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Welch AC, Gorden JA, Mooney SJ, Wilshire CL, Zeliadt SB. Understanding Washington State's Low Uptake of Lung Cancer Screening in Two Steps: A Geospatial Analysis of Patient Travel Time and Health Care Availability of Imaging Sites. Chest 2024; 166:622-631. [PMID: 38815622 DOI: 10.1016/j.chest.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/29/2024] [Accepted: 04/22/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Early detection of lung cancer reduces cancer mortality; yet uptake for lung cancer screening (LCS) has been limited in Washington State. Geographic disparities contribute to low uptake, but do not wholly explain gaps in access for underserved populations. Other factors, such as an adequate workforce to meet population demand and the capacity of accredited screening facility sites, must also be considered. RESEARCH QUESTION What proportion of the eligible population for LCS has access to LCS facilities in Washington State? STUDY DESIGN AND METHODS We used the enhanced two-step floating catchment area (E2SFCA) model to evaluate how geographic accessibility in addition to availability of LCS imaging centers contribute to disparities. We used available data on radiologic technologist volume at each American College of Radiology (ACR)-accredited screening facility site to estimate the capacity of each site to meet potential population demand. Spearman rank correlation coefficients of the spatial access ratios were compared with the 2010 Rural-Urban Commuting Area codes and area deprivation index quintiles to identify characteristics of populations at risk for lung cancer with greater and lesser levels of access. RESULTS A total of 549 radiologic technologists were identified across the 95 ACR-accredited screening facilities. We observed that 95% of the eligible population had proximate geographic access to any ACR facility. However, when we incorporated the E2SFCA method, we found significant variation of access for eligible populations. The inclusion of the availability measure attenuated access for most of the eligible population. Furthermore, we observed that rural areas were substantially correlated, and areas with greater socioeconomic disadvantage were modestly correlated, with lower access. INTERPRETATION Rural and socioeconomically disadvantaged areas face significant disparities. The E2SFCA models demonstrated that capacity is an important component and how geographic access and availability jointly contribute to disparities in access to LCS.
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Affiliation(s)
- Allison C Welch
- Thoracic Surgery and Interventional Pulmonology Clinic, Swedish Medical Center and Cancer Institute, Seattle, WA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
| | - Jed A Gorden
- Thoracic Surgery and Interventional Pulmonology Clinic, Swedish Medical Center and Cancer Institute, Seattle, WA
| | - Stephen J Mooney
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Candice L Wilshire
- Thoracic Surgery and Interventional Pulmonology Clinic, Swedish Medical Center and Cancer Institute, Seattle, WA
| | - Steven B Zeliadt
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA.
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Hasson RM, Bridges CJ, Curley RJ, Erhunmwunsee L. Access to Lung Cancer Screening. Thorac Surg Clin 2023; 33:353-363. [PMID: 37806738 DOI: 10.1016/j.thorsurg.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Rural and racial/ethnic minority communities experience higher risk and mortality from lung cancer. Lung cancer screening with low-dose computed tomography reduces mortality. However, disparities persist in the uptake of lung cancer screening, especially in marginalized communities. Barriers to lung cancer screening are multilevel and include patient, provider, and system-level barriers. This discussion highlights the key barriers faced by rural and racial/ethnic minority communities.
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Affiliation(s)
- Rian M Hasson
- Department of Surgery, Section of Thoracic Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, USA; The Dartmouth Institute of Health Policy and Clinical Practice, Williamson Translational Research Building, Level 51 Medical Center Drive Lebanon, NH 03756, USA
| | - Connor J Bridges
- The Geisel School of Medicine at Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, USA
| | - Richard J Curley
- Department of Surgery, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Loretta Erhunmwunsee
- Department of Surgery, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA 91010, USA; Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, 91010, USA.
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3
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Agunwamba AA, Zhu X, Sauver JS, Thompson G, Helmueller L, Finney Rutten LJ. Barriers and facilitators of colorectal cancer screening using the 5As framework: A systematic review of US studies. Prev Med Rep 2023; 35:102353. [PMID: 37576848 PMCID: PMC10415795 DOI: 10.1016/j.pmedr.2023.102353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/20/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023] Open
Abstract
Despite clear evidence that regular screening reduces colorectal cancer (CRC) mortality and the availability of multiple effective screening options, CRC screening continues to be underutilized in the US. A systematic literature search of four databases - Ovid, Medline, EBSCHOhost, and Web of Science - was conducted to identify US studies published after 2017 that reported on barriers and facilitators to CRC screening adherence. Articles were extracted to categorize relevant CRC screening barriers or facilitators that were assessed against CRC screening outcomes using the 5As dimensions: Access, Affordability, Acceptance, Awareness, Activation. Sixty-one studies were included. Fifty determinants of screening within the 5As framework and two additional dimensions including Sociodemographics and Health Status were identified. The Sociodemographics, Access, and Affordability dimensions had the greatest number of studies included. The most common factor in the Access dimension was contact with healthcare systems, within the Affordability dimension was insurance, within the Awareness dimension was knowledge CRC screening, within the Acceptance dimension was health beliefs, within the Activation dimension was prompts and reminders, within the Sociodemographics dimension was race/ethnicity, and among the Health Status dimension was chronic disease history. Among all studies, contact with healthcare systems, insurance, race/ethnicity, age, and education were the most common factors identified. CRC screening barriers and facilitators were identified across individual, clinical, and sociocontextual levels. Interventions that consider multilevel strategies will most effectively increase CRC screening adherence.
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Affiliation(s)
- Amenah A. Agunwamba
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Xuan Zhu
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jenny St. Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lila J. Finney Rutten
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Exact Sciences Corporation, Madison WI, USA
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DeBolt CL, Popovich JJ, Widere JC, Wibberly KH, Harris D. Rurality as a Risk Factor for Pulmonary Health Disparities. Clin Chest Med 2023; 44:501-508. [PMID: 37517830 DOI: 10.1016/j.ccm.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Rural populations experience significant pulmonary health disparities compared with urban populations. Patients in rural communities experience health determinants including high smoking prevalence, worse nutrition, lower educational attainment, specific occupational exposures, decreased health-care access, as well as unique cultural and political drivers of health. This article describes social determinants of pulmonary health relevant in rural communities, describes examples of existing pulmonary disparities in rural populations, and highlights health policies with potential to mitigate disparities.
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Affiliation(s)
| | - John J Popovich
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - J Christian Widere
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Katharine Hsu Wibberly
- Mid-Atlantic Telehealth Resource Center, University of Virginia, Charlottesville, VA, USA
| | - Drew Harris
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
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5
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Barta JA, Erkmen CP, Shusted CS, Myers RE, Saia C, Cohen S, Wainwright J, Zeigler-Johnson C, Dako F, Wender R, Kane GC, Vachani A, Rendle KA. The Philadelphia Lung Cancer Learning Community: a multi-health-system, citywide approach to lung cancer screening. JNCI Cancer Spectr 2023; 7:pkad071. [PMID: 37713466 PMCID: PMC10588937 DOI: 10.1093/jncics/pkad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/16/2023] [Accepted: 09/13/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Lung cancer screening uptake for individuals at high risk is generally low across the United States, and reporting of lung cancer screening practices and outcomes is often limited to single hospitals or institutions. We describe a citywide, multicenter analysis of individuals receiving lung cancer screening integrated with geospatial analyses of neighborhood-level lung cancer risk factors. METHODS The Philadelphia Lung Cancer Learning Community consists of lung cancer screening clinicians and researchers at the 3 largest health systems in the city. This multidisciplinary, multi-institutional team identified a Philadelphia Lung Cancer Learning Community study cohort that included 11 222 Philadelphia residents who underwent low-dose computed tomography for lung cancer screening from 2014 to 2021 at a Philadelphia Lung Cancer Learning Community health-care system. Individual-level demographic and clinical data were obtained, and lung cancer screening participants were geocoded to their Philadelphia census tract of residence. Neighborhood characteristics were integrated with lung cancer screening counts to generate bivariate choropleth maps. RESULTS The combined sample included 37.8% Black adults, 52.4% women, and 56.3% adults who currently smoke. Of 376 residential census tracts in Philadelphia, 358 (95.2%) included 5 or more individuals undergoing lung cancer screening, and the highest counts were geographically clustered around each health system's screening sites. A relatively low percentage of screened adults resided in census tracts with high tobacco retailer density or high smoking prevalence. CONCLUSIONS The sociodemographic characteristics of lung cancer screening participants in Philadelphia varied by health system and neighborhood. These results suggest that a multicenter approach to lung cancer screening can identify vulnerable areas for future tailored approaches to improving lung cancer screening uptake. Future directions should use these findings to develop and test collaborative strategies to increase lung cancer screening at the community and regional levels.
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Affiliation(s)
- Julie A Barta
- Department of Medicine, The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Cherie P Erkmen
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Christine S Shusted
- Department of Medicine, The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ronald E Myers
- Department of Medical Oncology, Division of Population Science, Thomas Jefferson University, Philadelphia, PA, USA
| | - Chelsea Saia
- Department of Family & Community Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Cohen
- Department of Family & Community Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jocelyn Wainwright
- Department of Family & Community Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Charnita Zeigler-Johnson
- Department of Medical Oncology, Division of Population Science, Thomas Jefferson University, Philadelphia, PA, USA
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Farouk Dako
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard Wender
- Department of Family & Community Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory C Kane
- Department of Medicine, The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anil Vachani
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA, USA
| | - Katharine A Rendle
- Department of Family & Community Medicine, University of Pennsylvania, Philadelphia, PA, USA
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6
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Peters AA, Christe A, von Stackelberg O, Pohl M, Kauczor HU, Heußel CP, Wielpütz MO, Ebner L. "Will I change nodule management recommendations if I change my CAD system?"-impact of volumetric deviation between different CAD systems on lesion management. Eur Radiol 2023; 33:5568-5577. [PMID: 36894752 PMCID: PMC10326095 DOI: 10.1007/s00330-023-09525-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/17/2022] [Accepted: 02/05/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES To evaluate and compare the measurement accuracy of two different computer-aided diagnosis (CAD) systems regarding artificial pulmonary nodules and assess the clinical impact of volumetric inaccuracies in a phantom study. METHODS In this phantom study, 59 different phantom arrangements with 326 artificial nodules (178 solid, 148 ground-glass) were scanned at 80 kV, 100 kV, and 120 kV. Four different nodule diameters were used: 5 mm, 8 mm, 10 mm, and 12 mm. Scans were analyzed by a deep-learning (DL)-based CAD and a standard CAD system. Relative volumetric errors (RVE) of each system vs. ground truth and the relative volume difference (RVD) DL-based vs. standard CAD were calculated. The Bland-Altman method was used to define the limits of agreement (LOA). The hypothetical impact on LungRADS classification was assessed for both systems. RESULTS There was no difference between the three voltage groups regarding nodule volumetry. Regarding the solid nodules, the RVE of the 5-mm-, 8-mm-, 10-mm-, and 12-mm-size groups for the DL CAD/standard CAD were 12.2/2.8%, 1.3/ - 2.8%, - 3.6/1.5%, and - 12.2/ - 0.3%, respectively. The corresponding values for the ground-glass nodules (GGN) were 25.6%/81.0%, 9.0%/28.0%, 7.6/20.6%, and 6.8/21.2%. The mean RVD for solid nodules/GGN was 1.3/ - 15.2%. Regarding the LungRADS classification, 88.5% and 79.8% of all solid nodules were correctly assigned by the DL CAD and the standard CAD, respectively. 14.9% of the nodules were assigned differently between the systems. CONCLUSIONS Patient management may be affected by the volumetric inaccuracy of the CAD systems and hence demands supervision and/or manual correction by a radiologist. KEY POINTS • The DL-based CAD system was more accurate in the volumetry of GGN and less accurate regarding solid nodules than the standard CAD system. • Nodule size and attenuation have an effect on the measurement accuracy of both systems; tube voltage has no effect on measurement accuracy. • Measurement inaccuracies of CAD systems can have an impact on patient management, which demands supervision by radiologists.
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Affiliation(s)
- Alan A Peters
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, Germany.
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Marsilius-Arkaden 130, 69120, Heidelberg, Germany.
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, University Hospital of Heidelberg, Thoraxklinik Heidelberg, Roentgenstrasse 1, 69126, Heidelberg, Germany.
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010, Freiburgstrasse, Switzerland.
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010, Freiburgstrasse, Switzerland
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Marsilius-Arkaden 130, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, University Hospital of Heidelberg, Thoraxklinik Heidelberg, Roentgenstrasse 1, 69126, Heidelberg, Germany
| | - Moritz Pohl
- Institute of Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Marsilius-Arkaden 130, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, University Hospital of Heidelberg, Thoraxklinik Heidelberg, Roentgenstrasse 1, 69126, Heidelberg, Germany
| | - Claus Peter Heußel
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Marsilius-Arkaden 130, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, University Hospital of Heidelberg, Thoraxklinik Heidelberg, Roentgenstrasse 1, 69126, Heidelberg, Germany
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 672, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Lung Research Center (DZL), Marsilius-Arkaden 130, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, University Hospital of Heidelberg, Thoraxklinik Heidelberg, Roentgenstrasse 1, 69126, Heidelberg, Germany
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010, Freiburgstrasse, Switzerland
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7
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Dias Marques V, Massago M, da Silva MT, Roskowski I, de Lima DAN, dos Santos L, Louro E, Gonçalves ST, Pedroso RB, Obale AM, Pelloso SM, Vissoci JRN, Staton CA, Nihei OK, Carvalho MDDB, Dutra ADC, de Andrade L. Exploring regional disparities in lung cancer mortality in a Brazilian state: A cross-sectional ecological study. PLoS One 2023; 18:e0287371. [PMID: 37352137 PMCID: PMC10289318 DOI: 10.1371/journal.pone.0287371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 06/04/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Lung cancer (LC) is one of the main causes of mortality in Brazil; geographic, cultural, socioeconomic and health access factors can affect the development of the disease. We explored the geospatial distribution of LC mortality, and associated factors, between 2015 and 2019, in Parana state, Brazil. METHODS AND FINDINGS We obtained mortality (from the Brazilian Health Informatics Department) and population rates (from the Brazilian Institute of Geography and Statistics [IBGE]) in people over 40 years old, accessibility of oncology centers by municipality, disease diagnosis rate (from Brazilian Ministry of Health), the tobacco production rate (IBGE) and Parana Municipal Performance Index (IPDM) (from Parana Institute for Economic and Social Development). Global Moran's Index and Local Indicators of Spatial Association were performed to evaluate the spatial distribution of LC mortality in Parana state. Ordinary Least Squares Regression and Geographically Weighted Regression were used to verify spatial association between LC mortality and socioeconomic indicators and health service coverage. A strong spatial autocorrelation of LC mortality was observed, with the detection of a large cluster of high LC mortality in the South of Parana state. Spatial regression analysis showed that all independent variables analyzed were directly related to LC mortality by municipality in Paraná. CONCLUSIONS There is a disparity in the LC mortality in Parana state, and inequality of socioeconomic and accessibility to health care services could be associated with it. Our findings may help health managers to intensify actions in regions with vulnerability in the detection and treatment of LC.
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Affiliation(s)
- Vlaudimir Dias Marques
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | - Miyoko Massago
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | | | - Igor Roskowski
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | | | - Lander dos Santos
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | - Estela Louro
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | - Simone Tomás Gonçalves
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | - Raissa Bocchi Pedroso
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | - Armstrong Mbi Obale
- Duke Global Health Institute, Duke University, Durhan, North Carolina, United States of America
| | - Sandra Marisa Pelloso
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
| | - João Ricardo Nickenig Vissoci
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
- Duke Global Health Institute, Duke University, Durhan, North Carolina, United States of America
| | - Catherine Ann Staton
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
- Duke Global Health Institute, Duke University, Durhan, North Carolina, United States of America
| | - Oscar Kenji Nihei
- Education, Languages and Health Center, Western Parana State University, Foz do Iguaçu, Parana, Brazil
| | | | | | - Luciano de Andrade
- Postgraduate Program in Health Sciences, State University of Maringa, Maringa, Parana, Brazil
- Duke Global Health Institute, Duke University, Durhan, North Carolina, United States of America
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Auger C, Moudgalya H, Neely MR, Stephan JT, Tarhoni I, Gerard D, Basu S, Fhied CL, Abdelkader A, Vargas M, Hu S, Hulett T, Liptay MJ, Shah P, Seder CW, Borgia JA. Development of a Novel Circulating Autoantibody Biomarker Panel for the Identification of Patients with 'Actionable' Pulmonary Nodules. Cancers (Basel) 2023; 15:2259. [PMID: 37190187 PMCID: PMC10136536 DOI: 10.3390/cancers15082259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
Due to poor compliance and uptake of LDCT screening among high-risk populations, lung cancer is often diagnosed in advanced stages where treatment is rarely curative. Based upon the American College of Radiology's Lung Imaging and Reporting Data System (Lung-RADS) 80-90% of patients screened will have clinically "non-actionable" nodules (Lung-RADS 1 or 2), and those harboring larger, clinically "actionable" nodules (Lung-RADS 3 or 4) have a significantly greater risk of lung cancer. The development of a companion diagnostic method capable of identifying patients likely to have a clinically actionable nodule identified during LDCT is anticipated to improve accessibility and uptake of the paradigm and improve early detection rates. Using protein microarrays, we identified 501 circulating targets with differential immunoreactivities against cohorts characterized as possessing either actionable (n = 42) or non-actionable (n = 20) solid pulmonary nodules, per Lung-RADS guidelines. Quantitative assays were assembled on the Luminex platform for the 26 most promising targets. These assays were used to measure serum autoantibody levels in 841 patients, consisting of benign (BN; n = 101), early-stage non-small cell lung cancer (NSCLC; n = 245), other early-stage malignancies within the lung (n = 29), and individuals meeting United States Preventative Screening Task Force (USPSTF) screening inclusion criteria with both actionable (n = 87) and non-actionable radiologic findings (n = 379). These 841 patients were randomly split into three cohorts: Training, Validation 1, and Validation 2. Of the 26 candidate biomarkers tested, 17 differentiated patients with actionable nodules from those with non-actionable nodules. A random forest model consisting of six autoantibody (Annexin 2, DCD, MID1IP1, PNMA1, TAF10, ZNF696) biomarkers was developed to optimize our classification performance; it possessed a positive predictive value (PPV) of 61.4%/61.0% and negative predictive value (NPV) of 95.7%/83.9% against Validation cohorts 1 and 2, respectively. This panel may improve patient selection methods for lung cancer screening, serving to greatly reduce the futile screening rate while also improving accessibility to the paradigm for underserved populations.
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Affiliation(s)
- Claire Auger
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Hita Moudgalya
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Matthew R. Neely
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Jeremy T. Stephan
- Rush University Medical College, Rush University Medical Center, Chicago, IL 60612, USA
| | - Imad Tarhoni
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA
| | - David Gerard
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Sanjib Basu
- Division of Medical Oncology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Cristina L. Fhied
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Ahmed Abdelkader
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA
| | | | - Shaohui Hu
- CDI Laboratories, Mayagüez, PR 00680, USA
| | | | - Michael J. Liptay
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Palmi Shah
- Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Christopher W. Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Jeffrey A. Borgia
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Pathology, Rush University Medical Center, Chicago, IL 60612, USA
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9
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Maki KG, Talluri R, Toumazis I, Shete S, Volk RJ. Impact of U.S. Preventive Services Task Force lung cancer screening update on drivers of disparities in screening eligibility. Cancer Med 2023; 12:4647-4654. [PMID: 35871312 PMCID: PMC9972155 DOI: 10.1002/cam4.5066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In 2021, the U.S. Preventive Services Task Force (USPSTF) updated its recommendation to expand lung cancer screening (LCS) eligibility and mitigate disparities. Although this increased the number of non-White individuals who are eligible for LCS, the update's impact on drivers of disparities is less clear. This analysis focuses on racial disparities among Black individuals because members of this group disproportionately share late-stage lung cancer diagnoses, despite typically having a lower intensity smoking history compared to non-Hispanic White individuals. METHODS We used data from the National Health Interview Survey to examine the impact of the 2021 eligibility criteria on racial disparities by factors such as education, poverty, employment history, and insurance status. We also examined preventive care use and reasons for delaying medical care. RESULTS When comparing Black individuals and non-Hispanic White individuals, our analyses show significant differences in who would be eligible for LCS: Those who do not have a high school diploma (28.7% vs. 17.0%, p = 0.002), are in poverty (26.2% vs. 14.9%, p < 0.001), and have not worked in the past 12 months (66.5% vs. 53.9%, p = 0.009). Further, our analyses also show that more Black individuals delayed medical care due to not having transportation (11.1% vs. 3.6%, p < 0.001) compared to non-Hispanic White individuals. CONCLUSIONS Our results suggest that despite increasing the number of Black individuals who are eligible for LCS, the 2021 USPSTF recommendation highlights ongoing socioeconomic disparities that need to be addressed to ensure equitable access.
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Affiliation(s)
- Kristin G Maki
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rajesh Talluri
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Iakovos Toumazis
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sanjay Shete
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert J Volk
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Pérez-Morales J, Pathak R, Reyes M, Tolbert H, Tirbene R, Gray JE, Simmons VN, Schabath MB, Quinn GP. Qualitative Findings From a Survey on Patient Experiences and Satisfaction with Lung Cancer Screening. Cancer Control 2023; 30:10732748231167963. [PMID: 36971270 PMCID: PMC10052477 DOI: 10.1177/10732748231167963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND To reveal successes and potential limitations of the lung cancer screening program, we conducted a survey that included both quantitative and open-ended questions to measure patient experiences and satisfaction with screening. METHODS We report on the five open-ended items related to barriers to returning for screening, experience with other cancer prevention screenings, positive and negative experiences, and suggestions for improving future appointments. The open-ended responses were analyzed using constant comparison method and inductive content analysis. RESULTS Respondents (182 patients, 86% response rate for open-ended questions) provided generally positive comments about their lung cancer screening experience. Negative comments were related to desire for more information about results, long wait times for results, and billing issues. Suggestions for improvements included: scheduling on-line appointments and text or email reminders, lower costs, and responding to uncertainty about eligibility criteria. CONCLUSION Findings provide insights about patient experiences and satisfaction with lung cancer screening which is important given low uptake. Ongoing patient-centered feedback may improve the lung cancer screening experience and increase follow-up screening rates.
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Affiliation(s)
- Jaileene Pérez-Morales
- Department of Cancer Epidemiology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Rashmi Pathak
- Department of Cancer Epidemiology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Monica Reyes
- Department of Cancer Epidemiology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Haley Tolbert
- Department of Thoracic Oncology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Rajwantee Tirbene
- Department of Cancer Epidemiology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jhanelle E Gray
- Department of Thoracic Oncology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Vani N Simmons
- Department of Health Outcomes and Behavior, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Matthew B Schabath
- Department of Cancer Epidemiology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
- Department of Thoracic Oncology, 25301H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Gwendolyn P Quinn
- Departments of Obstetrics and Gynecology and Population Health, 12296New York University Grossman School of Medicine, New York, NY, USA
- Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
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11
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Moore JX, Tingen MS, Coughlin SS, O’Meara C, Odhiambo L, Vernon M, Jones S, Petcu R, Johnson R, Islam KM, Nettles D, Albashir G, Cortes J. Understanding geographic and racial/ethnic disparities in mortality from four major cancers in the state of Georgia: a spatial epidemiologic analysis, 1999–2019. Sci Rep 2022; 12:14143. [PMID: 35986041 PMCID: PMC9391349 DOI: 10.1038/s41598-022-18374-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
We examined geographic and racial variation in cancer mortality within the state of Georgia, and investigated the correlation between the observed spatial differences and county-level characteristics. We analyzed county-level cancer mortality data collected by the Centers for Disease Control and Prevention on breast, colorectal, lung, and prostate cancer mortality among adults (aged ≥ 18 years) in 159 Georgia counties from years 1999 through 2019. Geospatial methods were applied, and we identified hot spot counties based on cancer mortality rates overall and stratified by non-Hispanic white (NH-white) and NH-black race/ethnicity. Among all adults, 5.0% (8 of 159), 8.2% (13 of 159), 5.0% (8 of 159), and 6.9% (11 of 159) of Georgia counties were estimated hot spots for breast cancer, colorectal, lung, and prostate cancer mortality, respectively. Cancer mortality hot spots were heavily concentrated in three major areas: (1) eastern Piedmont to Coastal Plain regions, (2) southwestern rural Georgia area, or (3) northern-most rural Georgia. Overall, hot spot counties generally had higher proportion of NH-black adults, older adult population, greater poverty, and more rurality. In Georgia, targeted cancer prevention strategies and allocation of health resources are needed in counties with elevated cancer mortality rates, focusing on interventions suitable for NH-black race/ethnicity, low-income, and rural residents.
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12
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Le T, Miller S, Berry E, Zamarripa S, Rodriguez A, Barkley B, Kandathil A, Brewington C, Argenbright KE, Gerber DE. Implementation and Uptake of Rural Lung Cancer Screening. J Am Coll Radiol 2022; 19:480-487. [PMID: 35143786 PMCID: PMC8923939 DOI: 10.1016/j.jacr.2021.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/15/2021] [Accepted: 12/18/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Given the higher rates of tobacco use along with increased mortality specific to lung cancer in rural settings, low-dose CT (LDCT)-based lung cancer screening could be particularly beneficial to such populations. However, limited radiology facilities and increased geographical distance, combined with lower income and education along with reduced patient engagement, present heightened barriers to screening initiation and adherence. METHODS In collaboration with community leaders and stakeholders, we developed and implemented a community-based lung cancer screening program, including telephone-based navigation and tobacco cessation counseling support, serving 18 North Texas counties. Funding was available to support clinical services costs where needed. We collected data on LDCT referrals, orders, and completion. RESULTS To raise awareness for lung cancer screening, we leveraged our established collaborative network of more than 700 community partners. In the first year of operation, 107 medical providers referred 570 patients for lung cancer screening, of whom 488 (86%) were eligible for LDCT. The most common reasons for ineligibility were age (43%) and insufficient tobacco history (20%). Of 381 ordered LDCTs, 334 (88%) were completed. Among screened patients, 61% were current smokers and 36% had insurance coverage for the procedure. The program cost per patient was $430. DISCUSSION Implementation, uptake, and completion of LDCT-based lung cancer screening is feasible in rural settings. Community outreach, health promotion, and algorithm-based navigation may support such efforts. Given low lung cancer screening rates nationally and heightened lung cancer risk in rural populations, similar programs in other regions may be particularly impactful.
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Affiliation(s)
- Tri Le
- Department of Internal Medicine (Hematology-Oncology), University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stacie Miller
- Senior Program Manager, Oncology Screening Services, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emily Berry
- Clinical Research Manager, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sarah Zamarripa
- Population Research Project Associate, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Aurelio Rodriguez
- Senior Grants and Contracts Specialist, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin Barkley
- Assistant Director of Clinical Facilities and Operations, Moncrief Cancer Institute, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Asha Kandathil
- Assistant Professor of Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cecelia Brewington
- Professor of Radiology; Vice Chair of Clinical Operations, Department of Radiology; Chief of Community Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Keith E Argenbright
- Professor of Population and Data Sciences, and Family and Community Medicine; Director of Behavioral Sciences; Director of Moncrief Cancer Institute, Department of Population and Data Sciences, and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David E Gerber
- Professor of Internal Medicine (Hematology-Oncology) and Population and Data Sciences; Associate Director of Clinical Research, Department of Internal Medicine (Hematology-Oncology), Department of Population and Data Sciences; and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.
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13
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Slatore CG, Golden SE, Thomas T, Patzel M, Bumatay S, Shannon J, Davis M. Beliefs and Practices of Primary Care Providers Regarding Performing Low-Dose CT Studies for Lung Cancer Screening. Chest 2022; 161:853-859. [PMID: 34480957 PMCID: PMC8941621 DOI: 10.1016/j.chest.2021.08.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/29/2021] [Accepted: 08/16/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Departments of Medicine and of Radiation Medicine, Division of Pulmonary & Critical Care Medicine, Knight Cancer Institute, Oregon Health & Science University Portland, OR; Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR.
| | - Tara Thomas
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
| | - Mary Patzel
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR
| | - Sarah Bumatay
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR
| | - Jackilen Shannon
- Community Outreach and Engagement, Knight Cancer Institute, Oregon Health & Science University, Portland, OR; School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR
| | - Melinda Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR; Department of Family Medicine, Oregon Health & Science University, Portland, OR; School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR
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14
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Adams SJ, Babyn P, Burbridge B, Tang R, Mendez I. Access to ultrasound imaging: A qualitative study in two northern, remote, Indigenous communities in Canada. Int J Circumpolar Health 2021; 80:1961392. [PMID: 34347560 PMCID: PMC8344228 DOI: 10.1080/22423982.2021.1961392] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Ultrasound imaging is an essential component of healthcare services. This study sought to explore perceptions of access, and factors which shape access, to ultrasound imaging in two northern, remote, Indigenous communities in Canada. Using interpretive description as a methodological approach and a multi-dimensional conceptualisation of access to care as a theoretical framework, 15 semi-structured interviews were conducted in the northern Canadian communities of Stony Rapids and Black Lake, Saskatchewan. All participants had an obstetrical or non-obstetrical ultrasound exam performed in the past 10 years. Interviews were audio recorded and interview transcripts were analysed using constant comparative analysis. Geographic isolation from imaging facilities was a central barrier to participants accessing ultrasound imaging. Other barriers became apparent when participants had to travel for ultrasound, including fear of air travel, isolation from family, financial means, and unfamiliarity with larger cities. Barriers such as family and work responsibilities were exacerbated by the barrier of geography. Participants overcame these barriers as they were motivated by potential diagnostic benefits of ultrasound imaging. This study highlights disparities in access to ultrasound for northern, remote, Indigenous populations. Future efforts to improve access to imaging should consider barriers of distance to imaging facilities and strategies to bridge these barriers.
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Affiliation(s)
- Scott J Adams
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Canada
| | - Paul Babyn
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Canada
| | - Brent Burbridge
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Canada
| | - Rachel Tang
- Canadian Hub for Applied and Social Research, University of Saskatchewan, 9 Campus Drive, Saskatoon, Canada
| | - Ivar Mendez
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
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15
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Lam S, Tammemagi M. Contemporary issues in the implementation of lung cancer screening. Eur Respir Rev 2021; 30:30/161/200288. [PMID: 34289983 DOI: 10.1183/16000617.0288-2020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/08/2021] [Indexed: 12/24/2022] Open
Abstract
Lung cancer screening with low-dose computed tomography can reduce death from lung cancer by 20-24% in high-risk smokers. National lung cancer screening programmes have been implemented in the USA and Korea and are being implemented in Europe, Canada and other countries. Lung cancer screening is a process, not a test. It requires an organised programmatic approach to replicate the lung cancer mortality reduction and safety of pivotal clinical trials. Cost-effectiveness of a screening programme is strongly influenced by screening sensitivity and specificity, age to stop screening, integration of smoking cessation intervention for current smokers, screening uptake, nodule management and treatment costs. Appropriate management of screen-detected lung nodules has significant implications for healthcare resource utilisation and minimising harm from radiation exposure related to imaging studies, invasive procedures and clinically significant distress. This review focuses on selected contemporary issues in the path to implement a cost-effective lung cancer screening at the population level. The future impact of emerging technologies such as deep learning and biomarkers are also discussed.
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Affiliation(s)
- Stephen Lam
- British Columbia Cancer Agency, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Martin Tammemagi
- Dept of Health Sciences, Brock University, St Catharines, ON, Canada
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16
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"It's Really Like Any Other Study": Rural Radiology Facilities Performing Low-Dose Computed Tomography for Lung Cancer Screening. Ann Am Thorac Soc 2021; 18:2058-2066. [PMID: 34129451 DOI: 10.1513/annalsats.202103-333oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE The majority of eligible people have not been screened for lung cancer. There is emerging evidence that there are location-based disparities applicable to lung cancer screening. OBJECTIVE Describe lung cancer screening radiologic services in rural Oregon and understand the barriers and facilitators to implementation of lung cancer screening using LDCT. METHODS A mixed-methods descriptive study utilizing surveys and semi-structured interviews of key informants. We approached representatives from all 37 small and rural hospitals in Oregon. We purposively interviewed key informants from a sub-set based on LDCT implementation outcomes. RESULTS We surveyed representatives from 29 radiology facilities and qualitatively interviewed 18 key informants from 19 facilities (representing 12 health care systems). Among the surveyed radiology facilities, 59% were performing LDCT for lung cancer screening. Key informants reported that facilities which performed this service were often motivated by community needs, less by financial gain or evidence strength and all described the importance of a champion. Key informants described that implementing lung cancer screening programmatic components that were within their normal scope of practice (e.g. specifying the LDCT parameters) were burdensome to establish but were surmountable barriers. Most informants reported they did not perform other components of high-quality programs (e.g. ensuring adherence to recommended follow-up testing) and suggested these steps were important but the responsibility of primary care providers. CONCLUSIONS Many rural hospital facilities in Oregon offer LDCT for lung cancer screening, but do not perform all the recommended components of a screening program. Disparities in lung cancer screening utilization and adherence are unlikely to be solved by an exclusive focus at the radiology facility level and may require additional interventions at the primary care level.
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17
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Rogers JR, Hripcsak G, Cheung YK, Weng C. Clinical comparison between trial participants and potentially eligible patients using electronic health record data: A generalizability assessment method. J Biomed Inform 2021; 119:103822. [PMID: 34044156 DOI: 10.1016/j.jbi.2021.103822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To present a generalizability assessment method that compares baseline clinical characteristics of trial participants (TP) to potentially eligible (PE) patients as presented in their electronic health record (EHR) data while controlling for clinical setting and recruitment period. METHODS For each clinical trial, a clinical event was defined to identify patients of interest using available EHR data from one clinical setting during the trial's recruitment timeframe. The trial's eligibility criteria were then applied and patients were separated into two mutually exclusive groups: (1) TP, which were patients that participated in the trial per trial enrollment data; (2) PE, the remaining patients. The primary outcome was standardized differences in clinical characteristics between TP and PE per trial. A standardized difference was considered prominent if its absolute value was greater than or equal to 0.1. The secondary outcome was the difference in mean propensity scores (PS) between TP and PE per trial, in which the PS represented prediction for a patient to be in the trial. Three diverse trials were selected for illustration: one focused on hepatitis C virus (HCV) patients receiving a liver transplantation; one focused on leukemia patients and lymphoma patients; and one focused on appendicitis patients. RESULTS For the HCV trial, 43 TP and 83 PE were found, with 61 characteristics evaluated. Prominent differences were found among 69% of characteristics, with a mean PS difference of 0.13. For the leukemia/lymphoma trial, 23 TP and 23 PE were found, with 39 characteristics evaluated. Prominent differences were found among 82% of characteristics, with a mean PS difference of 0.76. For the appendicitis trial, 123 TP and 242 PE were found, with 52 characteristics evaluated. Prominent differences were found among 52% of characteristics, with a mean PS difference of 0.15. CONCLUSIONS Differences in clinical characteristics were observed between TP and PE among all three trials. In two of the three trials, not all of the differences necessarily compromised trial generalizability and subsets of PE could be considered similar to their corresponding TP. In the remaining trial, lack of generalizability appeared present, but may be a result of other factors such as small sample size or site recruitment strategy. These inconsistent findings suggest eligibility criteria alone are sometimes insufficient in defining a target group to generalize to. With caveats in limited scalability, EHR data quality, and lack of patient perspective on trial participation, this generalizability assessment method that incorporates control for temporality and clinical setting promise to better pinpoint clinical patterns and trial considerations.
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Affiliation(s)
- James R Rogers
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, NY, United States; Medical Informatics Services, New York-Presbyterian Hospital, New York, NY, United States
| | - Ying Kuen Cheung
- Department of Biostatistics, Columbia University, New York, NY, United States
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, NY, United States.
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18
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Hasson RM, Fay KA, Phillips JD, Millington TM, Finley DJ. Rural barriers to early lung cancer detection: Exploring access to lung cancer screening programs in New Hampshire and Vermont. Am J Surg 2021; 221:725-730. [PMID: 32829909 PMCID: PMC10750228 DOI: 10.1016/j.amjsurg.2020.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Rural populations face many health disadvantages compared to urban areas. There is a critical need to better understand the current lung cancer screening landscape in these communities to identify targeted areas to improve the impact of this proven tool. METHODS Data from the County Health Rankings of New Hampshire and Vermont was reviewed for population density, distribution of adult smokers, and level of education compared to the distribution of Lung Cancer Screening Facilities throughout these two states. RESULTS Screening programs in southern counties of Vermont with lower levels of education have decreased access. In New Hampshire, there are no programs within 30 miles of the areas with the largest distribution of smokers, and decreased access in some areas with the lowest levels of education. CONCLUSIONS Improving equitable access to high-quality screening services in rural regions and the creation of targeted interventions to address decreased access in areas of high tobacco use and low education is vital to decreasing the incidence of latestage presentations of lung cancer within these populations.
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Affiliation(s)
- Rian M Hasson
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon; The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, NH 03756, Lebanon.
| | - Kayla A Fay
- The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, NH 03756, Lebanon.
| | - Joseph D Phillips
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon.
| | - Timothy M Millington
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon.
| | - David J Finley
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, 1 Medical Center Drive, NH 03756, Lebanon.
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19
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Utilization of Lung Cancer Screening in the Medicare Fee-for-Service Population. Chest 2020; 158:2200-2210. [DOI: 10.1016/j.chest.2020.05.592] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/02/2020] [Accepted: 05/14/2020] [Indexed: 01/20/2023] Open
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20
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Geographic Dispersion and Rural Versus Urban Utilization of CT Colonography in the United States. J Am Coll Radiol 2020; 17:475-483. [DOI: 10.1016/j.jacr.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 02/06/2023]
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21
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Schiffelbein JE, Carluzzo KL, Hasson RM, Alford-Teaster JA, Imset I, Onega T. Barriers, Facilitators, and Suggested Interventions for Lung Cancer Screening Among a Rural Screening-Eligible Population. J Prim Care Community Health 2020; 11:2150132720930544. [PMID: 32506999 PMCID: PMC7278309 DOI: 10.1177/2150132720930544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction: Rural areas are disproportionally affected by lung cancer late-stage incidence and mortality. Lung cancer screening (LCS) is recommended to find lung cancer early and reduce mortality, yet uptake is low. The purpose of this study was to elucidate the barriers to, facilitators of, and suggested interventions for increasing LCS among a rural screening-eligible population using a mixed methods concurrent embedded design study. Methods: Qualitative and quantitative data were collected from rural-residing adults who met the eligibility criteria for LCS but who were not up-to-date with LCS recommendations. Study participants (n = 23) took part in 1 of 5 focus groups and completed a survey. Focus group discussions were recorded, transcribed, and coded through a mixed deductive and inductive approach. Survey data were used to enhance and clarify focus group results; these data were integrated in the design and during analysis, in accordance with the mixed methods concurrent embedded design approach. Results: Several key barriers to LCS were identified, including an overall lack of knowledge about LCS, not receiving information or recommendation from a health care provider, and lack of transportation. Key facilitators were receiving a provider recommendation and high motivation to know the screening results. Participants suggested that LCS uptake could be increased by addressing provider understanding and recommendation of LCS and conducting community outreach to promote LCS awareness and access. Conclusion: The results suggest that the rural screening-eligible population is generally receptive to LCS. Patient-level factors important to getting this population screened include knowledge, transportation, motivation to know their screening results, and receiving information or recommendation from a provider. Addressing these factors may be important to increase rural LCS uptake.
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Affiliation(s)
- Jenna E. Schiffelbein
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | | | - Rian M. Hasson
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jennifer A. Alford-Teaster
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Inger Imset
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Tracy Onega
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, NH, USA
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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