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Albano D, Dhamija A, Liao Y, Mclarty A, Talavera H, Kim EK, Ashamalla M. Lung cancer in nonsmokers- A risk factor analysis. Cancer Epidemiol 2023; 86:102439. [PMID: 37598649 DOI: 10.1016/j.canep.2023.102439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/01/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023]
Abstract
INSTITUTIONS STONY BROOK MEDICAL CENTERRATIONALE: Lung Cancer screening for the high-risk smoking population has been proven to save lives. However, in 2022, 20% of newly diagnosed lung cancers (47,300) were in nonsmokers. These patients were found to be diagnosed at later stages. This may be at least partly due to not meeting criteria for and participating in current lung cancer screening. This study aims to describe characteristics of a never smoker patient population to help identify common risk factors which might merit inclusion in lung cancer screening and thus improve patient outcomes. METHODS This retrospective single center study included never-smoker patients diagnosed with lung nodules and never-smoker patients diagnosed with lung cancer from 2016 to 2022. Data was obtained from the Stony Brook Medical Center electronic medical record. 16,056 patients were identified as never-smokers who were asked by the medical assistant if they ever smoked in their lifetime. Patients were eliminated if they had any smoking history up to first diagnosis date. Demographics, radiology, histology, diagnosis dates, comorbidities, smoking status, and exposures collected through ICD10 codes and not self-reported, were investigated. RESULTS Of 16,056 never-smoking patients, 9315 (58.02%) were females diagnosed with lung nodules and 6741 (41.98%) were males diagnosed with lung nodules. The univariate analysis showed significant differences between gender, age at nodule diagnosis, and patients with and without comorbidities including chronic obstructive pulmonary disease (COPD), hypertension (HTN), and family history (FHX) of lung cancer. The percentage of lung cancer patients among females was significantly higher than among males. Patients having lung cancer were older. The percentages of lung cancer patients with these comorbidities were significantly higher than those without. However, there was no significant difference found between patients with and without diabetes mellitus (DM). The multivariable logistic regression suggested that age at nodule diagnosis and comorbidities including COPD (which included asthma, emphysema and chronic bronchitis) and family history of lung cancer were significantly associated with lung cancer. Older patients and patients with those comorbidities had a higher risk of developing cancer than those who were younger or without those comorbidities. The study excluded HTN and included age at nodule diagnosis in the logistic regression model as HTN was found to be protective against lung cancer due to age at lung nodule diagnosis. Please refer to the appendix for further details. CONCLUSION Never-smoker patients who were older and with COPD and Family History of lung cancer had higher risk of developing lung cancer than younger patients without these comorbidities. In this study, gender had no impact on outcome.
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Affiliation(s)
- Denise Albano
- Department of Surgery, Stony Brook University Hospital, USA.
| | - Ankit Dhamija
- Department of Surgery, Stony Brook University Hospital, USA
| | - Yunhan Liao
- Biostatistician, Biostatistics Shared Resource, USA
| | | | | | - Esther K Kim
- Department of Surgery, Stony Brook University Hospital, USA
| | - Mark Ashamalla
- Department of Radiation Oncology, Stony Brook University Hospital, USA
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Li J, Stults CD, Liang SY, Martinez M. Factors associated with adherence to provider referrals for lung cancer screening with low dose computed tomography before and during COVID-19 pandemic. BMC Cancer 2023; 23:809. [PMID: 37644406 PMCID: PMC10463613 DOI: 10.1186/s12885-023-11256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Lung cancer has been the leading cause of American deaths from cancer. Although Medicare started covering lung cancer screening (LCS) with low-dose computed tomography (LDCT) in 2015, the uptake of LDCT-LCS remains low. This study examines the changes in adherence to provider referrals for LDCT-LCS and the factors at patient, provider, and health system levels that influence the completion rate of LDCT-LCS orders before and during the COVID-19 pandemic. METHODS Our study examined electronic health record data (December 2013 - December 2020) from a large, community-based clinical healthcare delivery system in California. We plotted monthly trends in the frequency of LDCT-LCS orders and completion rate and compared the annual LDCT-LCS completion rate between LCS-eligible, LCS-ineligible, and unknown eligibility groups. We then explored multilevel factors associated with the completion of LDCT-LCS orders using hierarchical generalized linear models. RESULTS There was an increase in LDCT-LCS orders (N = 12,469) from 2013 to 2019, followed by a sharp decline in March 2020 due to the onset of the COVID-19 pandemic. Thereafter, LDCT-LCS orders slowly increased again in June 2020. The completion rate of LDCT-LCS increased from 0% in December 2013 to approximately 70% in 2018-2019 but declined to 50-60% in 2020 during the pandemic. Ineligible patients had lower completion rates of LDCT-LCS. Patients who were new to the healthcare system, Black, received the LDCT-LCS order in the first few years after Medicare coverage (2016 or 2017), during the pandemic, had major comorbidities, and smoked less than 30 pack-years were less likely to complete an order. Patients were more likely to complete LDCT-LCS orders if they were younger, received the LDCT-LCS order from a physician (vs. nonphysician provider), from family medicine or other specialties (vs. internal medicine), or saw a provider with more experience in LDCT-LCS. CONCLUSIONS The beginning of the COVID-19 pandemic largely decreased the volume of LDCT-LCS orders, but rates have since been slowing recovering. Future interventions to improve lung cancer screening should consider doing more targeted outreach to new patients and Black patients as well as providing additional education to nonphysician practitioners and those providers with lower rates of LDCT-LCS referral orders.
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Affiliation(s)
- Jiang Li
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, 795 El Camino Real, 94301, Palo Alto, CA, USA.
| | - Cheryl D Stults
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, 795 El Camino Real, 94301, Palo Alto, CA, USA
| | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, 795 El Camino Real, 94301, Palo Alto, CA, USA
| | - Meghan Martinez
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, 795 El Camino Real, 94301, Palo Alto, CA, USA
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Rintala S, Dahlstrom KR, Franco EL, Louvanto K. A synthesis of evidence for cancer-specific screening interventions: A Preventive Medicine Golden Jubilee Review. Prev Med 2023; 167:107395. [PMID: 36565859 DOI: 10.1016/j.ypmed.2022.107395] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
The goal of cancer screening guidelines is to inform health practitioners to practice evidence-based cancer prevention. Cancer screening aims to detect treatable precancerous lesions or early-stage disease to enable actions aimed at decreasing morbidity and mortality. Continuous assessment of the available evidence for or against screening interventions by various organizations often results in conflicting recommendations and create challenges for providers and policymakers. Here we have summarized the current cancer screening recommendations by five leading organizations in North America and Europe: the National Cancer Institute's Physician Data Query (PDQ), the U.S. Preventive Services Task Force (USPSTF), the Canadian Task Force on Preventive Health Care (CTFPHC), the Cochrane Database of Systematic Reviews (CDSR), and the UK National Screening Committee for the National Health Service (UK NSC). All organizations assess evidence based on strength, quality, and quantity, and recommendations are similar although with differences with respect to screening start and stop ages. Recommendations are consistent for colorectal cancer screening with fecal occult blood test or fecal immunochemical test, cervical cancer screening with Pap-test, HPV-test, or co-testing, and breast cancer screening with mammography. However, guidelines vary with respect to age to start and end screening and testing frequency. Tests that have proven to be inefficient or whose use is capable of causing harm are routinely recommended against. Continuous review of screening guidelines is necessary to evaluate the many promising screening tests currently under investigation.
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Affiliation(s)
- Suvi Rintala
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology, Tampere University, Finn-Medi1, Biokatu 6, 33100 Tampere, Finland.
| | - Kristina R Dahlstrom
- Section of Epidemiology & Population Sciences, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Eduardo L Franco
- Division of Cancer Epidemiology, McGill University, 5100 Maisonneuve Blvd West, Suite 720, Montreal, Quebec H4A 3T2, Canada.
| | - Karolina Louvanto
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology, Tampere University, Finn-Medi1, Biokatu 6, 33100 Tampere, Finland; Department of Obstetrics and Gynecology, Tampere University Hospital, Elämänaukio 2, 33520 Tampere, Finland.
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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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Doria-Rose VP, Breen N, Brown ML, Feuer EJ, Geiger AM, Kessler L, Lipscomb J, Warren JL, Yabroff KR. A History of Health Economics and Healthcare Delivery Research at the National Cancer Institute. J Natl Cancer Inst Monogr 2022; 2022:21-27. [PMID: 35788380 DOI: 10.1093/jncimonographs/lgac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
With increased attention to the financing and structure of healthcare, dramatic increases in the cost of diagnosing and treating cancer, and corresponding disparities in access, the study of healthcare economics and delivery has become increasingly important. The Healthcare Delivery Research Program (HDRP) in the Division of Cancer Control and Population Sciences at the National Cancer Institute (NCI) was formed in 2015 to provide a hub for cancer-related healthcare delivery and economics research. However, the roots of this program trace back much farther, at least to the formation of the NCI Division of Cancer Prevention and Control in 1983. The creation of a division focused on understanding and explaining trends in cancer morbidity and mortality was instrumental in setting the direction of cancer-related healthcare delivery and health economics research over the subsequent decades. In this commentary, we provide a brief history of health economics and healthcare delivery research at NCI, describing the organizational structure and highlighting key initiatives developed by the division, and also briefly discuss future directions. HDRP and its predecessors have supported the growth and evolution of these fields through the funding of grants and contracts; the development of data, tools, and other research resources; and thought leadership including stimulation of research on previously understudied topics. As the availability of new data, methods, and computing capacity to evaluate cancer-related healthcare delivery and economics expand, HDRP aims to continue to support this growth and evolution.
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Affiliation(s)
- V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Nancy Breen
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.,Office of Science Policy, Strategic Planning, Analysis, Reporting, and Data, National Institute of Minority Health and Health Disparities, Bethesda, MD, USA
| | - Martin L Brown
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Ann M Geiger
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Larry Kessler
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, and Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Joan L Warren
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
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Leng J, Lei SF, Lei L, Cortez J, Capua J, Lui F, Gany F. Primary Care Providers' Knowledge, Attitudes, Beliefs, and Practice Related to Lung Cancer Screening in Five High-Risk Communities in New York City. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:631-640. [PMID: 32844367 PMCID: PMC7904966 DOI: 10.1007/s13187-020-01857-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Racial/ethnic minorities face stark inequalities in lung cancer incidence, treatment, survival, and mortality compared with US born non-Hispanic Whites. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is effective at reducing lung cancer mortality in high-risk current and former smokers and is recommended by the US Preventive Services Task Force (USPSTF). This study sought to assess primary care providers' (PCPs') knowledge, attitudes, beliefs, and practice related to LCS and the recent USPSTF guidelines in five high-risk immigrant communities in New York City. We surveyed 83 eligible PCPs between December 2016 and January 2018 through surveys sent by mail, email, and fax, administered by phone or in person. The survey included questions about providers' clinical practice, knowledge, attitudes, and beliefs related to LCS and the USPSTF guidelines. Information about patient demographics, PCPs' training background, and practice type were also collected. Sixty-seven percent of respondents reported that they did not have established guidelines for LCS at their practice, and 52% expressed that "vague" screening criteria influenced their referral processes for LCS. Barriers to LCS with LDCT included concerns that LDCT is not covered by insurance, patients' fears of screening results, and patients' concerns regarding radiation exposure. Targeted educational interventions for both PCPs and patients may increase access to recommended LCS, especially for populations at disproportionate risk for lung cancer.
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Affiliation(s)
- Jennifer Leng
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Department of Medicine, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., 2nd Floor, New York, NY, 10017, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
| | - Shu Fang Lei
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lei Lei
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jeralyn Cortez
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John Capua
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Florence Lui
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Clinical Psychology, The City College of New York, New York, NY, USA
| | - Francesca Gany
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Department of Medicine, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., 2nd Floor, New York, NY, 10017, USA
- Department of Healthcare Policy and Research, Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Referring high-risk individuals for lung cancer screening: A systematic review of interventions with healthcare professionals. Eur J Cancer Prev 2022; 31:540-550. [PMID: 35383631 DOI: 10.1097/cej.0000000000000755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This systematic review described the effect of interventions aimed at helping Healthcare Professionals refer high-risk individuals for lung cancer screening. Primary outcomes included: patient outcomes such as lung cancer detection, screening for lung cancer, lung cancer treatments received and lung cancer mortality. Healthcare professionals' knowledge and awareness of lung cancer screening served as secondary outcomes. METHODS Experimental studies published between January 2016 and 2021 were included. The search was conducted in MEDLINE, CINAHL, ERIC, PsycARTICLES, PsycInfo and Psychology and Behavioral Sciences Collection. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool and the level of evidence was assessed using the Scottish Intercollegiate Guidelines Network grading system. RESULTS Nine studies were included. Nurse navigation, electronic prompts for lung cancer screening and shared decision-making helped improve patient outcomes. Specialist screenings yielded more significant incidental findings and a higher percentage of Lung-RADS 1 results (i.e. no nodules/definitely benign nodules), while Primary Care Physician screenings were associated with higher numbers of Lung-RADS 2 results (i.e. benign nodules with a very low likelihood to becoming malignant). An increase in Healthcare Professionals' knowledge and awareness of lung cancer screening was achieved using group-based learning compared to lecture-based education delivery. CONCLUSIONS The effectiveness of Nurse navigation is evident, as are the benefits of adequate training, shared decision-making, as well as a structured, clear and well-understood referral processes supported by the use of electronic system-incorporated prompts.
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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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Leng J, Lui F, Gany F. Chinese Livery Drivers' Perspectives on Adapting a Community Health Worker Intervention to Facilitate Lung Cancer Screening. J Health Care Poor Underserved 2022; 33:332-348. [PMID: 35153223 PMCID: PMC9126037 DOI: 10.1353/hpu.2022.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chinese immigrant livery drivers with a smoking history are at high risk for lung cancer. A culturally adapted community health worker (CHW) program may be an effective approach to increase lung cancer screening (LCS) uptake in this underserved group. Five focus groups were conducted with 39 Chinese immigrant male livery drivers with a smoking history in New York City to assess their needs, priorities, and preferences regarding the proposed intervention. Transcripts were qualitatively analyzed using Atlas. ti. Focus group participants were uncertain about whether smoking was associated with cancer, unfamiliar with LCS, and reported numerous barriers to LCS uptake. Most believed a CHW program to facilitate LCS would be acceptable and feasible, if tailored to meet their needs. Our results have implications for improving access to early detection of lung cancer and preventive care (e.g., culturally appropriate smoking cessation and health education programs) for Chinese livery drivers.
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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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Miller EA, Pinsky PF. Healthcare Access, Utilization, and Preventive Health Behaviors by Eligibility for Lung Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:330-337. [PMID: 31656025 DOI: 10.1007/s13187-019-01634-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In 2013, the US Preventive Services Task Force recommended low-dose computed tomography screening for smokers at high risk of lung cancer; however, use remains low. Efforts to promote lung cancer screening need to consider how receptive this population is to preventive healthcare and cancer screening. In addition, because of demonstrated heterogeneity in behaviors by smoking status, interventions may need to differ among eligible high-risk subgroups. To assess the engagement of high-risk smokers in other preventive healthcare behaviors, we examined healthcare use, including non-lung cancer screening, and healthcare provider discussions regarding screening by eligibility for lung cancer screening. We used the 2015 National Health Interview Survey to assess smoking history, healthcare use, cancer screening, vaccinations, and healthcare provider discussions regarding non-lung cancer screening. We calculated weighted prevalence estimates and prevalence ratios comparing eligible and ineligible current and former smokers to never smokers. Eligible current and former smokers had significantly different healthcare utilization and screening concordance compared to never smokers and to each other. Compared to never smokers, eligible current smokers were significantly less likely to be concordant with breast, colorectal, and cervical cancer screening while eligible former smokers were only less likely to be concordant with breast cancer screening. Eligible current smokers were less likely to report physician discussions about non-lung screening tests. Provider discussions about screening and engagement in preventive healthcare differed among current and former smokers eligible for lung cancer screening. Intervention efforts to increase lung cancer screening levels will likely need to differ as well.
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Affiliation(s)
- Eric A Miller
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Paul F Pinsky
- Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
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Shah M, Surapaneni PK, Sandhu K, Shafi S, Abe T, Jain S, Oprea G, Volcy J. Assessment and Efficacy of Low-Dose CT Screening and Primary Care Providers Perspective on Lung Cancer Screening: An Institutional Review. Cureus 2021; 13:e13778. [PMID: 33842154 PMCID: PMC8029595 DOI: 10.7759/cureus.13778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/05/2022] Open
Abstract
Lung cancer is the most common cause of death in both men and women. The United States Preventive Services Task Force (USPSTF) recommends annual lung screening with low-dose computed tomography (LDCT) chest for individuals aged 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. We reviewed the electronic medical records of patients visiting our outpatient clinic over a period of one year. We included all eligible individuals according to USPSTF guidelines for LDCT to identify screening rates at our institution. All primary care physicians, including residents and attendings, were given a prepared questionnaire to understand their beliefs and concerns with the implementation of this program. A total of 13,500 patients visited the outpatient clinic and 1178 were eligible for LDCT. Forty-five percent (45%) of patients received LDCT screening, which was higher than the national average of 2%-5%. A total of 50 primary care providers were included in the survey. The majority of the providers were aware of the USPSTF guidelines and believed that patients with multiple comorbidities and insurance issues were barriers in initiating LDCT screening. Lung cancer screening is an important component in cancer preventive strategies. Widespread awareness among the primary care providers and the public is extremely necessary for improving the use of LDCT.
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Affiliation(s)
- Manan Shah
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | | | - Kirat Sandhu
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | - Saba Shafi
- Pathology and Laboratory Medicine, Yale School of Medicine, New Haven, USA
| | - Temidayo Abe
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
| | - Sanjay Jain
- Hematology and Medical Oncology, Morehouse School of Medicine, Atlanta, USA
| | - Gabriela Oprea
- Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, USA
| | - Judith Volcy
- Internal Medicine, Morehouse School of Medicine, Atlanta, USA
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Kommineni N, Nottingham E, Bagde A, Patel N, Rishi AK, Dev SRS, Singh M. Role of nano-lipid formulation of CARP-1 mimetic, CFM-4.17 to improve systemic exposure and response in osimertinib resistant non-small cell lung cancer. Eur J Pharm Biopharm 2021; 158:172-184. [PMID: 33220423 PMCID: PMC7857068 DOI: 10.1016/j.ejpb.2020.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/22/2020] [Accepted: 11/11/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND EGFR mutated NSCLCs have been shown to employ the use of CARP-1 in overriding the signaling inhibition of tyrosine kinase inhibitors (such as Osimertinib). CFM 4.17 is a CARP-1 inhibitor which has a promising role in overcoming Tyrosine Kinase Inhibitor (TKI) resistance when used as a pre-treatment through promoting apoptosis. Lack of solubility, hydrophobicity leading to poor systemic exposure are the limitations of CFM 4.17. This can be overcome by nano lipid-based formulation (NLPF) of CFM 4.17 which can enhance systemic exposure in preclinical animal models as well as improve therapeutic efficacy in drug-resistant cancer cell lines. METHODS Molecular docking simulation studies were performed for CFM 4.17. CFM 4.17-NLPF was formulated by melt dispersion technique and optimized using a Box-Behnken designed surface response methodology approach using Design Expert and MATLAB. In vitro, CFM 4.17 release studies were performed in simulated gastric fluids (SGF-pH-1.2) and simulated intestinal fluids (SIF- pH-6.8). Cell viability assays were performed with HCC827 and H1975 Osimertinib resistant and non-resistant cells in 2D and 3D culture models of Non-small cell lung cancer to determine the effects of CFM 4.17 pre-treatment in Osimertinib response. In vivo pharmacokinetics in rats were performed measuring the effects of NLPF on CFM 4.17 to improve the systemic exposure. RESULTS CFM 4.17 was well accommodated in the active pocket of the active site of human EGFR tyrosine kinase. CFM 4.17 NLPF was optimized with robust experimental design with particle size less than 300 nm and % entrapment efficiency of 92.3 ± 1.23. Sustained diffusion-based release of CFM 4.17 was observed from NLPF in SGF and SIFs with Peppas and Higuchi based release kinetics, respectively. CFM 4.17 pretreatment improved response by decreasing IC50 value by 2-fold when compared to single treatment Osimertinib in both 2D monolayer and 3D spheroid assays in HCC827 and H1975 Osimertinib resistant and non-resistant cells of Non-small cell lung cancer. There were no differences between CFM 4.17 NLPF and suspension in 2D monolayer culture pretreatments; however, The 3D culture assays showed that CFM 4.17 NLPF improved combination sensitivity. Pharmacokinetic analysis showed that CFM 4.17 NLPF displayed higher AUCtot (2.9-fold) and Cmax (1.18-fold) as compared to free CFM 4.17. In contrast, the animal groups administered CFM 4.17 NLPF showed a 4.73-fold (in half-life) and a 3.07-fold increase (in MRT) when compared to equivalent dosed suspension. CONCLUSION We have successfully formulated CFM 4.17 NLPFs by robust RSM design approach displaying improved response through sensitizing cells to Osimertinib treatment as well as improving the oral bioavailability of CFM 4.17.
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Affiliation(s)
- Nagavendra Kommineni
- College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, United States
| | - Ebony Nottingham
- College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, United States
| | - Arvind Bagde
- College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, United States
| | - Nilkumar Patel
- College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, United States
| | - Arun K Rishi
- John D. Dingell VA Medical Center, Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI 48201, United States
| | - Satyanarayan R S Dev
- Biological Systems Engineering, College of Agriculture and Food Sciences, Florida A&M University, Tallahassee, FL 32310, United States.
| | - Mandip Singh
- College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, United States.
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Abstract
Lung cancer screening with low-dose computed tomography provides an opportunity to save lives by early detection of the deadliest cancer in the United States. Uptake of lung cancer screening has been quite low but may be improving. Clinician and patient education, integration of lung cancer screening protocols into electronic medical records, support for shared decision making and tobacco cessation, and improved communication between referral centers and clinicians are all important areas for improvement for lung cancer screening to reach its potential in improving morbidity and mortality from lung cancer.
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Affiliation(s)
- Thomas Houston
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
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15
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Alishahi Tabriz A, Neslund-Dudas C, Turner K, Rivera MP, Reuland DS, Elston Lafata J. How Health-Care Organizations Implement Shared Decision-making When It Is Required for Reimbursement: The Case of Lung Cancer Screening. Chest 2020; 159:413-425. [PMID: 32798520 DOI: 10.1016/j.chest.2020.07.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Centers for Medicare and Medicaid Services stipulate shared decision-making (SDM) counseling as a prerequisite to lung cancer screening (LCS) reimbursement, despite well-known challenges implementing SDM in practice. RESEARCH QUESTION How have health-care organizations implemented SDM for LCS? STUDY DESIGN AND METHODS For this qualitative study, we used data from in-depth, semistructured interviews with key informants directly involved in implementing SDM for LCS, managing SDM for LCS, or both. We identified respondents using a snowball sampling technique and used template analysis to identify and analyze responses thematically. RESULTS We interviewed 30 informants representing 23 health-care organizations located in 12 states and 4 Census regions. Respondents described two types of SDM for LCS programs: centralized models (n = 7), in which front-end practitioners (eg, primary care providers) referred patients to an LCS clinic where trained staff (eg, advanced practice nurses) delivered SDM at the time of screening, or decentralized models (n = 10), in which front-end practitioners delivered SDM before referring patients for screening. Some organizations used both models simultaneously (n = 6). Respondents discussed tradeoffs between SDM quality and access. They perceived centralized models as enhancing SDM quality, but limiting patient access to care, and vice versa. Respondents reported ongoing challenges with limited resources and budgetary constraints, ambiguity regarding what constitutes SDM, and an absence of benchmarks for evaluating SDM for LCS quality. INTERPRETATION Those responsible for developing and managing SDM for LCS programs voiced concerns regarding both patient access and SDM quality, regardless of organizational context, or the SDM for LCS model implemented. The challenge facing these organizations, and those wanting to help patients and clinicians balance the tradeoffs inherent with LCS, is how to move beyond a check-box documentation requirement to a process that enables LCS to be offered to all high-risk patients, but used only by those who are informed and for whom screening represents a value-concordant service.
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Affiliation(s)
| | | | - Kea Turner
- University of South Florida College of Medicine, Tampa, FL; Moffitt Cancer Center, Tampa, FL
| | - M Patricia Rivera
- School of Medicine, University of North Carolina, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Daniel S Reuland
- School of Medicine, University of North Carolina, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Jennifer Elston Lafata
- Eshelman School of Pharmacy, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Henry Ford Health System, Detroit, MI.
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16
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Lewis JA, Chen H, Weaver KE, Spalluto LB, Sandler KL, Horn L, Dittus RS, Massion PP, Roumie CL, Tindle HA. Low Provider Knowledge Is Associated With Less Evidence-Based Lung Cancer Screening. J Natl Compr Canc Netw 2020; 17:339-346. [PMID: 30959463 DOI: 10.6004/jnccn.2018.7101] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite widespread recommendation and supportive policies, screening with low-dose CT (LDCT) is incompletely implemented in the US healthcare system. Low provider knowledge of the lung cancer screening (LCS) guidelines represents a potential barrier to implementation. Therefore, we tested the hypothesis that low provider knowledge of guidelines is associated with less provider-reported screening with LDCT. PATIENTS AND METHODS A cross-sectional survey was performed in a large academic medical center and affiliated Veterans Health Administration in the Mid-South United States that comprises hospital and community-based practices. Participants included general medicine providers and specialists who treat patients aged >50 years. The primary exposure was LCS guideline knowledge (US Preventive Services Task Force/Centers for Medicare & Medicaid Services). High knowledge was defined as identifying 3 major screening eligibility criteria (55 years as initial age of screening eligibility, smoking status as current or former smoker, and smoking history of ≥30 pack-years), and low knowledge was defined as not identifying these 3 criteria. The primary outcome was self-reported LDCT order/referral within the past year, and the secondary outcome was screening chest radiograph. Multivariable logistic regression evaluated the adjusted odds ratio (aOR) of screening by knowledge. RESULTS Of 625 providers recruited, 407 (65%) responded, and 378 (60.5%) were analyzed. Overall, 233 providers (62%) demonstrated low LCS knowledge, and 224 (59%) reported ordering/referring for LDCT. The aOR of ordering/referring LDCT was less among providers with low knowledge (0.41; 95% CI, 0.24-0.71) than among those with high knowledge. More providers with low knowledge reported ordering screening chest radiographs (aOR, 2.7; 95% CI, 1.4-5.0) within the past year. CONCLUSIONS Referring provider knowledge of LCS guidelines is low and directly proportional to the ordering rate for LDCT in an at-risk US population. Strategies to advance evidence-based LCS should incorporate provider education and system-level interventions to address gaps in provider knowledge.
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Affiliation(s)
- Jennifer A Lewis
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,bDivision of Hematology/Oncology, Department of Medicine, and
| | - Heidi Chen
- cDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn E Weaver
- dDepartment of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lucy B Spalluto
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,eDepartment of Radiology
| | | | - Leora Horn
- bDivision of Hematology/Oncology, Department of Medicine, and
| | - Robert S Dittus
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,fDivision of General Internal Medicine and Public Health, Department of Medicine, and
| | - Pierre P Massion
- gDivision of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; and.,hDepartment of Medicine, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Christianne L Roumie
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,fDivision of General Internal Medicine and Public Health, Department of Medicine, and
| | - Hilary A Tindle
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,fDivision of General Internal Medicine and Public Health, Department of Medicine, and
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17
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Li J, Chung S, Martinez MC, Luft HS. Smoking-Cessation Interventions After Lung Cancer Screening Guideline Change. Am J Prev Med 2020; 59:88-97. [PMID: 32417022 DOI: 10.1016/j.amepre.2020.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Recent guideline changes for lung cancer screening with low-dose computed tomography recommend smoking-cessation interventions be done in parallel with screening. The purpose of this study is to determine the post-guideline rates of smoking-cessation interventions among patients eligible and ineligible for lung cancer screening. METHODS Using electronic health records collected from a large ambulatory care system in northern California between 2010 and 2017, authors identified new patients who were current smokers aged 55-80 years visiting a primary care provider, and grouped patients into lung cancer screening-eligible heavy smokers, screening-ineligible moderate smokers, and screening-ineligible light smokers. Screening-eligible smokers versus screening-ineligible smokers were compared in receipt of smoking-cessation interventions before (2010-2013) and after (2014-2017) the guideline change, overall and by intervention type (formal counseling, informal counseling, pharmacotherapy) using hierarchical generalized linear models. Analyses were conducted in 2018-2019. RESULTS After the guideline change, the likelihood of receiving any smoking-cessation intervention (OR=1.44, 95% CI=1.28, 1.61, p<0.05), informal counseling (OR=1.29, 95% CI=1.15, 1.46, p<0.05), and pharmacotherapy (OR=1.24, 95% CI=1.02, 1.50, p<0.05) during a new patient visit significantly increased, with the increase not varying by level of smoking. For formal counseling, the post-guideline increase was greater for screening-eligible heavy smokers (OR=3.15, 95% CI=1.18, 8.36, p<0.05) and moderate smokers (OR=3.58, 95% CI=1.29, 9.95, p<0.05) relative to light smokers. CONCLUSIONS Smoking-cessation interventions increased after new lung cancer screening guidelines. Given the sizable adverse impacts of smoking on morbidity and mortality, small increases in the implementation of smoking-cessation interventions could have substantial public health benefits.
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Affiliation(s)
- Jiang Li
- Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California.
| | - Sukyung Chung
- Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Meghan C Martinez
- Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Harold S Luft
- Center for Health Systems Research, Sutter Health, Palo Alto Medical Foundation Research Institute, Palo Alto, California
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18
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Abeyweera PD, Brims FJH, Piccolo F, Lei C, Manners D. Australia-wide cross-sectional survey of general practitioners' knowledge and practice of lung cancer screening. Intern Med J 2020; 51:1111-1116. [PMID: 32237100 DOI: 10.1111/imj.14838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Low-dose computed tomography (LDCT) screening can reduce lung cancer deaths in high-risk individuals, yet current Australian guidelines do not recommend screening. Little is known about current screening practices in Australia. AIM To evaluate the proportion of general practitioners who report ordering lung cancer screening for their patients, identify factors associated with ordering lung cancer screening and assess general practitioners (GP) rationale for recommending screening and preference of composition of any future national targeted screening programme. METHODS A survey was distributed to a nationally representative sample of 4000 Australian GP. The questionnaire included respondent demographics, self-reported screening practices, knowledge of screening recommendations, recent screening education, preference for recruitment methodologies for potential screening programmes and potential factors influencing the screening practices of GP. Two logistic regression models identified factors associated with self-reported chest X-ray (CXR) and LDCT screening within the past 12 months. RESULTS A total of 323 GP completed the survey (participation rate 8.1%). Participants were mostly females (50.6%), from collective/group (79.1%) and metropolitan-based practices (73.5%). Despite the majority of responders understanding that screening is not recommended by Australian professional societies (71.2%), a substantial proportion of participants requested a CXR or LDCT screening (46.4% and 20.8% respectively). A variety of shared (GP reassurance, affordability of screening, believing screening is funded) and unique practice, educational and cognitive factors were associated with self-reported LDCT and CXR screening, with the strongest association being recent education about screening from radiology practices (odds ratio (aOR) for LDCT screening 10.4, P < 0.001). CONCLUSION In Australia, lung cancer screening occurs outside a coordinated programme, and there is discordance between practice and national recommendations. This highlights an urgent need for clearer guidance from national and professional bodies.
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Affiliation(s)
| | - Fraser J H Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Francesco Piccolo
- Midland Physician Service, St John of God Midland Public and Private Hospitals, Perth, Western Australia, Australia
| | - Cory Lei
- Currambine Family Practice, Perth, Western Australia, Australia
| | - David Manners
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia.,Midland Physician Service, St John of God Midland Public and Private Hospitals, Perth, Western Australia, Australia
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19
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Lee SJ, Hamann HA, Browning T, Santini NO, Abbara S, Balis DS, Chiu H, Moran BA, McGuire M, Gerber DE. Stakeholder engagement to initiate lung cancer screening in an urban safety-net health system. Healthcare (Basel) 2020; 8:100370. [DOI: 10.1016/j.hjdsi.2019.100370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 07/18/2019] [Accepted: 08/17/2019] [Indexed: 11/27/2022] Open
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20
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Henderson LM, Marsh MW, Benefield TS, Jones LM, Reuland DS, Brenner AT, Goldstein AO, Molina PL, Maygarden SJ, Rivera MP. Opinions and Practices of Lung Cancer Screening by Physician Specialty. N C Med J 2019; 80:19-26. [PMID: 30622199 DOI: 10.18043/ncm.80.1.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In response to the National Lung Screening Trial, numerous professional organizations published guidelines recommending annual lung cancer screening with low-dose computed tomography (LDCT) for high-risk patients. Prior studies found that physician attitudes and knowledge about lung cancer screening directly impacts the number of screening exams ordered.METHODS In 2015, we surveyed 34 pulmonologists and 186 primary care providers (PCPs) to evaluate opinions and practices of lung cancer screening in a large academic medical center. We compared PCP and pulmonologist responses using t-tests and χ2 tests.RESULTS The overall survey response rate was 40% (39% for PCPs and 50% for pulmonologists). Pulmonologists were more likely than PCPs to report lung cancer screening as beneficial for patients (88.2% versus 37.7%, P < .0001) and as being cost-effective (47.1% versus 14.3%, P = .02). More pulmonologists (76%) reported ordering a LDCT for screening in the past 12 months compared to PCPs (41%, P = .012). Pulmonologists and PCPs reported similar barriers to referring patients for lung cancer screening, including patient costs (82.4% versus 77.8%), potential for emotional harm (58.8% versus 58.3%), high false positive rate (47.1% versus 69.4%), and likelihood for medical complications (47.1% versus 59.7%).LIMITATIONS Our results are generalizable to academic medical centers and responses may be susceptible to recall bias, non-response bias, and social desirability bias.CONCLUSION We found significant differences in opinions and practices between PCPs and pulmonologists regarding lung cancer screening referrals and perceived benefits. As lung cancer screening continues to emerge in clinical practice, it is important to understand these differences across provider specialty to ensure screening is implemented and offered to patients appropriately.
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Affiliation(s)
- Louise M Henderson
- associate professor, Department of Radiology; Adjunct Associate Professor, Department of Epidemiology; Member, Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, North Carolina
| | - Mary W Marsh
- research associate, Department of Radiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Thad S Benefield
- statistician, Department of Radiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Laura M Jones
- research associate, Department of Radiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Daniel S Reuland
- professor, Department of Medicine, Division of General Medicine & Clinical Epidemiology; Member, Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, North Carolina
| | - Alison T Brenner
- assistant professor, Department of Medicine, Division of General Medicine & Clinical Epidemiology; Member, Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, North Carolina
| | - Adam O Goldstein
- professor, Department of Family Medicine, The University of North Carolina, Chapel Hill, North Carolina
| | - Paul L Molina
- professor, Department of Radiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Susan J Maygarden
- professor, Department of Pathology and Laboratory Medicine, The University of North Carolina, Chapel Hill, North Carolina
| | - M Patricia Rivera
- professor, Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine; Member, Lineberger Comprehensive Cancer Center, The University of North Carolina, Chapel Hill, North Carolina
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21
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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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22
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Disparities in Lung Cancer Screening Availability: Lessons From Southwest Virginia. Ann Thorac Surg 2019; 108:412-416. [PMID: 30951691 DOI: 10.1016/j.athoracsur.2019.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/06/2019] [Accepted: 03/01/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Little is known about health disparities in access to low-dose computed tomography (LDCT) screening. This study hypothesized that the current capacity for LDCT screening would be exceeded by the number of at-risk individuals in Virginia. METHODS Cancer incidence data and adult smoking rates for Virginia were obtained from public sources between 2006 and 2012. The American College of Radiology website was queried in 2015 to identify lung cancer screening facilities in Virginia, which were surveyed. Spatial exploratory data analysis was used to examine secondary data, and descriptive analysis was used to examine primary survey data. RESULTS Rural counties have higher lung cancer death rates and smoking rates than metropolitan counties. Despite a tremendous burden for LDCT screening in rural counties, particularly in southwest Virginia, there were only two LDCT facilities. In total, 37 accredited LDCT facilities were identified in Virginia. On average, facilities had been screening for 14.6 months and screened an average of 76 patients. CONCLUSIONS At-risk smokers in Virginia, particularly those living in rural areas with high smoking rates, do not have adequate recommended LDCT coverage. More screening centers are needed to care for the high number of rural smokers at risk for lung cancer.
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23
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Neugut AI, MacLean SA, Dai WF, Jacobson JS. Physician Characteristics and Decisions Regarding Cancer Screening: A Systematic Review. Popul Health Manag 2019; 22:48-62. [DOI: 10.1089/pop.2017.0206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Alfred I. Neugut
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | | | - Wei F. Dai
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Judith S. Jacobson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
- Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York
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24
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Byrne MM, Lillie SE, Studts JL. Lung cancer screening in a community setting: Characteristics, motivations, and attitudes of individuals being screened. Health Psychol Open 2019; 6:2055102918819163. [PMID: 30643640 PMCID: PMC6322099 DOI: 10.1177/2055102918819163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We describe the characteristics of individuals being screened in community settings including factors influencing screening decisions and the level of information sought prior to screening. Individuals from two community-based radiology clinics (N = 27) were surveyed after screening. Screening efficacy and salience were the most important factors in screening decisions, whereas healthcare provider recommendations were rated not important. Half of participants reported no or little conversation about screening with their primary care provider, and 61.5 percent had not sought any information on screening. Individuals being screened in a community setting are unlikely to have sufficient information for an informed decision about screening.
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25
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Manners D, Wilcox H, McWilliams A, Piccolo F, Liira H, Brims F. Current lung cancer screening practice amongst general practitioners in Western Australia: a cross-sectional study. Intern Med J 2018; 48:78-80. [PMID: 29314524 DOI: 10.1111/imj.13670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 11/28/2022]
Abstract
Lung cancer screening with low dose computed tomography (LDCT) is recommended in the USA and Canada for high-risk smokers but not in Australia. We administered a cross-sectional survey to Western Australian general practitioners (GP). The majority (64/93, 69%) reported requesting a screening chest X-ray (42/93, 45%) and/or LDCT (38/93, 41%) in the past year. LDCT screening was more common if the GP had received education from radiology practices (odds ratio (OR) 2.81, P = 0.03) or if they believed screening is funded by the Medical Benefits Scheme (OR 3.57, P = 0.02). Lung cancer screening with LDCT is occurring outside a coordinated programme, contrary to Australian guidelines.
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Affiliation(s)
- David Manners
- Midland Physician Service, St John of God Public and Private Hospital, Perth, Western Australia, Australia
| | - Helen Wilcox
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia, Australia
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Francesco Piccolo
- Midland Physician Service, St John of God Public and Private Hospital, Perth, Western Australia, Australia
| | - Helena Liira
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia, Australia
| | - Fraser Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Curtin Medical School, Curtin University, Perth, Western Australia, Australia
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Hofer F, Kauczor HU, Stargardt T. Cost-utility analysis of a potential lung cancer screening program for a high-risk population in Germany: A modelling approach. Lung Cancer 2018; 124:189-198. [PMID: 30268459 DOI: 10.1016/j.lungcan.2018.07.036] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer is the leading cause of cancer death in Germany. Although several randomized trials in Europe have evaluated the effectiveness of lung cancer screening programs, evidence on the cost-effectiveness of lung cancer screening is scarce. OBJECTIVE To evaluate the cost-effectiveness of a population-based lung cancer screening program from the perspective of a German payer. METHODS We conducted a cost-effectiveness analysis from the public payer perspective for a high-risk population defined as heavy former and current smokers (≥20 cigarettes per day) between 55 and 75 years of age. The underlying model consisted of two Markov models. We differentiated between a population-based annual screening program and standard clinical care. Depending on stage at diagnosis, simulated patients were assigned to one of five treatment paths according to the German clinical guideline for the diagnosis and treatment of lung cancer. Costs, life years saved, and quality adjusted life years (QALYs) were used as outcomes. Values for input parameters were taken from the literature. The model was run for 60 cycles with a cycle length of three months. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS In the base case, annual lung cancer screening led to an increase in incremental costs (€ 1,153 per person) compared to standard clinical care. However, the screening approach was associated with an incremental gain in life years (0.06 per person) and QALYs (0.04 per person). Thus, the incremental cost-effectiveness ratio (ICER) was € 19,302 per life year saved and € 30,291 per QALY. A probabilistic sensitivity analysis with 10,000 draws resulted in average ICERs of € 22,118 per life year and € 34,841 per QALY. CONCLUSION We provide evidence that lung cancer screening for a high-risk population may be more effective, but also more costly, than standard clinical care from the perspective of a German payer.
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Affiliation(s)
- Florian Hofer
- Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354 Hamburg, Germany.
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Tom Stargardt
- Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
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Li J, Chung S, Wei EK, Luft HS. New recommendation and coverage of low-dose computed tomography for lung cancer screening: uptake has increased but is still low. BMC Health Serv Res 2018; 18:525. [PMID: 29976189 PMCID: PMC6034213 DOI: 10.1186/s12913-018-3338-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 06/27/2018] [Indexed: 12/18/2022] Open
Abstract
Background In 2013, the US Preventive Services Task Force (USPSTF) issued recommendations for low-dose computed tomography for lung cancer screening (LDCT-LCS), but there continues to be a dearth of information on the adoption of LDCT-LCS in healthcare systems. Using a multilevel perspective, our study aims to assess referrals for LDCT-LCS and identify facilitators and barriers to adoption following recent policy changes. Methods A retrospective analysis of electronic medical record data from patients aged 55–80 years with no history of lung cancer who visited a primary care provider in a large healthcare system in California during 2010–2016 (1,572,538 patient years). Trends in documentation of smoking history, number of eligible patients, and lung cancer screening orders were assessed. Using Hierarchical Generalized Linear Models, we also evaluated provider-level and patient-level factors associated with lung cancer screening orders among 970 primary care providers and 12,801 eligible patients according to USPSTF guidelines between January 1st, 2014 and December 31st, 2016. Results Documentation of smoking history to determine eligibility (59.2% in 2010 to 77.8% in 2016) and LDCT-LCS orders (0% in 2010 to 7.3% in 2016) have increased since USPSTF guidelines. Patient factors associated with increased likelihood of lung cancer screening orders include: younger patient age (78–80 vs. 55–64 years old: OR, 0.4; 95% CI, 0.3–0.7), Asian race (vs. Non-Hispanic White: OR, 1.6; 95% CI, 1.1–2.4), reported current smoking (vs. former smoker: OR, 1.7; 95% CI, 1.4–2.0), no severe comorbidity (severe vs. no major comorbidity: OR = 0.2, 95% CI = 0.1–0.3; moderate vs. no major comorbidity: OR = 0.5; 95% CI = 0.4–0.7), and making a visit to own primary care provider (vs. other primary care providers: OR, 2.4; 95% CI, 1.7–3.4). Appropriate referral for lung cancer screening varies considerably across primary care providers. Provider factors include being a female physician (vs. male: OR, 1.6; 95% CI, 1.1–2.3) and receiving medical training in the US (foreign vs. US medical school graduates: OR = 0.4, 95% CI = 0.3–0.7). Conclusions Future interventions to improve lung cancer screening may be more effective if they focus on accurate documentation of smoking history and target former smokers who do not regularly see their own primary care providers.
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Affiliation(s)
- Jiang Li
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA.
| | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
| | - Esther K Wei
- California Pacific Medical Center Research Institute, Sutter Health Affiliate, 475 Brannan St #220, San Francisco, CA, 94107, USA
| | - Harold S Luft
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA
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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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Pathways to Lung Cancer Diagnosis: A Qualitative Study of Patients and General Practitioners about Diagnostic and Pretreatment Intervals. Ann Am Thorac Soc 2018; 14:742-753. [PMID: 28222271 DOI: 10.1513/annalsats.201610-817oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
RATIONALE Pathways to lung cancer diagnosis and treatment are complex. International evidence shows significant variations in pathways. Qualitative research investigating pathways to lung cancer diagnosis rarely considers both patient and general practitioner views simultaneously. OBJECTIVES To describe the lung cancer diagnostic pathway, focusing on the perspective of patients and general practitioners about diagnostic and pretreatment intervals. METHODS This qualitative study of patients with lung cancer and general practitioners in Australia used qualitative interviews or a focus group in which participants responded to a semistructured questionnaire designed to explore experiences of the diagnostic pathway. The Model of Pathways to Treatment (the Model) was used as a framework for analysis, with data organized into (1) events, (2) processes, and (3) contributing factors for variations in diagnostic and pretreatment intervals. RESULTS Thirty participants (19 patients with lung cancer and 11 general practitioners) took part. Nine themes were identified during analysis. For the diagnostic interval, these were: (1) taking patient concerns seriously, (2) a sense of urgency, (3) advocacy that is doctor-driven or self-motivated, and (4) referral: "knowing who to refer to." For the pretreatment interval, themes were: (5) uncertainty, (6) psychosocial support for the patient and family before treatment, and (7) communication among the multidisciplinary team and general practitioners. Two cross-cutting themes were: (8) coordination of care and "handing over" the patient, and (9) general practitioner knowledge about lung cancer. Events were perceived as complex, with diagnosis often being revealed over time, rather than as a single event. Contributing factors at patient, system, and disease levels are described for both intervals. CONCLUSIONS Patients and general practitioners expressed similar themes across the diagnostic and pretreatment intervals. Significant improvements could be made to health systems to facilitate better patient and general practitioner experiences of the diagnostic pathway. This novel presentation of patient and general practitioner perspectives indicates that systemic interventions have a role in timely and appropriate referrals to specialist care and coordination of investigations. Systemic interventions may alleviate concerns about urgency of diagnostic workup, communication, and coordination of care as patients transition from primary to specialist care.
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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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Hong S, Kim S, Suh M, Park B, Choi KS, Jun JK. Physician's awareness of lung cancer screening and its related medical radiation exposure in Korea. Epidemiol Health 2018; 40:e2018002. [PMID: 29681140 PMCID: PMC6060336 DOI: 10.4178/epih.e2018002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/17/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Through a survey on perception of lung cancer screening and accompanying medical radiation exposure in Korea, the present study was to investigate its current situations and evaluate various perception of physicians regarding it in order to propose measures for improvements. METHODS Medical specialists in national cancer screening institutions selected through stratified random sampling were subjected to face-to-face interview using a structured questionnaire. We investigated physicians' perception on effectiveness of lung cancer screening depending on screening modality, selection criteria for subjects of screening, types of equipment used to screen, and perception for seriousness of adverse effects following the test. In addition, odds ratios to underestimate risk of radiation exposure from screening were calculated through logistic regression analysis. RESULTS Each response that chest X-ray is effective for lung cancer screening and that smoking history is not considered prior to screening recommendation accounted for more than 60% of respondents, suggesting the chance of unnecessary screening tests. Regarding adverse effects of lung cancer screening, about 85% of respondents replied that false positive, radiation exposure, and overdiagnosis could be ignored. About 70% of respondents underestimated radiation dose from lung cancer screening, and a low proportion of physicians informed patients of radiation exposure risk. CONCLUSIONS It was found that most physicians underestimated harms of lung cancer screening including radiation exposure and were lack of awareness regarding lung cancer screening. It should be noted that physicians need to have proper perceptions about screening recommendation and accompanying possible harms, for successful implementation of the screening program.
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Affiliation(s)
- Seri Hong
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Suyeon Kim
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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Raz DJ, Wu GX, Consunji M, Nelson RA, Kim H, Sun CL, Sun V, Kim JY. The Effect of Primary Care Physician Knowledge of Lung Cancer Screening Guidelines on Perceptions and Utilization of Low-Dose Computed Tomography. Clin Lung Cancer 2018; 19:51-57. [PMID: 28652090 PMCID: PMC8794575 DOI: 10.1016/j.cllc.2017.05.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/03/2017] [Accepted: 05/16/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is recommended by the U.S. Preventive Services Task Force (USPSTF) in high-risk patients, but a minority of eligible people are screened. It is not clear whether knowledge of USPSTF recommendations among primary care physicians (PCP) affects utilization of LDCT. METHODS A randomly selected sample of 1384 PCPs in Los Angeles County was surveyed between January and October 2015, using surveys sent by mail, fax, and e-mail. The response rate was 18% (n = 250). Training background, years in practice, practice type, and respondent demographics were collected. We analyzed results based on the response to a question on whether the USPSTF recommends the use of LDCT to screen high-risk individuals for lung cancer. RESULTS A total of 117 (47%) PCPs responded that the USPSTF recommends LDCT for LCS. Of PCPs who were aware of USPSTF recommendations, 97% responded that CT was effective at reducing lung cancer mortality among individuals meeting eligibility criteria, compared with 90% who were unaware of guidelines (P = .02). A larger proportion of PCPs aware of guidelines ordered LDCT (71% vs. 38%, P < .001) and initiated a discussion on screening (86% vs. 62%, P < .001). Both groups of PCPs reported similar perceptions of barriers to screening, such as insurance coverage, risks of LCS, and cost to society. Practice size, training background, and years in practice did not affect knowledge of guidelines. DISCUSSION Awareness of USPSTF recommendations for LDCT is associated with increased utilization of LDCT for screening. Educational interventions for PCPs may improve adherence with LCS recommendations.
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Affiliation(s)
- Dan J Raz
- Division of Thoracic Surgery, City of Hope, Duarte, CA.
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope, Duarte, CA
| | | | | | - Heeyoung Kim
- Department of Population Sciences, City of Hope, Duarte, CA
| | - Can-Lan Sun
- Department of Population Sciences, City of Hope, Duarte, CA
| | - Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope, Duarte, CA
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Rankin NM, Collett GK, Brown CM, Shaw TJ, White KM, Beale PJ, Trevena LJ, Anderiesz C, Barnes DJ. Implementation of a lung cancer multidisciplinary team standardised template for reporting to general practitioners: a mixed-method study. BMJ Open 2017; 7:e018629. [PMID: 29288182 PMCID: PMC5770820 DOI: 10.1136/bmjopen-2017-018629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Few interventions have been designed that provide standardised information to primary care clinicians about the diagnostic and treatment recommendations resulting from cancer multidisciplinary team (MDT) (tumour board) meetings. This study aimed to develop, implement and evaluate a standardised template for lung cancer MDTs to provide clinical information and treatment recommendations to general practitioners (GPs). Specific objectives were to (1) evaluate template feasibility (acceptability, appropriateness and timeliness) with GPs and (2) document processes of preimplementation, implementation and evaluation within the MDT setting. DESIGN A mixed-method study design using structured interviews with GPs and qualitative documentation of project logs about implementation processes. SETTING Two hospitals in Central Sydney, New South Wales, Australia. PARTICIPANTS 61 GPs evaluated the template. Two lung cancer MDTs, consisting of 33 clinicians, and eight researchers participated in template development and implementation strategy. RESULTS The MDT-reporting template appears to be a feasible way of providing clinical information to GPs following patient presentation at a lung cancer MDT meeting. Ninety-five per cent of GPs strongly agreed or agreed that the standardised template provided useful and relevant information, that it was received in a timely manner (90%) and that the information was easy to interpret and communicate to the patient (84%). Implementation process data show that the investment made in the preimplementation stage to integrate the template into standard work practices was a critical factor in successful implementation. CONCLUSIONS This study demonstrates that it is feasible to provide lung cancer MDT treatment recommendations to GPs through implementation of a standardised template. A simple intervention, such as a standardised template, can help to address quality gaps and ensure that timely information is communicated between tertiary and primary care healthcare providers.
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Affiliation(s)
- Nicole M Rankin
- Sydney Medical School, Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Gemma K Collett
- Sydney Medical School, Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Clare M Brown
- Cancer Services, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Tim J Shaw
- Research in Implementation Science and eHealth (RISe), Faculty of Health Sciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Kahren M White
- Cancer Institute NSW, Eveleigh, New South Wales, Australia
| | - Philip J Beale
- Cancer Services, Concord Repatriation and General Hospital Cancer Centre, Sydney Local Health District, Concord, New South Wales, Australia
| | - Lyndal J Trevena
- Discipline of General Practice, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | | | - David J Barnes
- Cancer Services, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
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Gressard L, DeGroff AS, Richards TB, Melillo S, Kish-Doto J, Heminger CL, Rohan EA, Allen KG. A qualitative analysis of smokers' perceptions about lung cancer screening. BMC Public Health 2017; 17:589. [PMID: 28637439 PMCID: PMC5479014 DOI: 10.1186/s12889-017-4496-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/12/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In 2013, the US Preventive Services Task Force (USPSTF) began recommending lung cancer screening for high risk smokers aged 55-80 years using low-dose computed tomography (CT) scan. In light of these updated recommendations, there is a need to understand smokers' knowledge of and experiences with lung cancer screening in order to inform the design of patient education and tobacco cessation programs. The purpose of this study is to describe results of a qualitative study examining smokers' perceptions around lung cancer screening tests. METHODS In 2009, prior to the release of the updated USPSTF recommendations, we conducted 12 120-min, gender-specific focus groups with 105 current smokers in Charlotte, North Carolina and Cincinnati, Ohio. Focus group facilitators asked participants about their experience with three lung cancer screening tests, including CT scan, chest x-ray, and sputum cytology. Focus group transcripts were transcribed and qualitatively analyzed using constant comparative methods. RESULTS Participants were 41-67 years-old, with a mean smoking history of 38.9 pack-years. Overall, 34.3% would meet the USPSTF's current eligibility criteria for screening. Most participants were unaware of all three lung cancer screening tests. The few participants who had been screened recalled limited information about the test. Nevertheless, many participants expressed a strong desire to pursue lung cancer screening. Using the social ecological model for health promotion, we identified potential barriers to lung cancer screening at the 1) health care system level (cost of procedure, confusion around results), 2) cultural level (fatalistic beliefs, distrust of medical system), and 3) individual level (lack of knowledge, denial of risk, concerns about the procedure). Although this study was conducted prior to the updated USPSTF recommendations, these findings provide a baseline for future studies examining smokers' perceptions of lung cancer screening. CONCLUSION We recommend clear and patient-friendly educational tools to improve patient understanding of screening risks and benefits and the use of best practices to help smokers quit. Further qualitative studies are needed to assess changes in smokers' perceptions as lung cancer screening with CT scan becomes more widely used in community practice.
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Affiliation(s)
- Lindsay Gressard
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341-3717 USA
| | - Amy S. DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341-3717 USA
| | - Thomas B. Richards
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341-3717 USA
| | - Stephanie Melillo
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341-3717 USA
| | | | | | - Elizabeth A. Rohan
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341-3717 USA
| | - Kristine Gabuten Allen
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-76, Atlanta, GA 30341-3717 USA
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Willson ML, Vernooij RW, Gagliardi AR, Armstrong M, Bernhardsson S, Brouwers M, Bussières A, Fleuren M, Gali K, Huckson S, Jones S, Lewis SZ, James R, Marshall C, Mazza D. Questionnaires used to assess barriers of clinical guideline use among physicians are not comprehensive, reliable, or valid: a scoping review. J Clin Epidemiol 2017; 86:25-38. [DOI: 10.1016/j.jclinepi.2016.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/27/2016] [Accepted: 12/23/2016] [Indexed: 01/26/2023]
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Wu G, Consunji M, Nelson RA, Yeung K, Sun C, Kim JY, Raz DJ. Perspectives on Managing Solitary Pulmonary Nodules: A Survey of Primary Care Physicians. Semin Thorac Cardiovasc Surg 2017; 29:391-405. [PMID: 29195577 DOI: 10.1053/j.semtcvs.2017.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2017] [Indexed: 12/16/2022]
Abstract
Primary care physicians (PCPs) may be involved in the evaluation of solitary pulmonary nodules (SPNs) detected through lung cancer screening. Little is known about their perspectives on the management or the referral of SPN. Using the American Medical Association's Physician Masterfile, we randomly surveyed 1384 PCPs between January and October 2015 with an 18% response rate. A subset analysis was performed on SPN management and referral practices of PCP. These results and those relating to practice characteristics were compared between family practice and internal medicine physicians. Responders and nonresponders did not differ by demographic characteristics. A total of 137 (55.5%) PCPs reported feeling confident in managing the workup of imaging-detected SPN. However, only 53 PCPs (21.3%) were inclined to manage the evaluation and follow-up of SPN. There was no significant difference between family practice and internal medicine physicians with regard to years in practice, size of practice, or referral to specialists. Family practitioners and internists similarly disagreed or were neutral to self-managing SPN (P = 0.60). Internists were twice as likely to express confidence as family practitioners (odds ratio 1.95, 95% confidence interval 1.09-3.48). Among all PCPs, 75.4% would refer management of these patients to a pulmonologist, 28.9% to a surgeon, and 24.2% to an oncologist. Confidence did not predict lung cancer screening practices. Although more than half of PCPs expressed confidence in the workup of SPN, most preferred referral to specialists. Additional research is needed to understand barriers to PCP management of incidental SPN in the effort to facilitate lung cancer screening.
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Affiliation(s)
- Geena Wu
- Division of Thoracic Surgery, City of Hope, Duarte, California.
| | - Martin Consunji
- Division of Thoracic Surgery, City of Hope, Duarte, California
| | | | - Kenny Yeung
- Division of Thoracic Surgery, City of Hope, Duarte, California
| | - Canlan Sun
- Department of Population Sciences, City of Hope, Duarte, California
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope, Duarte, California
| | - Dan J Raz
- Division of Thoracic Surgery, City of Hope, Duarte, California
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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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Parda N, Stępień M, Zakrzewska K, Madaliński K, Kołakowska A, Godzik P, Rosińska M. What affects response rates in primary healthcare-based programmes? An analysis of individual and unit-related factors associated with increased odds of non-response based on HCV screening in the general population in Poland. BMJ Open 2016; 6:e013359. [PMID: 27927665 PMCID: PMC5168657 DOI: 10.1136/bmjopen-2016-013359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Response rate in public health programmes may be a limiting factor. It is important to first consider their delivery and acceptability for the target. This study aimed at determining individual and unit-related factors associated with increased odds of non-response based on hepatitis C virus screening in primary healthcare. DESIGN Primary healthcare units (PHCUs) were extracted from the Register of Health Care Centres. Each of the PHCUs was to enrol adult patients selected on a random basis. Data on the recruitment of PHCUs and patients were analysed. Multilevel modelling was applied to investigate individual and unit-related factors associated with non-response. Multilevel logistic model was developed with fixed effects and only a random intercept for the unit. Preliminary analysis included a random effect for unit and each of the individual or PHCU covariates separately. For each of the PHCU covariates, we applied a two-level model with individual covariates, unit random effect and a single fixed effect of this unit covariate. SETTING This study was conducted in primary care units in selected provinces in Poland. PARTICIPANTS A total of 242 PHCUs and 24 480 adults were invited. Of them, 44 PHCUs and 20 939 patients agreed to participate. Both PHCUs and patients were randomly selected. RESULTS Data on 44 PHCUs and 24 480 patients were analysed. PHCU-level factors and recruitment strategies were important predictors of non-response. Unit random effect was significant in all models. Larger and private units reported higher non-response rates, while for those with a history of running public health programmes the odds of non-response was lower. Proactive recruitment, more working hours devoted to the project and patient resulted in higher acceptance of the project. Higher number of personnel had no such effect. CONCLUSIONS Prior to the implementation of public health programme, several factors that could hinder its execution should be addressed.
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Affiliation(s)
- Natalia Parda
- Department of Epidemiology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
| | - Małgorzata Stępień
- Department of Epidemiology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
| | - Karolina Zakrzewska
- Department of Virology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
- Department of Epidemiology, Medical University of Warsaw, Warsaw, Poland
| | - Kazimierz Madaliński
- Department of Virology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
| | - Agnieszka Kołakowska
- Department of Virology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
| | - Paulina Godzik
- Department of Virology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
| | - Magdalena Rosińska
- Department of Epidemiology, National Institute of Public Health—National Institute of Hygiene, Warsaw, Poland
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Raz DJ, Wu GX, Consunji M, Nelson R, Sun C, Erhunmwunsee L, Ferrell B, Sun V, Kim JY. Perceptions and Utilization of Lung Cancer Screening Among Primary Care Physicians. J Thorac Oncol 2016; 11:1856-1862. [PMID: 27346412 DOI: 10.1016/j.jtho.2016.06.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/26/2016] [Accepted: 06/12/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is effective at reducing lung cancer mortality in high-risk current and former smokers. Despite the fact that screening is recommended by the U.S. Preventative Services Task Force (USPSTF), few eligible patients are screened. We set out to study the barriers to LCS by surveying primary care physicians (PCPs). METHODS We surveyed a randomly selected sample of 1384 eligible PCPs between January and October 2015, using the American Medical Association Physician Masterfile, though surveys sent by mail, fax, and e-mail. The survey included questions regarding knowledge of LCS guidelines, utilization of LCS over the prior 12 months, and perceptions of barriers to LCS. Training background, years in practice, practice type, and demographics were also collected. RESULTS The survey response rate was 18%. Responders and nonresponders did not differ by practice or demographic characteristics. Of the respondents, 47% indicated that LCS was recommended by the USPSTF, 52% had referred at least one patient for LDCT, and 12% had referred at least one patient to a LCS program over the prior 12 months. Perceived barriers to LCS included uncertainty regarding ther benefit of LCS, concern regarding insurance coverage, and the harm of LCS. CONCLUSIONS Although LCS is recommended by the USPSTF, LDCT is utilized in a minority of eligible patients, as reported by surveyed PCPs. Approximately half of PCPs are familiar with USPSTF recommendations for LCS and a number of physician barriers to adherence to guidelines exist. Additional study of physician- and system-based interventions to improve adherence to LCS recommendations is needed.
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Affiliation(s)
- Dan J Raz
- Division of Thoracic Surgery, City of Hope, Duarte, California.
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope, Duarte, California
| | - Martin Consunji
- Division of Thoracic Surgery, City of Hope, Duarte, California
| | - Rebecca Nelson
- Department of Biostatistics, City of Hope, Duarte, California
| | - Canlan Sun
- Department of Population Sciences, City of Hope, Duarte, California
| | | | - Betty Ferrell
- Department of Population Sciences, City of Hope, Duarte, California
| | - Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, California
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope, Duarte, California
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Rogers AR, Christensen T, Welsh EM, Faseru B. Patient-provider discussions about lung cancer screening: Results from the 2012/2013 Kansas Adult Tobacco Survey. Prev Med Rep 2016; 2:577-9. [PMID: 26844120 PMCID: PMC4721494 DOI: 10.1016/j.pmedr.2015.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Prior to the 2013 US Preventive Services Task Force (USPSTF) guidelines for lung cancer screening, the American Cancer Society released interim guidance recommending physicians discuss lung cancer screening with high risk patients. We included a question on patient–provider discussions about lung cancer screening on a statewide population-based survey to establish baseline prevalence for surveillance and to identify subpopulation disparities. Methods We analyzed the 2012/2013 Kansas Adult Tobacco Survey to assess patient–provider discussions about lung cancer screening. Weighted prevalence estimates and adjusted odds ratios were calculated to examine characteristics associated with discussing screening. Results The prevalence of patient–provider discussions about lung cancer screening among current and former smokers aged 55 to 74 years was 31.0% (95% CI 27.0–35.0). The adjusted prevalence odds of having these discussions was higher among males, adults aged 65 to 74 years, adults living with a disability, as well as those who saw a health professional in the past year and had their smoking status assessed or were advised to quit. Conclusions The current study is unique as it is the first to assess patient–provider discussions about lung cancer screening using a statewide survey. These results may inform strategies to increase patient–provider discussions about lung cancer screening among high risk Kansans. We assessed lung cancer screening discussions with a Kansas population-based survey. Prevalence of lung cancer screening discussions was 31% among our target population. Sex, age, and disability status were associated with screening discussions. Tobacco use assessment and advice to quit were also associated with the discussions.
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Affiliation(s)
- Austin R Rogers
- Kansas Department of Health and Environment, Bureau of Health Promotion, Topeka, KS, USA
| | - Trevor Christensen
- Kansas Department of Health and Environment, Bureau of Health Promotion, Topeka, KS, USA
| | - Ericka M Welsh
- Kansas Department of Health and Environment, Bureau of Health Promotion, Topeka, KS, USA
| | - Babalola Faseru
- Kansas Department of Health and Environment, Bureau of Health Promotion, Topeka, KS, USA; Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS, USA; Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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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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Hu J, Qian GS, Bai CX. Chinese consensus on early diagnosis of primary lung cancer (2014 version). Cancer 2015; 121 Suppl 17:3157-64. [PMID: 26331822 DOI: 10.1002/cncr.29571] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/14/2015] [Accepted: 06/16/2015] [Indexed: 11/09/2022]
Abstract
The incidence and mortality of lung cancer in China have rapidly increased. Lung cancer is the leading cause of cancer death in China, possibly because of the inadequate early diagnosis of lung cancer. Reaching a consensus on early diagnostic strategies for lung cancer in China is an unmet needed. Recently, much progress has been made in lung cancer diagnosis, such as screening in high-risk populations, the application of novel imaging technologies, and the use of minimally invasive techniques for diagnosis. However, systemic reviews of disease history, risk assessment, and patients' willingness to undergo invasive diagnostic procedures also need to be considered. A diagnostic strategy for lung cancer should be proposed and developed by a multidisciplinary group. A comprehensive evaluation of patient factors and clinical findings should be completed before treatment.
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Affiliation(s)
- Jie Hu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, China
| | - Gui-Sheng Qian
- Department of Pulmonary Medicine, Xinqiao Hospital of the Third Military Medical University, Chongqing, China
| | - Chun-Xue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, China.,State Key Laboratory of Respiratory Disease, Guangzhou, Guangzhou Medical University, Guangzhou, China
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Abstract
We examined the readiness of primary care clinicians to implement lung cancer screening programs in their practice settings in light of recent policy changes in the U.S. Attendees of two large continuing medical education events in Texas held in October and November of 2014 completed surveys about their current lung cancer screening practices and implementation needs. Surveys were completed by 350 participants (57.2% of registered attendees). Although 89.5% of participants routinely screened their patients for tobacco use, only 10.1% had a formal lung cancer screening program in their practice. More than half (56.0%) planned to refer eligible patients for lung cancer screening, 35.6% were not sure, and 8.3% did not plan to refer. Priority areas for implementing lung cancer screening programs in their settings included 1) greater clarity about coverage by private insurance and Medicare, 2) information about available screening centers offering low-dose computed tomography, 3) patient education and shared decision-making tools, 4) implementation toolkits and training for clinic staff, 5) integrating screening programs in electronic health records, and 6) more clarity about clinical guidelines. Practical needs related to identifying eligible patients, referral to screening centers, and tools for shared decision-making must be addressed before lung cancer screening can be implemented on a national scale.
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Affiliation(s)
- Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lewis E Foxhall
- Division of Cancer Prevention & Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, 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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Lewis JA, Petty WJ, Tooze JA, Miller DP, Chiles C, Miller AA, Bellinger C, Weaver KE. Low-Dose CT Lung Cancer Screening Practices and Attitudes among Primary Care Providers at an Academic Medical Center. Cancer Epidemiol Biomarkers Prev 2015; 24:664-70. [PMID: 25613118 DOI: 10.1158/1055-9965.epi-14-1241] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/16/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Low-dose computed tomography (LDCT) screening reduces lung cancer-specific and overall mortality. We sought to assess lung cancer screening practices and attitudes among primary care providers (PCPs) in the era of new LDCT screening guidelines. METHODS In 2013, we surveyed PCPs at an academic medical center (60% response) and assessed: lung cancer screening use, perceived screening effectiveness, knowledge of screening guidelines, perceived barriers to LDCT use, and interest in LDCT screening education. RESULTS Few PCPs (n = 212) reported ordering lung cancer screening: chest X-ray (21%), LDCT (12%), and sputum cytology (3%). Only 47% of providers knew three or more of six guideline components for LDCT screening; 24% did not know any guideline components. In multiple logistic regression analysis, providers who knew three or more guideline components were more likely to order LDCT (OR, 7.1; 95% confidence intervals, 2.0-25.6). Many providers (30%) were unsure of the effectiveness of LDCT. Mammography, colonoscopy, and Pap smear were rated more frequently as effective in reducing cancer mortality compared with LDCT (all P values < 0.0001). Common perceived barriers included patient cost (86.9% major or minor barrier), harm from false positives (82.7%), patients' lack of awareness (81.3%), risk of incidental findings (81.3%), and insurance coverage (80.1%). CONCLUSIONS LDCT lung cancer screening is currently an uncommon practice at an academic medical center. PCPs report ordering chest X-ray, a nonrecommended screening test, more often than LDCT. PCPs had a limited understanding of lung cancer screening guidelines and LDCT effectiveness. Provider educational interventions are needed to facilitate shared decision-making with patients. IMPACT This study describes some of the first data available about PCPs' use of lung cancer screening tests since the publication of multiple professional guidelines endorsing LDCT. Knowledge gaps were identified that may hinder the uptake of evidence-based lung cancer screening guidelines.
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Affiliation(s)
- Jennifer A Lewis
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Jeffrey Petty
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Janet A Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Caroline Chiles
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Antonius A Miller
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christina Bellinger
- Department of Internal Medicine, Section on Pulmonology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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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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Tseng CH. Diabetes but not insulin increases the risk of lung cancer: a Taiwanese population-based study. PLoS One 2014; 9:e101553. [PMID: 24991802 PMCID: PMC4081573 DOI: 10.1371/journal.pone.0101553] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 06/07/2014] [Indexed: 12/29/2022] Open
Abstract
Background The trend of lung cancer incidence in Taiwan is unknown, and the association between type 2 diabetes/insulin use and lung cancer is rarely studied. Methods The trends of lung cancer incidence in 1979–2007 in the Taiwanese general population were calculated. A random sample of 1,000,000 subjects covered by the National Health Insurance in 2005 was recruited. A total of 494,002 men and 502,948 women and without lung cancer were followed for the annual cumulative incidence of lung cancer in 2005, with calculation of the risk ratios between diabetic and non-diabetic subjects. Logistic regression estimated the adjusted odds ratios for risk factors. Results The trends increased significantly in both sexes (P<0.0001). The sex-specific annual cumulative incidence increased with age in either the diabetic or non-diabetic subjects, but the risk ratios attenuated with age. In logistic regressions, diabetes was associated with a significantly higher risk, with odds ratios (95% confidence interval) for diabetes duration <1, 1–3, 3–5 and ≥5 years versus non-diabetes of 2.189 (1.498-3.200), 1.420 (1.014-1.988), 1.545 (1.132-2.109), and 1.329 (1.063-1.660), respectively. Such an association was not related to a higher detection with chest X-ray examination. Insulin use and medications including oral anti-diabetic drugs, statin, fibrate, and anti-hypertensive agents were not significantly associated with lung cancer. Age, male sex, and chronic obstructive pulmonary disease were positively; but dyslipidemia, stroke and higher socioeconomic status were negatively associated with lung cancer. Conclusions Diabetes is significantly associated with a higher risk of lung cancer, but insulin use does not increase the risk.
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Affiliation(s)
- Chin-Hsiao Tseng
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Environmental Health and Occupational Medicine of the National Health Research Institutes, Taipei, Taiwan
- * E-mail:
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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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Powell AA, Bloomfield HE, Burgess DJ, Wilt TJ, Partin MR. A Conceptual Framework for Understanding and Reducing Overuse by Primary Care Providers. Med Care Res Rev 2013; 70:451-72. [DOI: 10.1177/1077558713496166] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary care providers frequently recommend, administer, or prescribe health care services that are unlikely to benefit their patients. Yet little is known about how to reduce provider overuse behavior. In the absence of a theoretically grounded causal framework, it is difficult to predict the contexts under which different types of interventions to reduce provider overuse will succeed and under which they will fail. In this article, we present a framework based on the theory of planned behavior that is designed to guide overuse research and intervention development. We describe categories of primary care provider beliefs that lead to the formation of intentions to assess the appropriateness of services, and propose factors that may affect whether the presence of assessment intentions results in an appropriate recommendation. Interventions that have been commonly used to address provider overuse behavior are reviewed within the context of the framework.
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Affiliation(s)
- Adam A. Powell
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Hanna E. Bloomfield
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Diana J. Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Timothy J. Wilt
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Melissa R. Partin
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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