1
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Whitham T, Wima K, Harnett B, Kues JR, Eckman MH, Starnes SL, Schmidt KA, Kapur S, Salfity H, Van Haren RM. Lung cancer screening utilization rate varies based on patient, provider, and hospital factors. J Thorac Cardiovasc Surg 2023; 166:1331-1339. [PMID: 36934071 DOI: 10.1016/j.jtcvs.2023.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/26/2022] [Accepted: 01/20/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Low-dose computed tomography has been proven to reduce mortality, yet utilization remains low. The purpose of this study is to identify factors that impact the utilization of lung cancer screening. METHODS We performed a retrospective review of our institution's primary care network from November 2012 to June 2022 to identify patients who were eligible for lung cancer screening. Eligible patients were 55 to 80 years of age and current or former smokers with at least a 30 pack-year history. Analyses were performed on the screened populations and patients who met eligibility criteria but were not screened. RESULTS A total of 35,279 patients in our primary care network were current/former smokers aged 55 to 80 years. A total of 6731 patients (19%) had a 30 pack-year or more cigarette history, and 11,602 patients (33%) had an unknown pack-year history. A total of 1218 patients received low-dose computed tomography. The utilization rate of low-dose computed tomography was 18%. The utilization rate was significantly lower (9%) if patients with unknown pack-year history were included (P < .001). The utilization rates between primary care clinic locations were significantly different (range, 18% vs 41%, P < .05). Utilization of low-dose computed tomography on multivariate analysis was associated with Black race, former smoker, chronic obstructive pulmonary disease, bronchitis, family history of lung cancer, and number of primary care visits (all P < .05). CONCLUSIONS Lung cancer screening utilization rates are low and vary significantly on the basis of patient comorbidities, family history of lung cancer, primary care clinic location, and accurate documentation of pack-year cigarette history. The development of programs to address patient, provider, and hospital-level factors is needed to ensure appropriate lung cancer screening.
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Affiliation(s)
- Tarik Whitham
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Koffi Wima
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Brett Harnett
- Department of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio
| | - John R Kues
- Center for Improvement Science, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mark H Eckman
- Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sandra L Starnes
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Katherine A Schmidt
- Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sangita Kapur
- Division of Cardiopulmonary Imaging, Department of Radiology, University of Cincinnati, Ohio
| | - Hai Salfity
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Robert M Van Haren
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
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2
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Kruse GR, Lykken JM, Kim EJ, Haas JS, Higashi RT, Atlas SJ, McCarthy AM, Tiro JA, Silver MI, Skinner CS, Kamineni A. Provider beliefs in effectiveness and recommendations for primary HPV testing in 3 health-care systems. JNCI Cancer Spectr 2022; 7:6873747. [PMID: 36469348 PMCID: PMC9825247 DOI: 10.1093/jncics/pkac086] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 12/10/2022] Open
Abstract
In 2018, the US Preventive Services Task Force endorsed primary human papillomavirus testing (pHPV) for cervical cancer screening. We aimed to describe providers' beliefs about pHPV testing effectiveness and which screening approach they regularly recommend. We invited providers who performed 10 or more cervical cancer screens in 2019 in 3 healthcare systems that had not adopted pHPV testing: Kaiser Permanente Washington, Mass General Brigham, and Parkland Health; 53.7% (501/933) completed the survey between October and December 2020. Response distributions varied across modalities (P < .001), with cytology alone or cotesting being more often viewed as somewhat or very effective for 30- to 65-year-olds compared with pHPV (cytology alone 94.1%, cotesting 96.1%, pHPV 66.0%). In 21- to 29-year-olds, the pattern was similar (cytology alone 92.2%, 64.7% cotesting, 50.8% pHPV). Most providers were either incorrect or unsure of the guideline-recommended screening interval for pHPV. Educational efforts are needed about the relative effectiveness and recommended use of pHPV to promote guideline-concordant care.
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Affiliation(s)
- Gina R Kruse
- Correspondence to: Gina Kruse, MD, MPH, Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge St, 16th Fl, Boston, MA 02124, USA (e-mail: )
| | - Jacquelyn M Lykken
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Eric J Kim
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer S Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robin T Higashi
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven J Atlas
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jasmin A Tiro
- Department of Public Health Sciences, University of Chicago—Biological Sciences Division, Chicago, IL, USA
| | - Michelle I Silver
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Celette S Skinner
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA,Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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3
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Abstract
Lung cancer is a leading cause of cancer death in the United States and globally with the majority of lung cancer cases attributable to cigarette smoking. Given the high societal and personal cost of a diagnosis of lung cancer including that most cases of lung cancer when diagnosed are found at a late stage, work over the past 40 years has aimed to detect lung cancer earlier when curative treatment is possible. Screening trials using chest radiography and sputum failed to show a reduction in lung cancer mortality however multiple studies using low dose CT have shown the ability to detect lung cancer early and a survival benefit to those screened. This review will discuss the history of lung cancer screening, current recommendations and screening guidelines, and implementation and components of a lung cancer screening program.
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4
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Community-based Lung Cancer Screening Results in Relation to Patient and Radiologist Characteristics: The PROSPR Consortium. Ann Am Thorac Soc 2022; 19:433-441. [PMID: 34543590 PMCID: PMC8937226 DOI: 10.1513/annalsats.202011-1413oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Rationale: Lung-RADS classification was developed to standardize reporting and management of lung cancer screening using low-dose computed tomographic (LDCT) imaging. Although variation in Lung-RADS distribution between healthcare systems has been reported, it is unclear if this is explained by patient characteristics, radiologist experience with lung cancer screening, or other factors. Objectives: Our objective was to determine if patient or radiologist factors are associated with Lung-RADS score. Methods: In the Population-based Research to Optimize the Screening Process (PROSPR) Lung consortium, we conducted a study of patients who received their first screening LDCT imaging at one of the five healthcare systems in the PROSPR Lung Research Center from May 1, 2014, through December 31, 2017. Data on LDCT scans, patient factors, and radiologist characteristics were obtained via electronic health records. LDCT scan findings were categorized using Lung-RADS (negative [1], benign [2], probably benign [3], or suspicious [4]). We used generalized estimating equations with a multinomial distribution to compare the odds of Lung-RADS 3, and separately Lung-RADS 4, versus Lung-RADS 1 or 2 and estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between Lung-RADS assignment and patient and radiologist characteristics. Results: Analyses included 8,556 patients; 24% were assigned Lung-RADS 1, 60% Lung-RADS 2, 10% Lung-RADS 3, and 5% Lung-RADS 4. Age was positively associated with Lung-RADS 3 (OR, 1.02; 95% CI, 1.01-1.03) and 4 (OR, 1.03; 95% CI, 1.01-1.05); chronic obstructive pulmonary disease (COPD) was positively associated with Lung-RADS 4 (OR, 1.78; 95% CI, 1.45-2.20); obesity was inversely associated with Lung-RADS 3 (OR, 0.70; 95% CI, 0.58-0.84) and 4 (OR, 0.58; 95% CI, 0.45-0.75). There was no association between sex, race, ethnicity, education, or smoking status and Lung-RADS assignment. Radiologist volume of interpreting screening LDCT scans, years in practice, and thoracic specialty were also not associated with Lung-RADS assignment. Conclusions: Healthcare systems that are comprised of patients with an older age distribution or higher levels of COPD will have a greater proportion of screening LDCT scans with Lung-RADS 3 or 4 findings and should plan for additional resources to support appropriate and timely management of noted positive findings.
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5
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Fedewa SA, Kazerooni EA, Studts JL, Smith RA, Bandi P, Sauer AG, Cotter M, Sineshaw HM, Jemal A, Silvestri GA. State Variation in Low-Dose Computed Tomography Scanning for Lung Cancer Screening in the United States. J Natl Cancer Inst 2021; 113:1044-1052. [PMID: 33176362 PMCID: PMC8328984 DOI: 10.1093/jnci/djaa170] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/10/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Annual lung cancer screening (LCS) with low-dose chest computed tomography in older current and former smokers (ie, eligible adults) has been recommended since 2013. Uptake has been slow and variable across the United States. We estimated the LCS rate and growth at the national and state level between 2016 and 2018. METHODS The American College of Radiology's Lung Cancer Screening Registry was used to capture screening events. Population-based surveys, the US Census, and cancer registry data were used to estimate the number of eligible adults and lung cancer mortality (ie, burden). Lung cancer screening rates (SRs) in eligible adults and screening rate ratios with 95% confidence intervals (CI) were used to measure changes by state and year. RESULTS Nationally, the SR was steady between 2016 (3.3%, 95% CI = 3.3% to 3.7%) and 2017 (3.4%, 95% CI = 3.4% to 3.9%), increasing to 5.0% (95% CI = 5.0% to 5.7%) in 2018 (2018 vs 2016 SR ratio = 1.52, 95% CI = 1.51 to 1.62). In 2018, several southern states with a high lung-cancer burden (eg, Mississippi, West Virginia, and Arkansas) had relatively low SRs (<4%) among eligible adults, whereas several northeastern states with lower lung cancer burden (eg, Massachusetts, Vermont, and New Hampshire) had the highest SRs (12.8%-15.2%). The exception was Kentucky, which had the nation's highest lung cancer mortality rate and one of the highest SRs (13.7%). CONCLUSIONS Fewer than 1 in 20 eligible adults received LCS nationally, and uptake varied widely across states. LCS rates were not aligned with lung cancer burden across states, except for Kentucky, which has supported comprehensive efforts to implement LCS.
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Affiliation(s)
- Stacey A Fedewa
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Ella A Kazerooni
- Departments of Radiology and Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Jamie L Studts
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert A Smith
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Priti Bandi
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Ann Goding Sauer
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Megan Cotter
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Helmneh M Sineshaw
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Ahmedin Jemal
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Gerard A Silvestri
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
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6
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Castro S, Sosa E, Lozano V, Akhtar A, Love K, Duffels J, Raz DJ, Kim JY, Sun V, Erhunmwunsee L. The impact of income and education on lung cancer screening utilization, eligibility, and outcomes: a narrative review of socioeconomic disparities in lung cancer screening. J Thorac Dis 2021; 13:3745-3757. [PMID: 34277066 PMCID: PMC8264678 DOI: 10.21037/jtd-20-3281] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
Non-small cell lung cancer (NSCLC) is the leading cause of cancer deaths in the US and worldwide. In particular, vulnerable populations such as those of low socioeconomic status (SES) are at the highest risk for and suffer the highest mortality from NSCLC. Although lung cancer screening (LCS) has been demonstrated to be a powerful tool to lower NSCLC mortality, it is underutilized by eligible smokers, and disparities in screening are likely to contribute to inequities in NSCLC outcomes. It is imperative that we collect and analyze LCS data focused on individuals of low socioeconomic position to identify and address barriers to LCS utilization and help close the gaps in NSCLC mortality along socioeconomic lines. Toward this end, this review aims to examine published studies that have evaluated the impact of income and education on LCS utilization, eligibility, and outcomes. We searched the PubMed, Ovid MEDLINE, and CINAHL Plus databases for all studies published from January 1, 2010, to October 21, 2020, that discussed socioeconomic-based LCS outcomes. The review reveals that income and education have impact on LCS utilization, eligibility, false positive rates and smoking cessation attempts; however, there is a lack of studies evaluating the impact of SES on LCS follow-up, stage at diagnosis, and treatment. We recommend the intentional inclusion of lower SES participants in LCS studies in order to clarify appropriate eligibility criteria, risk-based metrics and outcomes in this high-risk group. We also anticipate that low SES smokers and their providers will require increased support and education regarding smoking cessation and shared decision-making efforts.
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Affiliation(s)
- Samuel Castro
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Ernesto Sosa
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Vanessa Lozano
- Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Aamna Akhtar
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Kyra Love
- Library Services, City of Hope National Medical Center, Duarte, CA, USA
| | - Jeanette Duffels
- Library Services, City of Hope National Medical Center, Duarte, CA, USA
| | - Dan J Raz
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jae Y Kim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Virginia Sun
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.,Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Loretta Erhunmwunsee
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.,Department of Populations Sciences, City of Hope National Medical Center, Duarte, CA, USA
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7
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Rennert L, Zhang L, Lumsden B, Harwood K, Tyler L, Ashby M, Hanna JW, Gimbel RW. Factors influencing lung cancer screening completion following participation in shared decision-making: A retrospective study in a U.S. academic health system. Cancer Treat Res Commun 2020; 24:100198. [PMID: 32736218 PMCID: PMC7366080 DOI: 10.1016/j.ctarc.2020.100198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/09/2020] [Accepted: 07/16/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Shared decision making (SDM) between patients and designated health professionals is recommended by several professional organizations prior to lung cancer screening by low dose CT (LDCT). This study seeks to identify factors, including characteristics of patients and referring clinicians, that influence LDCT screening completion following participation in SDM. MATERIALS AND METHODS This retrospective study consisted of n = 171 patients eligible for LDCT screening and who participated in SDM between 2016 and 2017 in one of two sites in Prisma Health, an academic health care delivery system in South Carolina. Patient characteristics included age, sex, race, body mass index, marital status, insurance, smoking status and history, family history of lung cancer, SDM site, and distance to screening site. Characteristics of referred clinicians included age, sex, race, specialty, years of practice, education, and residency. Descriptive statistics and multivariable generalized linear mixed models were used to compare effects of patient and referring clinician characteristics on LDCT completion. RESULTS A total of 152 patients (89%) completed LDCT screening after participation in SDM. SDM site (p = 0.02), longer distances to the screening site (p = 0.03), referrals from internal medicine clinicians (p = 0.03), and referrals from younger clinicians (p = 0.01) and from those with less years of experience (p = 0.02) were significantly associated with a lower likelihood of screening completion. CONCLUSIONS Several factors significantly associated with screening completion were identified. This information can assist with development of interventions to improve communication and decision-making between patients, clinicians, and SDM health professionals, and inform design of targeted decision aids embedded into SDM procedures.
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Affiliation(s)
- Lior Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States.
| | - Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Brandon Lumsden
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States; School of Mathematical and Statistical Sciences, Clemson University, Clemson, SC, United States
| | - Katon Harwood
- School of Osteopathic Medicine, Campbell University, Lillington, NC, United States
| | - Lauren Tyler
- School of Medicine, University of South Carolina, Greenville, SC, United States
| | - Morgan Ashby
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Jeffrey W Hanna
- Department of Radiology, Prisma Health System, Greenville, SC, United States
| | - Ronald W Gimbel
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
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8
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Maiga AW, Deppen SA, Massion PP, Callaway-Lane C, Pinkerman R, Dittus RS, Lambright ES, Nesbitt JC, Grogan EL. Communication About the Probability of Cancer in Indeterminate Pulmonary Nodules. JAMA Surg 2019; 153:353-357. [PMID: 29261826 DOI: 10.1001/jamasurg.2017.4878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Clinical guidelines recommend that clinicians estimate the probability of malignancy for patients with indeterminate pulmonary nodules (IPNs) larger than 8 mm. Adherence to these guidelines is unknown. Objectives To determine whether clinicians document the probability of malignancy in high-risk IPNs and to compare these quantitative or qualitative predictions with the validated Mayo Clinic Model. Design, Setting, and Participants Single-institution, retrospective cohort study of patients from a tertiary care Department of Veterans Affairs hospital from January 1, 2003, through December 31, 2015. Cohort 1 included 291 veterans undergoing surgical resection of known or suspected lung cancer from January 1, 2003, through December 31, 2015. Cohort 2 included a random sample of 239 veterans undergoing inpatient or outpatient pulmonary evaluation of IPNs at the hospital from January 1, 2003, through December 31, 2012. Exposures Clinician documentation of the quantitative or qualitative probability of malignancy. Main Outcomes and Measures Documentation from pulmonary and/or thoracic surgery clinicians as well as information from multidisciplinary tumor board presentations was reviewed. Any documented quantitative or qualitative predictions of malignancy were extracted and summarized using descriptive statistics. Clinicians' predictions were compared with risk estimates from the Mayo Clinic Model. Results Of 291 patients in cohort 1, 282 (96.9%) were men; mean (SD) age was 64.6 (9.0) years. Of 239 patients in cohort 2, 233 (97.5%) were men; mean (SD) age was 65.5 (10.8) years. Cancer prevalence was 258 of 291 cases (88.7%) in cohort 1 and 110 of 225 patients with a definitive diagnosis (48.9%) in cohort 2. Only 13 patients (4.5%) in cohort 1 and 3 (1.3%) in cohort 2 had a documented quantitative prediction of malignancy prior to tissue diagnosis. Of the remaining patients, 217 of 278 (78.1%) in cohort 1 and 149 of 236 (63.1%) in cohort 2 had qualitative statements of cancer risk. In cohort 2, 23 of 79 patients (29.1%) without any documented malignancy risk statements had a final diagnosis of cancer. Qualitative risk statements were distributed among 32 broad categories. The most frequently used statements aligned well with Mayo Clinic Model predictions for cohort 1 compared with cohort 2. The median Mayo Clinic Model-predicted probability of cancer was 68.7% (range, 2.4%-100.0%). Qualitative risk statements roughly aligned with Mayo predictions. Conclusions and Relevance Clinicians rarely provide quantitative documentation of cancer probability for high-risk IPNs, even among patients drawn from a broad range of cancer probabilities. Qualitative statements of cancer risk in current practice are imprecise and highly variable. A standard scale that correlates with predicted cancer risk for IPNs should be used to communicate with patients and other clinicians.
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Affiliation(s)
- Amelia W Maiga
- Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephen A Deppen
- Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Pierre P Massion
- Department of Medicine, Tennessee Valley Healthcare System, Nashville.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Rhonda Pinkerman
- Department of Surgery, Tennessee Valley Healthcare System, Nashville
| | - Robert S Dittus
- Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, Nashville
| | - Eric S Lambright
- Department of Surgery, Tennessee Valley Healthcare System, Nashville.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan C Nesbitt
- Department of Surgery, Tennessee Valley Healthcare System, Nashville.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric L Grogan
- Department of Surgery, Tennessee Valley Healthcare System, Nashville.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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9
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Kim DD, Cohen JT, Wong JB, Mohit B, Fendrick AM, Kent DM, Neumann PJ. Targeted Incentive Programs For Lung Cancer Screening Can Improve Population Health And Economic Efficiency. Health Aff (Millwood) 2019; 38:60-67. [PMID: 30615528 DOI: 10.1377/hlthaff.2018.05148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Because an intervention's clinical benefit depends on who receives it, a key to improving the efficiency of lung cancer screening with low-dose computed tomography (LDCT) is to incentivize its use among the current or former smokers who are most likely to benefit from it. Despite its clinical advantages and cost-effectiveness, only 3.9 percent of the eligible population underwent LDCT screening in 2015. Using individual lung cancer mortality risk, we developed a policy simulation model to explore the potential impact of implementing risk-targeted incentive programs, compared to either implementing untargeted incentive programs or doing nothing. We found that compared to the status quo, an untargeted incentive program that increased overall LDCT screening from 3,900 (baseline) to 10,000 per 100,000 eligible people would save 12,300 life-years and accrue a net monetary benefit (NMB) of $771 million over a lifetime horizon. Increasing screening by the same amount but targeting higher-risk people would yield an additional 2,470-6,600 life-years and an additional $210-$560 million NMB, depending on the extent of the risk-targeting. Risk-targeted incentive programs could include provider-level bonuses, health plan premium subsidies, and smoking cessation programs to maximize their impact. As clinical medicine becomes more personalized, targeting and incentivizing higher-risk people will help enhance population health and economic efficiency.
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Affiliation(s)
- David D Kim
- David D. Kim ( ) is an assistant professor of medicine in the School of Medicine, Tufts University, and an investigator in the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, in Boston, Massachusetts
| | - Joshua T Cohen
- Joshua T. Cohen is a research associate professor of medicine in the School of Medicine, Tufts University, and deputy director of the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center
| | - John B Wong
- John B. Wong is a professor of medicine in the School of Medicine, Tufts University, and chief of the Division of Clinical Decision Making, Tufts Medical Center
| | - Babak Mohit
- Babak Mohit is a postdoctoral research fellow in the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center
| | - A Mark Fendrick
- A. Mark Fendrick is a professor in the Department of Internal Medicine, University of Michigan, in Ann Arbor
| | - David M Kent
- David M. Kent is a professor of medicine in the School of Medicine, Tufts University, and director of the Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center
| | - Peter J Neumann
- Peter J. Neumann is a professor of medicine in the School of Medicine, Tufts University, and director of the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center
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10
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Soneji S, Yang J, Tanner NT, Dang R, Silvestri GA, Black W. Underuse of Chest Radiography Versus Computed Tomography for Lung Cancer Screening. Am J Public Health 2019; 107:1248-1250. [PMID: 28700293 DOI: 10.2105/ajph.2017.303919] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Samir Soneji
- Samir Soneji and Rui Dang are with the Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH. JaeWon Yang is with the Warren Alpert School of Medicine at Brown University, Providence, RI. Nichole T. Tanner and Gerard A. Silvestri are with the Medical University of South Carolina Thoracic Oncology Research Group and Division of Pulmonary Critical Care Medicine, Ralph H. Johnson Veterans Affairs Hospital, Charleston. William Black is with the Department of Radiology and Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth
| | - JaeWon Yang
- Samir Soneji and Rui Dang are with the Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH. JaeWon Yang is with the Warren Alpert School of Medicine at Brown University, Providence, RI. Nichole T. Tanner and Gerard A. Silvestri are with the Medical University of South Carolina Thoracic Oncology Research Group and Division of Pulmonary Critical Care Medicine, Ralph H. Johnson Veterans Affairs Hospital, Charleston. William Black is with the Department of Radiology and Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth
| | - Nichole T Tanner
- Samir Soneji and Rui Dang are with the Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH. JaeWon Yang is with the Warren Alpert School of Medicine at Brown University, Providence, RI. Nichole T. Tanner and Gerard A. Silvestri are with the Medical University of South Carolina Thoracic Oncology Research Group and Division of Pulmonary Critical Care Medicine, Ralph H. Johnson Veterans Affairs Hospital, Charleston. William Black is with the Department of Radiology and Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth
| | - Rui Dang
- Samir Soneji and Rui Dang are with the Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH. JaeWon Yang is with the Warren Alpert School of Medicine at Brown University, Providence, RI. Nichole T. Tanner and Gerard A. Silvestri are with the Medical University of South Carolina Thoracic Oncology Research Group and Division of Pulmonary Critical Care Medicine, Ralph H. Johnson Veterans Affairs Hospital, Charleston. William Black is with the Department of Radiology and Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth
| | - Gerard A Silvestri
- Samir Soneji and Rui Dang are with the Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH. JaeWon Yang is with the Warren Alpert School of Medicine at Brown University, Providence, RI. Nichole T. Tanner and Gerard A. Silvestri are with the Medical University of South Carolina Thoracic Oncology Research Group and Division of Pulmonary Critical Care Medicine, Ralph H. Johnson Veterans Affairs Hospital, Charleston. William Black is with the Department of Radiology and Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth
| | - William Black
- Samir Soneji and Rui Dang are with the Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH. JaeWon Yang is with the Warren Alpert School of Medicine at Brown University, Providence, RI. Nichole T. Tanner and Gerard A. Silvestri are with the Medical University of South Carolina Thoracic Oncology Research Group and Division of Pulmonary Critical Care Medicine, Ralph H. Johnson Veterans Affairs Hospital, Charleston. William Black is with the Department of Radiology and Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth
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Richards TB, Doria-Rose VP, Soman A, Klabunde CN, Caraballo RS, Gray SC, Houston KA, White MC. Lung Cancer Screening Inconsistent With U.S. Preventive Services Task Force Recommendations. Am J Prev Med 2019; 56:66-73. [PMID: 30467092 PMCID: PMC6319382 DOI: 10.1016/j.amepre.2018.07.030] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/20/2018] [Accepted: 07/24/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Prior studies suggest overuse of nonrecommended lung cancer screening tests in U.S. community practice and underuse of recommended tests. METHODS Data from the 2010 and 2015 National Health Interview Surveys was analyzed from 2016 to 2018. Prevalence, populations, and number of chest computed tomography (CT) and chest x-ray tests were estimated for people who did and did not meet U.S. Preventive Services Task Force (USPSTF) criteria for lung cancer screening, among people aged ≥40 years without lung cancer. RESULTS In 2015, among those who met USPSTF criteria, 4.4% (95% CI=3.0%, 6.6%), or 360,000 (95% CI=240,000, 535,000) people reported lung cancer screening with a chest CT; and 8.5% (95% CI=6.5%, 11.1%), or 689,000 (95% CI=526,000, 898,000) people reported a chest x ray. Among those who did not meet USPSTF criteria, 2.3% (95% CI=2.0%, 2.6%), or 3,259,000 (95% CI=2,850,000, 3,724,000) people reported a chest x ray; and 1.3% (95% CI=1.1%, 1.5%), or 1,806,000 (95% CI=1,495,000, 2,173,000) people reported a chest CT. The estimated population meeting USPSTF criteria for lung cancer screening in 2015 was 8,098,000 (95% CI=7,533,000, 8,702,000), which was smaller than the 9,620,000 people (95% CI=8,960,000, 10,325,000) in 2010. CONCLUSIONS The number of adults inappropriately screened for lung cancer greatly exceeds the number screened according to USPSTF recommendations, the prevalence of appropriate lung cancer screening is low, and the population meeting USPSTF criteria is shrinking. To realize the potential benefits of screening, better processes to appropriately triage eligible individuals to screening, plus screening with a USPSTF-recommended test, would be beneficial.
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Affiliation(s)
- Thomas B Richards
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | | | | | - Ralph S Caraballo
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Simone C Gray
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Keisha A Houston
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Division of Emergency and Environmental Health Services, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary C White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Eberth JM, McDonnell KK, Sercy E, Khan S, Strayer SM, Dievendorf AC, Munden RF, Vernon SW. A national survey of primary care physicians: Perceptions and practices of low-dose CT lung cancer screening. Prev Med Rep 2018; 11:93-99. [PMID: 29984145 PMCID: PMC6030390 DOI: 10.1016/j.pmedr.2018.05.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/16/2018] [Accepted: 05/14/2018] [Indexed: 12/30/2022] Open
Abstract
Soon after the National Lung Screening Trial, organizations began to endorse low-dose computed tomography (LCDT) screening for lung cancer in high-risk patients. Concerns about the risks versus benefits of screening, as well as the logistics of identifying and referring eligible patients, remained among physicians. This study aimed to examine primary care physicians' knowledge, attitudes, referral practices, and associated barriers regarding LDCT screening. We administered a national survey of primary care physicians in the United States between September 2016 and April 2017. Physicians received up to 3 mailings, 1 follow-up email, and received varying incentives to complete the survey. Overall, 293 physicians participated, for a response rate of 13%. We used weighted descriptive statistics to characterize participants and their responses. Over half of the respondents correctly reported that the US Preventive Services Task Force recommends LDCT screening for high-risk patients. Screening recommendations for patients not meeting high-risk criteria varied. Although 75% agreed that the benefits of LDCT screening outweigh the risks, fewer agreed that there is substantial evidence that screening reduces mortality (50%). The most commonly reported barriers to ordering screening included prior authorization requirements (57%), lack of insurance coverage (53%), and coverage denials (31%). The most frequently cited barrier to conducting LDCT screening shared decision making was patients' competing health priorities (42%). Given the impact of physician recommendations on cancer screening utilization, further understanding of physicians' LDCT screening attitudes and shared decision-making practices is needed. Clinical practice and policy changes are also needed to engage more patients in screening discussions. Most physicians had five or less lung cancer screening referrals in the past year Recommendation strategies varied, but often aligned with USPSTF or NCCN guidelines Physicians were uncertain about the efficacy and cost-effectiveness of screening Insurance coverage and costs were commonly cited as barriers to screening referral A common barrier to performing SDM was patients' competing health priorities
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Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | | | - Erica Sercy
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.,Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Samira Khan
- Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Scott M Strayer
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Amy C Dievendorf
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Reginald F Munden
- Department of Radiology, Wake Forest Baptist Medical Center, Winston Salem, NC, United States
| | - Sally W Vernon
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, United States
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13
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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: 29] [Impact Index Per Article: 4.8] [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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14
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Screening for Lung Cancer: Lexicon for Communicating With Health Care Providers. AJR Am J Roentgenol 2018; 210:473-479. [DOI: 10.2214/ajr.17.18865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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15
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Henderson LM, Jones LM, Marsh MW, Brenner AT, Goldstein AO, Benefield TS, Greenwood-Hickman MA, Molina PL, Rivera MP, Reuland DS. Opinions, practice patterns, and perceived barriers to lung cancer screening among attending and resident primary care physicians. Risk Manag Healthc Policy 2018; 10:189-195. [PMID: 29403320 PMCID: PMC5784747 DOI: 10.2147/rmhp.s143152] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The US Preventive Services Task Force recommended annual lung cancer screening with low-dose computed tomography (LDCT) for high-risk patients in December 2013. We compared lung cancer screening-related opinions and practices among attending and resident primary care physicians (PCPs). Methods In 2015, we conducted a 23-item survey among physicians at a large academic medical center. We surveyed 100 resident PCPs (30% response rate) and 86 attending PCPs (49% response rate) in Family Medicine and Internal Medicine. The questions focused on physicians’ opinions, knowledge of recommendations, self-reported practice patterns, and barriers to lung cancer screening. In 2015 and 2016, we compared responses among attending versus resident PCPs using chi-square/Fisher’s exact tests and 2-samples t-tests. Results Compared with resident PCPs, attending PCPs were older (mean age =47 vs 30 years) and more likely to be male (54% vs 37%). Over half of both groups concurred that inconsistent recommendations make deciding whether or not to screen difficult. A substantial proportion in both groups indicated that they were undecided about the benefit of lung cancer screening for patients (43% attending PCPs and 55% resident PCPs). The majority of attending and resident PCPs agreed that barriers to screening included limited time during patient visits (62% and 78%, respectively), cost to patients (74% and 83%, respectively), potential for complications (53% and 70%, respectively), and a high false-positive rate (67% and 73%, respectively). Conclusion There was no evidence to suggest that attending and resident PCPs had differing opinions about lung cancer screening. For population-based implementation of lung cancer screening, physicians and trainees will need resources and time to address the benefits and harms with their patients.
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Affiliation(s)
- Louise M Henderson
- Department of Radiology, The University of North Carolina, Chapel Hill, NC
| | - Laura M Jones
- Department of Radiology, The University of North Carolina, Chapel Hill, NC
| | - Mary W Marsh
- Department of Radiology, The University of North Carolina, Chapel Hill, NC
| | - Alison T Brenner
- Department of Medicine.,The University of North Carolina Lineberger Comprehensive Cancer Center
| | - Adam O Goldstein
- Department of Family Medicine, The University of North Carolina, Chapel Hill, NC
| | - Thad S Benefield
- Department of Radiology, The University of North Carolina, Chapel Hill, NC
| | | | - Paul L Molina
- Department of Radiology, The University of North Carolina, Chapel Hill, NC
| | | | - Daniel S Reuland
- Department of Medicine.,The University of North Carolina Lineberger Comprehensive Cancer Center
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16
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Khairy M, Duong DK, Shariff-Marco S, Cheng I, Jain J, Balakrishnan A, Liu L, Gupta A, Chandramouli R, Hsing A, Leung A, Singh B, Nair VS. An Analysis of Lung Cancer Screening Beliefs and Practice Patterns for Community Providers Compared to Academic Providers. Cancer Control 2018; 25:1073274818806900. [PMID: 30375235 PMCID: PMC6210633 DOI: 10.1177/1073274818806900] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/19/2018] [Accepted: 08/30/2018] [Indexed: 11/16/2022] Open
Abstract
Despite guidelines recommending annual low-dose computed tomography (LDCT) screening for lung cancer, uptake remains low due to the perceived complexity of initiating and maintaining a clinical program-problems that likely magnify in underserved populations. We conducted a survey of community providers at Federally Qualified Health Centers (FQHCs) in Santa Clara County, California, to evaluate provider-related factors that affect adherence. We then compared these findings to academic providers' (APs) LDCT screening knowledge, behaviors, and attitudes at an academic referral center in the same county. The 4 FQHCs enrolled care for 80 000 patients largely of minority descent and insured by Medi-Cal. Of the 75 FQHC providers (FQHCPs), 36 (48%) completed the survey. Of the 36 providers, 8 (22%) knew screening criteria. Fifteen (42%) FQHCPs discussed LDCT screening with patients. Compared to 36 APs, FQHCPs were more concerned about harms, false positives, discussion time, patient apathy, insurance coverage, and a lack of expertise for screening and follow-up. Yet, more FQHCPs thought screening was effective (27 [75%] of 36) compared to APs ( P = .0003). In conclusion, provider knowledge gaps are greater and barriers are different for community clinics caring for underserved populations compared to their academic counterparts, but practical and scalable solutions exist to enhance adoption.
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Affiliation(s)
- Marjon Khairy
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
- * Marjon Khairy and Duy K. Duong are equal contributors and co-primary authors
| | - Duy K. Duong
- Division of Pulmonary & Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
- * Marjon Khairy and Duy K. Duong are equal contributors and co-primary authors
| | | | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Jennifer Jain
- Cancer Prevention Institute of California, Fremont, CA, USA
| | | | - Lynn Liu
- North East Medical Center, San Jose, CA, USA
| | - Aarti Gupta
- Mayview Community Health Center, Mountain View, CA, USA
| | | | - Ann Hsing
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Ann Leung
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Baldeep Singh
- Department of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, USA
| | - Viswam S. Nair
- Division of Pulmonary & Critical Care Medicine, USF Health Morsani College of Medicine, Tampa, FL, USA
- Thoracic Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, FL, USA
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17
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Yang S, Chen L, Chan DW, Li QK, Zhang H. Protein signatures of molecular pathways in non-small cell lung carcinoma (NSCLC): comparison of glycoproteomics and global proteomics. Clin Proteomics 2017; 14:31. [PMID: 28814946 PMCID: PMC5557576 DOI: 10.1186/s12014-017-9166-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 08/05/2017] [Indexed: 12/18/2022] Open
Abstract
Background Non-small cell lung carcinoma (NSCLC) remains the leading cause of cancer deaths in the United States. More than half of NSCLC patients have clinical presentations with locally advanced or metastatic disease at the time of diagnosis. The large-scale genomic analysis of NSCLC has demonstrated that molecular alterations are substantially different between adenocarcinoma (ADC) and squamous cell carcinoma (SqCC). However, a comprehensive analysis of proteins and glycoproteins in different subtypes of NSCLC using advanced proteomic approaches has not yet been conducted. Methods We applied mass spectrometry (MS) technology featuring proteomics and glycoproteomics to analyze six primary lung SqCCs and eleven ADCs, and we compared the expression level of proteins and glycoproteins in tumors using quantitative proteomics. Glycoproteins were analyzed by enrichment using a chemoenzymatic method, solid-phase extraction of glycopeptides, and quantified by iTRAQ-LC–MS/MS. Protein quantitation was further annotated via Ingenuity Pathway Analysis. Results Over 6000 global proteins and 480 glycoproteins were quantitatively identified in both SqCC and ADC. ADC proteins (8337) consisted of enzymes (22.11%), kinases (5.11%), transcription factors (6.85%), transporters (6.79%), and peptidases (3.30%). SqCC proteins (6967) had a very similar distribution. The identified glycoproteins, in order of relative abundance, included membrane (42%) and extracellular matrix (>33%) glycoproteins. Oncogene-coded proteins (82) increased 1.5-fold among 1047 oncogenes identified in ADC, while 124 proteins from SqCC were up-regulated in tumor tissues among a total of 827 proteins. We identified 680 and 563 tumor suppressor genes from ADC and SqCC, respectively. Conclusion Our systematic analysis of proteins and glycoproteins demonstrates changes of protein and glycoprotein relative abundance in SqCC (TP53, U2AF1, and RXR) and in ADC (SMARCA4, NOTCH1, PTEN, and MST1). Among them, eleven glycoproteins were upregulated in both ADC and SqCC. Two glycoproteins (ELANE and IGFBP3) were only increased in SqCC, and six glycoproteins (ACAN, LAMC2, THBS1, LTBP1, PSAP and COL1A2) were increased in ADC. Ingenuity Pathway Analysis (IPA) showed that several crucial pathways were activated in SqCC and ADC tumor tissues. Electronic supplementary material The online version of this article (doi:10.1186/s12014-017-9166-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuang Yang
- Department of Pathology, Johns Hopkins Medicine, Smith Bldg 4013, 400 N. Broadway, Baltimore, MD 21287 USA
| | - Lijun Chen
- Department of Pathology, Johns Hopkins Medicine, Smith Bldg 4013, 400 N. Broadway, Baltimore, MD 21287 USA
| | - Daniel W Chan
- Department of Pathology, Johns Hopkins Medicine, Smith Bldg 4013, 400 N. Broadway, Baltimore, MD 21287 USA
| | - Qing Kay Li
- Department of Pathology, Johns Hopkins Medicine, Smith Bldg 4013, 400 N. Broadway, Baltimore, MD 21287 USA
| | - Hui Zhang
- Department of Pathology, Johns Hopkins Medicine, Smith Bldg 4013, 400 N. Broadway, Baltimore, MD 21287 USA
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18
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Erkmen CP, Moore RF, Belden C, DiSesa V, Kaiser LR, Ma GX, Paranjape A. Overcoming Barriers to Lung Cancer Screening by Implementing a Single-Visit Patient Experience. ACTA ACUST UNITED AC 2017; 4. [PMID: 29399636 PMCID: PMC5796669 DOI: 10.15436/2377-0902.17.1469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Cherie P Erkmen
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA.,Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Ryan F Moore
- Department of Surgery, Temple University Hospital, Philadelphia, PA
| | - Clifford Belden
- Department of Radiology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Verdi DiSesa
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Larry R Kaiser
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA.,Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Anuradha Paranjape
- Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
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19
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Abbasi A, Siddiqi R, Owais A, Laeeq T, Ali SN, Mushahid Z, Ahsan SM, Jatoi AS, Abbasi A, Butt I, Ali R, Abbasi M, Jaffri SNN, Jabir M, Khanani H, Fatima K. Prevalence and Barriers to Lung Cancer Screening in Karachi, Pakistan: A Cross-Sectional Survey of Smokers and Physicians. Cureus 2017. [PMID: 28630806 PMCID: PMC5472400 DOI: 10.7759/cureus.1248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Early detection of lung cancer using low-dose computed tomography (LDCT) can potentially reduce morbidity and mortality. However, LDCT for lung cancer screening, especially in low income countries, has been underutilized. The objective of this study was to evaluate the prevalence and the potential personal, social, and economic barriers of lung cancer screening using LDCT. Methods A total sample of 156 smokers and 200 general physicians was collected during December 2016-February 2017 from community settings in Karachi, Pakistan. Two separate questionnaires were constructed to characterize participants’ knowledge, attitudes, and practices regarding lung cancer screening. Screening-eligible smokers and physicians were asked to identify patient barriers to screening and were asked their opinion regarding most effective approach for increasing awareness of screening guidelines. Results The majority of smokers' (n=91, 58.3%) and physicians' (n=131, 65.7%) beliefs about the US Preventive Services Task Force (USPSTF) eligibility criteria were inconsistent with the actual recommendations. Major barriers to screening included financial cost, lack of patient counseling and health anxiety related to screening. Over two-thirds (n=105, 67.3%) of smokers were receptive to further information about LDCT screening, and half (n=78, 50.0%) favored one-on-one counseling by their physician, compared to other media. Only one-third (n=65, 33.3%) of physicians reported use of LDCT screening, although 54.5% (n=108) felt that screening implementation would be very effective in their practice. Conclusion LDCT screening is currently an uncommon practice in Pakistan. Financial cost, inadequate doctor-patient communication, and lack of awareness of guidelines among both patients and physicians are the major barriers in the utilization of LDCT screening.
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Affiliation(s)
- Aleeza Abbasi
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Rabbia Siddiqi
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Aatika Owais
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Tooba Laeeq
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Sara N Ali
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Zonaira Mushahid
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Syed M Ahsan
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Aliya S Jatoi
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Aleena Abbasi
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Ifrah Butt
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Ruba Ali
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Maham Abbasi
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | | | - Mariam Jabir
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Hajra Khanani
- Dow Medical College, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Kaneez Fatima
- Department of Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, Pakistan
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20
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Evaluations of Implementation at Early-Adopting Lung Cancer Screening Programs: Lessons Learned. Chest 2017; 152:70-80. [PMID: 28223153 DOI: 10.1016/j.chest.2017.02.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/24/2016] [Accepted: 02/01/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Guidelines recommend lung cancer screening (LCS), and it is currently being adopted nationwide. The American College of Chest Physicians advises inclusion of specific programmatic components to ensure high-quality screening. However, little is known about how LCS has been implemented in practice. We sought to evaluate the experience of early-adopting programs, characterize barriers faced, and identify strategies to achieve successful implementation. METHODS We performed qualitative evaluations of LCS implementation at three Veterans Administration facilities, conducting semistructured interviews with key staff (n = 29). Guided by the Promoting Action on Research Implementation in Health Services framework, we analyzed transcripts using principals of grounded theory. RESULTS Programs successfully incorporated most recommended elements of LCS, although varying in approaches to patient selection, tobacco treatment, and quality audits. Barriers to implementation included managing workload to ensure appropriate evaluation of pulmonary nodules detected by screening and difficulty obtaining primary care "buy-in." To manage workload, programs used nurse coordinators to actively maintain screening registries, held multidisciplinary conferences that generated explicit management recommendations, and rolled out implementation in a staged fashion. Successful strategies to engage primary care providers included educational sessions, audit and feedback of local outcomes, and assisting with and assigning clear responsibility for nodule evaluation. Capitalizing on pre-existing relationships and including a designated program champion helped facilitate intradisciplinary communication. CONCLUSIONS Lung cancer screening implementation is a complex undertaking requiring coordination at many levels. The insight gained from evaluation of these early-adopting programs may inform subsequent design and implementation of LCS programs.
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21
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Duong DK, Shariff-Marco S, Cheng I, Naemi H, Moy LM, Haile R, Singh B, Leung A, Hsing A, Nair VS. Patient and primary care provider attitudes and adherence towards lung cancer screening at an academic medical center. Prev Med Rep 2017; 6:17-22. [PMID: 28210538 PMCID: PMC5304233 DOI: 10.1016/j.pmedr.2017.01.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 01/18/2017] [Accepted: 01/22/2017] [Indexed: 12/17/2022] Open
Abstract
Low dose CT (LDCT) for lung cancer screening is an evidence-based, guideline recommended, and Medicare approved test but uptake requires further study. We therefore conducted patient and provider surveys to elucidate factors associated with utilization. Patients referred for LDCT at an academic medical center were questioned about their attitudes, knowledge, and beliefs on lung cancer screening. Adherent patients were defined as those who met screening eligibility criteria and completed a LDCT. Referring primary care providers within this same medical system were surveyed in parallel about their practice patterns, attitudes, knowledge and beliefs about screening. Eighty patients responded (36%), 48 of whom were adherent. Among responders, non-Hispanic patients (p = 0.04) were more adherent. Adherent respondents believed that CT technology is accurate and early detection is useful, and they trusted their providers. A majority of non-adherent patients (79%) self-reported an intention to obtain a LDCT in the future. Of 36 of 87 (41%) responding providers, only 31% knew the correct lung cancer screening eligibility criteria, which led to a 37% inappropriate referral rate from 2013 to 2015. Yet, 75% had initiated lung cancer screening discussions, 64% thought screening was at least moderately effective, and 82% were interested in learning more of the 33 providers responding to these questions. Overall, patients were motivated and providers engaged to screen for lung cancer by LDCT. Non-adherent patient “procrastinators” were motivated to undergo screening in the future. Additional follow through on non-adherence may enhance screening uptake, and raising awareness for screening eligibility through provider education may reduce inappropriate referrals. Lung cancer screening was viewed favorably by patients at our medical center. Non-Hispanic patients were more likely to adhere to a prescribed screening test. Eligible, non-adherent, patients were still interested in screening. Providers were motivated to screen but under-informed on patient eligibility. Providers were open to additional education on lung cancer screening.
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Affiliation(s)
- Duy K Duong
- Santa Clara Valley Medical Center, Department of Medicine, San Jose, CA, United States; Stanford University School of Medicine, Division of Pulmonary & Critical Care Medicine, Stanford, CA, United States
| | - Salma Shariff-Marco
- Cancer Prevention Institute of California, Fremont, CA, United States; Stanford Cancer Institute, Stanford, CA, United States
| | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, CA, United States; Stanford Cancer Institute, Stanford, CA, United States
| | - Harris Naemi
- Stanford University School of Medicine, Department of Radiology, Stanford, CA, United States; Stanford University School of Medicine, Division of Pulmonary & Critical Care Medicine, Stanford, CA, United States
| | - Lisa M Moy
- Cancer Prevention Institute of California, Fremont, CA, United States
| | - Robert Haile
- Stanford University School of Medicine, Department of Health & Research Policy, Stanford, CA, United States
| | - Baldeep Singh
- Stanford University School of Medicine, Department of General Medical Disciplines, Stanford, CA, United States
| | - Ann Leung
- Stanford University School of Medicine, Department of Radiology, Stanford, CA, United States
| | - Ann Hsing
- Stanford Cancer Institute, Stanford, CA, United States; Stanford University School of Medicine, Stanford Prevention Research Center, Stanford, CA, United States
| | - Viswam S Nair
- Stanford University School of Medicine, Department of Radiology, Stanford, CA, United States; Stanford University School of Medicine, Division of Pulmonary & Critical Care Medicine, Stanford, CA, United States
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Al-Ayoubi AM, Flores RM. Lung cancer screening: did we really need a randomized controlled trial? Eur J Cardiothorac Surg 2016; 50:29-33. [DOI: 10.1093/ejcts/ezw043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Ersek JL, Eberth JM, McDonnell KK, Strayer SM, Sercy E, Cartmell KB, Friedman DB. Knowledge of, attitudes toward, and use of low-dose computed tomography for lung cancer screening among family physicians. Cancer 2016; 122:2324-31. [PMID: 27294476 DOI: 10.1002/cncr.29944] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/08/2016] [Accepted: 01/12/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The results of the National Lung Screening Trial showed a 20% reduction in lung cancer mortality and a 6.7% reduction in all-cause mortality when high-risk patients were screened with low-dose computed tomography (LDCT) versus chest x-ray (CXR). The US Preventive Services Task Force has issued a grade B recommendation for LDCT screening, and the Centers for Medicare and Medicaid Services and private insurers now cover the screening cost under certain conditions. The purpose of this study was to assess the knowledge of, attitudes toward, and use of LDCT screening for lung cancer among family physicians. METHODS A 32-item questionnaire was distributed to members of the South Carolina Academy of Family Physicians in 2015. Descriptive statistics were calculated. RESULTS There were 101 respondents, and most had incorrect knowledge about which organizations recommended screening. Many physicians continued to recommend CXR for lung cancer screening. Most felt that LDCT screening increased the odds of detecting disease at earlier stages (98%) and that the benefits outweighed the harms (75%). Concerns included unnecessary procedures (88%), stress/anxiety (52%), and radiation exposure (50%). Most physicians discussed the risks/benefits of screening with their patients in some capacity (76%); however, more than 50% reported making 1 or no screening recommendations in the past year. CONCLUSIONS Most family physicians report discussing LDCT with patients at high risk for lung cancer; however, referrals remain low. There are gaps in physician knowledge about screening guidelines and reimbursement, and this indicates a need for further educational outreach. The development of decision aids may facilitate shared decision-making discussions about screening, and targeted interventions may improve knowledge gaps. Cancer 2016;122:2324-2331. © 2016 American Cancer Society.
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Affiliation(s)
- Jennifer L Ersek
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Levine Cancer Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Scott M Strayer
- Department of Family Medicine, University of South Carolina, Columbia, South Carolina
| | - Erica Sercy
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Kathleen B Cartmell
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina
| | - Daniela B Friedman
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, South Carolina
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Carter-Harris L, Ceppa DP, Hanna N, Rawl SM. Lung cancer screening: what do long-term smokers know and believe? Health Expect 2015; 20:59-68. [PMID: 26701339 PMCID: PMC4919238 DOI: 10.1111/hex.12433] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 01/07/2023] Open
Abstract
Objective To explore knowledge and beliefs of long‐term smokers about lung cancer, associated risk factors and lung cancer screening. Design Qualitative study theoretically framed by the expanded Health Belief Model based on four focus group discussions. Content analysis was performed to identify themes of knowledge and beliefs about lung cancer, associated risk factors and lung cancer screening among long‐term smokers' who had and had not been screened for lung cancer. Methods Twenty‐six long‐term smokers were recruited; two groups (n = 9; n = 3) had recently been screened and two groups (n = 7; n = 7) had never been screened. Results While most agreed lung cancer is deadly, confusion or inaccurate information exists regarding the causes and associated risk factors. Knowledge related to lung cancer screening and how it is performed was low; awareness of long‐term smoking's association with lung cancer risk remains suboptimal. Perceived benefits of screening identified include: (i) finding lung cancer early; (ii) giving peace of mind; and (iii) motivation to quit smoking. Perceived barriers to screening identified include: (i) inconvenience; (ii) distrust; and (iii) stigma. Conclusions Perceived barriers to lung cancer screening, such as distrust and stigma, must be addressed as lung cancer screening becomes more widely implemented. Heightened levels of health‐care system distrust may impact successful implementation of screening programmes. Perceived smoking‐related stigma may lead to low levels of patient engagement with medical care and decreased cancer screening participation. It is also important to determine modifiable targets for intervention to enhance the shared decision‐making process between health‐care providers and their high‐risk patients.
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Affiliation(s)
| | | | - Nasser Hanna
- Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Susan M Rawl
- Indiana University School of Nursing, Indianapolis, IN, USA
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Hoffman RM, Sussman AL, Getrich CM, Rhyne RL, Crowell RE, Taylor KL, Reifler EJ, Wescott PH, Murrietta AM, Saeed AI, Mishra SI. Attitudes and Beliefs of Primary Care Providers in New Mexico About Lung Cancer Screening Using Low-Dose Computed Tomography. Prev Chronic Dis 2015; 12:E108. [PMID: 26160294 PMCID: PMC4509091 DOI: 10.5888/pcd12.150112] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION On the basis of results from the National Lung Screening Trial (NLST), national guidelines now recommend using low-dose computed tomography (LDCT) to screen high-risk smokers for lung cancer. Our study objective was to characterize the knowledge, attitudes, and beliefs of primary care providers about implementing LDCT screening. METHODS We conducted semistructured interviews with primary care providers practicing in New Mexico clinics for underserved minority populations. The interviews, conducted from February through September 2014, focused on providers' tobacco cessation efforts, lung cancer screening practices, perceptions of NLST and screening guidelines, and attitudes about informed decision making for cancer screening. Investigators iteratively reviewed transcripts to create a coding structure. RESULTS We reached thematic saturation after interviewing 10 providers practicing in 6 urban and 4 rural settings; 8 practiced at federally qualified health centers. All 10 providers promoted smoking cessation, some screened with chest x-rays, and none screened with LDCT. Not all were aware of NLST results or current guideline recommendations. Providers viewed study results skeptically, particularly the 95% false-positive rate, the need to screen 320 patients to prevent 1 lung cancer death, and the small proportion of minority participants. Providers were uncertain whether New Mexico had the necessary infrastructure to support high-quality screening, and worried about access barriers and financial burdens for rural, underinsured populations. Providers noted the complexity of discussing benefits and harms of screening and surveillance with their patient population. CONCLUSION Providers have several concerns about the feasibility and appropriateness of implementing LDCT screening. Effective lung cancer screening programs will need to educate providers and patients to support informed decision making and to ensure that high-quality screening can be efficiently delivered in community practice.
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Affiliation(s)
- Richard M Hoffman
- University of New Mexico School of Medicine, University of New Mexico Cancer Center, Albuquerque Veterans Affairs Medical Center, Albuquerque, New Mexico
| | - Andrew L Sussman
- University of New Mexico Cancer Center and Department of Family Medicine and Community Medicine, Albuquerque, New Mexico
| | | | - Robert L Rhyne
- University of New Mexico Cancer Center and Department of Family Medicine and Community Medicine, Albuquerque, New Mexico
| | - Richard E Crowell
- University of New Mexico School of Medicine and University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Kathryn L Taylor
- Georgetown Lombardi Comprehensive Cancer Center and Georgetown University Medical Center, Washington, DC
| | | | | | - Ambroshia M Murrietta
- Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Ali I Saeed
- University of New Mexico School of Medicine and University of New Mexico Cancer Center, Albuquerque, New Mexico
| | - Shiraz I Mishra
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM 87131. . Dr Mishra is also affiliated with the University of New Mexico Cancer Center and the Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Simmons J, Gould MK, Woloshin S, Schwartz LM, Wiener RS. Attitudes about low-dose computed tomography screening for lung cancer: a survey of American Thoracic Society Clinicians. Am J Respir Crit Care Med 2015; 191:483-6. [PMID: 25679109 DOI: 10.1164/rccm.201409-1747le] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- James Simmons
- 1 Boston University School of Medicine Boston, Massachusetts
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Eberth JM, Qiu R, Adams SA, Salloum RG, Bell N, Arrington AK, Linder SK, Munden RF. Lung cancer screening using low-dose CT: the current national landscape. Lung Cancer 2014; 85:379-84. [PMID: 25088660 DOI: 10.1016/j.lungcan.2014.07.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/03/2014] [Accepted: 07/04/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Although the National Lung Screening Trial (NLST) lauds the efficacy of low-dose computed tomography (LDCT) at reducing lung cancer mortality, it has not been widely used for population-based screening. By examining the availability of U.S. LDCT screening centers, and underlying rates of lung cancer incidence, mortality, and smoking prevalence, the need for additional centers may be determined. MATERIALS AND METHODS Locations of 203 LDCT screening centers from the Lung Cancer Alliance Screening Centers of Excellence database, a list of active NLST and International Early Lung and Cardiac Action Program (I-ELCAP) screening centers, and an independently conducted survey of Society of Thoracic Radiology members were geocoded and mapped. County-level rates of lung cancer incidence, mortality, and smoking prevalence were also mapped and overlaid with the locations of the 203 LDCT screening centers. RESULTS AND CONCLUSIONS Results showed the majority of LDCT screening centers were located in the counties with the highest quartiles of lung cancer incidence and mortality in the Northeast and East North Central states, but several high-risk states had no or few identified screening centers including Oklahoma, Nevada, Mississippi, and Arkansas. As guidelines are implemented and reimbursement for LDCT screening follows, equitable access to LDCT screening centers will become increasingly important, particularly in regions with high rates of lung cancer incidence and smoking prevalence.
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Affiliation(s)
- Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, United States; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, United States.
| | - Rebecca Qiu
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, United States.
| | - Swann A Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, United States; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, United States; School of Nursing, University of South Carolina, United States.
| | - Ramzi G Salloum
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, United States.
| | - Nathanial Bell
- School of Nursing, University of South Carolina, United States.
| | - Amanda K Arrington
- Department of Surgery, School of Medicine, University of South Carolina, United States.
| | - Suzanne K Linder
- Sealy Center on Aging, The University of Texas Medical Branch-Galveston, United States.
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Richards TB, White MC, Caraballo RS. Lung cancer screening with low-dose computed tomography for primary care providers. Prim Care 2014; 41:307-30. [PMID: 24830610 DOI: 10.1016/j.pop.2014.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This review provides an update on lung cancer screening with low-dose computed tomography (LDCT) and its implications for primary care providers. One of the unique features of lung cancer screening is the potential complexity in patient management if an LDCT scan reveals a small pulmonary nodule. Additional tests, consultation with multiple specialists, and follow-up evaluations may be needed to evaluate whether lung cancer is present. Primary care providers should know the resources available in their communities for lung cancer screening with LDCT and smoking cessation, and the key points to be addressed in informed and shared decision-making discussions with patients.
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Affiliation(s)
- Thomas B Richards
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Building 107, F-76, 4770 Buford Highway Northeast, Atlanta, GA 30341-3717, USA.
| | - Mary C White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Building 107, F-76, 4770 Buford Highway Northeast, Atlanta, GA 30341-3717, USA
| | - Ralph S Caraballo
- Office of Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Building 107, F-79, 4770 Buford Highway Northeast, Atlanta, GA 30341-3717, USA
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Li QK, Gabrielson E, Askin F, Chan DW, Zhang H. Glycoproteomics using fluid-based specimens in the discovery of lung cancer protein biomarkers: promise and challenge. Proteomics Clin Appl 2014; 7:55-69. [PMID: 23112109 DOI: 10.1002/prca.201200105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 10/01/2012] [Accepted: 10/05/2012] [Indexed: 12/29/2022]
Abstract
Lung cancer is the leading cancer in the United States and worldwide. In spite of the rapid progression in personalized treatments, the overall survival rate of lung cancer patients is still suboptimal. Over the past decade, tremendous efforts have been focused on the discovery of protein biomarkers to facilitate the early detection and monitoring of lung cancer progression during treatment. In addition to tumor tissues and cancer cell lines, a variety of biological material has been studied. Particularly in recent years, studies using fluid-based specimen or so-called "fluid-biopsy" specimens have progressed rapidly. Fluid specimens are relatively easier to collect than tumor tissue, and they can be repeatedly sampled during the disease progression. Glycoproteins are the major content of fluid specimens and have long been recognized to play fundamental roles in many physiological and pathological processes. In this review, we focus the discussion on recent advances of glycoproteomics, particularly in the identification of potential glyco protein biomarkers using fluid-based specimens in lung cancer. The purpose of this review is to summarize current strategies, achievements, and perspectives in the field. This insight will highlight the discovery of tumor-associated glycoprotein biomarkers in lung cancer and their potential clinical applications.
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Affiliation(s)
- Qing Kay Li
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA.
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Aberle DR, Abtin F, Brown K. Computed tomography screening for lung cancer: has it finally arrived? Implications of the national lung screening trial. J Clin Oncol 2013; 31:1002-8. [PMID: 23401434 DOI: 10.1200/jco.2012.43.3110] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The National Lung Screening Trial (NLST) has provided compelling evidence of the efficacy of lung cancer screening using low-dose helical computed tomography (LDCT) to reduce lung cancer mortality. The NLST randomized 53,454 older current or former heavy smokers to receive LDCT or chest radiography (CXR) for three annual screens. Participants were observed for a median of 6.5 years for outcomes. Vital status was available in more than 95% of participants. LDCT was positive in 24.2% of screens, compared with 6.9% of CXRs; more than 95% of all positive LDCT screens were not associated with lung cancer. LDCT detected more than twice the number of early-stage lung cancers and resulted in a stage shift from advanced to early-stage disease. Complications of LDCT screening were minimal. Lung cancer-specific mortality was reduced by 20% relative to CXR; all-cause mortality was reduced by 6.7%. The major harms of LDCT are radiation exposure, high false-positive rates, and the potential for overdiagnosis. This review discusses the risks and benefits of LDCT screening as well as an approach to LDCT implementation that incorporates systematic screening practice with smoking cessation programs and offers opportunities for better determination of appropriate risk cohorts for screening and for better diagnostic prediction of lung cancer in the setting of screen-detected nodules. The challenges of implementation are considered for screening programs, for primary care clinicians, and across socioeconomic strata. Considerations for future research to complement imaging-based screening to reduce the burden of lung cancer are discussed.
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Affiliation(s)
- Denise R Aberle
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90024, USA.
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How have we diagnosed early-stage lung cancer without radiographic screening? A contemporary single-center experience. PLoS One 2012; 7:e52313. [PMID: 23284984 PMCID: PMC3528766 DOI: 10.1371/journal.pone.0052313] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 11/16/2012] [Indexed: 11/30/2022] Open
Abstract
Background The National Lung Screening Trial (NLST), which demonstrated a reduction in lung cancer mortality, may result in widespread computed tomography (CT)-based screening of select populations. How early-stage lung cancer has been diagnosed without screening, and what proportion of these cases would be captured by a screening program modeled on the NLST, is not currently known. We therefore evaluated current patterns of early-stage lung cancer presentation. Methodology/Principal Findings We performed a single-institution retrospective analysis of patients diagnosed with stage I–II non-small cell lung cancer (NSCLC) from 2000–2009. Associations between patient and imaging characteristics were assessed using univariate and multivariate analyses. A total of 412 patients met criteria for analysis. Among those with available reason for initial imaging, the reason was symptoms in 51%, follow-up of other conditions in 43%, and screening in 6%. Reason for imaging was associated with race (P<0.001), insurance type (P = 0.005), and disease stage (P<0.001). Type of initial imaging was associated with reason for imaging (P<0.001), year (chest x-ray 67% in 2000–2004 vs. 49% in 2005–2009; P<0.001), and disease stage (P = 0.005). Among patients with available quantified smoking history, 48% were age 55–74 years and smoked 30-plus pack-years, therefore meeting NLST entry criteria. Conclusions/Significance Symptoms remain a dominant but declining reason for detection of early-stage NSCLC. The proportion of cases detected initially by CT scan without antecedent chest x-ray has increased considerably. Because as few as half of cases meet NLST eligibility criteria, clinicians should remain aware of the diverse circumstances of early-stage lung cancer presentation to expedite therapy.
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Li QK, Gabrielson E, Zhang H. Application of glycoproteomics for the discovery of biomarkers in lung cancer. Proteomics Clin Appl 2012; 6:244-56. [PMID: 22641610 DOI: 10.1002/prca.201100042] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths in the United States. Approximately 40-60% of lung cancer patients present with locally advanced or metastatic disease at the time of diagnosis. Lung cancer development and progression are a multistep process that is characterized by abnormal gene and protein expressions ultimately leading to phenotypic change. Glycoproteins have long been recognized to play fundamental roles in many physiological and pathological processes, particularly in cancer genesis and progression. In order to improve the survival rate of lung cancer patients, the discovery of early diagnostic and prognostic biomarkers is urgently needed. Herein, we reviewed the recent technological developments of glycoproteomics and published data in the field of glycoprotein biomarkers in lung cancer, and discussed their utility and limitations for the discovery of potential biomarkers in lung cancer. Although numerous papers have already acknowledged the importance of the discovery of cancer biomarkers, the systemic study of glycoproteins in lung cancer using glycoproteomic approaches is still suboptimal. Recent development in the glycoproteomics will provide new platforms for identification of potential protein biomarkers in lung cancers.
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Affiliation(s)
- Qing Kay Li
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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Doria-Rose VP, White MC, Klabunde CN, Nadel MR, Richards TB, McNeel TS, Rodriguez JL, Marcus PM. Use of lung cancer screening tests in the United States: results from the 2010 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev 2012; 21:1049-59. [PMID: 22573798 PMCID: PMC3392469 DOI: 10.1158/1055-9965.epi-12-0343] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Before evidence of efficacy, lung cancer screening was being ordered by many physicians. The National Lung Screening Trial (NLST), which showed a 20% reduction in lung cancer mortality among those randomized to receive low-dose computed tomography (LDCT), will likely lead to increased screening use. METHODS We estimated the prevalence of chest X-ray and CT use in the United States using data from the 2010 National Health Interview Survey (NHIS). Subjects included 15,537 NHIS respondents aged ≥40 years without prior diagnosis of lung cancer. Estimates of the size of the U. S. population by age and smoking status were calculated. Multivariate logistic regression examined predictors of test use adjusting for potential confounders. RESULTS Twenty-three percent of adults reported chest X-ray in the previous year and 2.5% reported chest X-ray specifically to check for lung cancer; corresponding numbers for chest CT were 7.5% and 1.3%. Older age, black race, male gender, smoking, respiratory disease, personal history of cancer, and having health insurance were associated with test use. Approximately, 8.7 million adults in the United States would be eligible for LDCT screening according to NLST eligibility criteria. CONCLUSIONS AND IMPACT Monitoring of trends in the use of lung screening tests will be vital to assess the impact of NLST and possible changes in lung cancer screening recommendations and insurance coverage in the future. Education of patients by their physicians, and of the general public, may help ensure that screening is used appropriately, in those most likely to benefit.
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Affiliation(s)
- V Paul Doria-Rose
- Health Services and Economics Branch/Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA.
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Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2012: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin 2012; 62:129-42. [PMID: 22261986 DOI: 10.3322/caac.20143] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Each year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, a report on data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, current ACS cancer screening guidelines are summarized, as are the latest data on the use of cancer screening from the National Health Interview Survey.
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Affiliation(s)
- Robert A Smith
- Cancer Control Science Department, American Cancer Society, Atlanta, GA 30303, USA.
| | - Vilma Cokkinides
- Program Director for Risk Factor Surveillance, Department of Epidemiology and Research Surveillance, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Executive Vice President for Research and Medical Affairs, American Cancer Society, Atlanta, GA, and Editor-in-Chief of CA
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Klabunde CN, Marcus PM, Han PKJ, Richards TB, Vernon SW, Yuan G, Silvestri GA. Lung cancer screening practices of primary care physicians: results from a national survey. Ann Fam Med 2012; 10:102-10. [PMID: 22412001 PMCID: PMC3315128 DOI: 10.1370/afm.1340] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 08/02/2011] [Accepted: 08/23/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although current practice guidelines do not recommend screening asymptomatic patients for lung cancer, physicians may still order lung cancer screening tests. No recent national survey of health care professionals has focused on lung cancer screening. In this study, we examined the lung cancer screening practices of US primary care physicians and characteristics of those who order lung cancer screening tests. METHODS We conducted a nationally representative survey of practicing primary care physicians in 2006-2007. Mailed questionnaires assessed the physicians' knowledge of lung cancer screening guidelines, beliefs about the effectiveness of screening tests, and ordering of screening chest radiograph, low-dose spiral computed tomography, or sputum cytology in the past 12 months. Clinical vignettes were used to assess the physicians' intentions to screen asymptomatic 50-year-old patients with varying smoking histories for lung cancer. RESULTS A total of 962 family physicians, general practitioners, and general internists completed questionnaires (cooperation rate = 76.8%). Overall, 38% had ordered no lung cancer screening tests; 55% had ordered chest radiograph, 22% low-dose spiral computed tomography, and less than 5% sputum cytology. In multivariate modeling, physicians were more likely to have ordered lung cancer screening tests if they believed that expert groups recommend lung cancer screening or that screening tests are effective; if they would recommend screening for asymptomatic patients, including patients without substantial smoking exposure; and if their patients had asked them about screening. CONCLUSIONS Primary care physicians in the United States frequently order lung cancer screening tests for asymptomatic patients, even though expert groups do not recommend it. Primary care physicians and patients need more information about lung cancer screening's evidence base, guidelines, potential harms, and costs to avert inappropriate ordering.
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Affiliation(s)
- Carrie N Klabunde
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA.
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A qualitative analysis of lung cancer screening practices by primary care physicians. J Community Health 2012; 36:949-56. [PMID: 21442338 DOI: 10.1007/s10900-011-9394-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lung cancer is the leading cause of cancer death in the United States, but no scientific organization currently recommends screening because of limited evidence for its effectiveness. Despite this, physicians often order screening tests such as chest X-rays and computerized tomography scans for their patients. Limited information is available about how physicians decide when to order these tests. To identify factors that affect whether physicians' screen patients for lung cancer, we conducted five 75-min telephone-based focus groups with 28 US primary care physicians and used inductive qualitative research methods to analyze their responses. We identified seven factors that influenced these physicians' decisions about screening patients for lung cancer: (1) their perception of a screening test's effectiveness, (2) their attitude toward recommended screening guidelines, (3) their practice experience, (4) their perception of a patient's risk for lung cancer, (5) reimbursement and payment for screening, (6) their concern about litigation, and (7) whether a patient requested screening. Because these factors may have conflicting effects on physicians' decisions to order screening tests, physicians may struggle in determining when screening for lung cancer is appropriate. We recommend (1) more clinician education, beginning in medical school, about the existing evidence related to lung cancer screening, with emphasis on the benefit of and training in tobacco use prevention and cessation, (2) more patient education about the benefits and limitations of screening, (3) further studies about the effect of patients' requests to be screened on physicians' decisions to order screening tests, and (4) larger, quantitative studies to follow up on our formative data.
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Abstract
Cancer is one of the leading causes of death throughout the world. Advancements in early and improved diagnosis could help prevent a significant number of these deaths. Raman spectroscopy is a vibrational spectroscopic technique which has received considerable attention recently with regards to applications in clinical oncology. Raman spectroscopy has the potential not only to improve diagnosis of cancer but also to advance the treatment of cancer. A number of studies have investigated Raman spectroscopy for its potential to improve diagnosis and treatment of a wide variety of cancers. In this paper the most recent advances in dispersive Raman spectroscopy, which have demonstrated promising leads to real world application for clinical oncology are reviewed. The application of Raman spectroscopy to breast, brain, skin, cervical, gastrointestinal, oral, and lung cancers is reviewed as well as a special focus on the data analysis techniques, which have been employed in the studies.
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Slatore CG, Gould MK, Au DH, Deffebach ME, White E. Lung cancer stage at diagnosis: Individual associations in the prospective VITamins and lifestyle (VITAL) cohort. BMC Cancer 2011; 11:228. [PMID: 21649915 PMCID: PMC3129325 DOI: 10.1186/1471-2407-11-228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 06/07/2011] [Indexed: 12/21/2022] Open
Abstract
Background Lung cancer is the leading cause of cancer death in the United States. Identifying factors associated with stage of diagnosis can improve our understanding of biologic and behavioral pathways of lung cancer development and detection. We used data from a prospective cohort study to evaluate associations of demographic, health history, and health behaviors with early versus late stage at diagnosis of non-small cell lung cancer (NSCLC). Methods We calculated odds ratios (ORs) for the association of patient-level characteristics with advanced stage of diagnosis for NSCLC. The OR's were then adjusted for age, gender, race/ethnicity, smoking status, income, education, chronic obstructive pulmonary disease, and a comorbidity index. Results We identified 612 cases of NSCLC among 77,719 adults, aged 50 to 76 years from Washington State recruited in 2000-2002, with followup through December 2007. In univariate analyses, subjects who quit smoking <10 years (OR 2.56, 95% CI 1.17 - 5.60) and were college graduates (OR 1.67, 95% CI, 1.00 - 2.76) had increased risks of being diagnosed with advanced stage NSCLC, compared to never smokers and non-college graduates, respectively. Receipt of sigmoidoscopy/colonoscopy, compared to no receipt, was associated with a decreased risk of advanced stage (OR 0.65, 95% CI, 0.43 - 0.99). The adjusted OR for receipt of sigmoidoscopy/colonoscopy was 0.55 (95% CI, 0.36 - 0.86). There was evidence that increasing the number of screening activities was associated with a decreased risk of advanced stage NSCLC (P for trend = 0.049). Conclusions Smoking status, education, and a screening activity were associated with stage at diagnosis of NSCLC. These results may guide future studies of the underlying mechanisms that influence how NSCLC is detected and diagnosed.
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Affiliation(s)
- Christopher G Slatore
- Portland VA Medical Center, Health Services Research & Development, Portland, OR, USA.
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