidence makes it impossible to determine whether or not mass screening for lung cancer would be cost effective and, indeed, whether a clinical trial to investigate the problem would be justified. Attempts have been made to resolve this issue by modelling, although the complex models developed to date have required more real-world data than are currently available. Being founded on unsubstantiated assumptions, they have produced estimates with wide confidence intervals and of uncertain relevance to the United Kingdom. Method I develop a simple, deterministic, model of a screening regimen potentially applicable to the UK. The model includes only a limited number of parameters, for the majority of which, values have already been established in non-trial settings. The component costs of screening are derived from government guidance and from published audits, whilst the values for test parameters are derived from clinical studies. The expected health gains as a result of screening are calculated by combining published survival data for screened and unscreened cohorts with data from Life Tables. When a degree of uncertainty over a parameter value exists, I use a conservative estimate, i.e. one likely to make screening appear less, rather than more, cost effective. Results The incremental cost effectiveness ratio of a single screen amongst a high-risk male population is calculated to be around £14,000 per quality-adjusted life year gained. The average cost of this screening regimen per person screened is around £200. It is possible that, when obtained experimentally in any future trial, parameter values will be found to differ from those previously obtained in non-trial settings. On the basis both of differing assumptions about evaluation conventions and of reasoned speculations as to how test parameters and costs might behave under screening, the model generates cost effectiveness ratios as high as around £20,000 and as low as around £7,000. Conclusion It is evident that eventually being able to identify a cost effective regimen of CT screening for lung cancer in the UK is by no means an unreasonable expectation.
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Affiliation(s)
- David K Whynes
- Professor of Health Economics, School of Economics, University of Nottingham, Nottingham, NG7 2RD, UK.
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Schnoll RA, Wileyto EP, Hornik R, Schiller J, Lerman C. Spiral computed tomography and lung cancer: science, the media, and public opinion. J Clin Oncol 2007; 25:5695-7. [PMID: 18089863 DOI: 10.1200/jco.2007.13.5228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Robert A Schnoll
- Transdisciplinary Tobacco Use Research Center, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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