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J.C. Ruckdeschel
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P2.06 - Poster Session/ Screening and Early Detection (ID 219)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.06-003 - A System-Wide Lung Cancer Screening Program: First Year Experiences (ID 56)
09:30 - 09:30 | Author(s): J.C. Ruckdeschel
- Abstract
Background:
The United States Preventive Services Task Force (USPSTF) and National Comprehensive Cancer Network (NCCN) recommend screening with Low-Dose Computed Tomography (LDCT) for asymptomatic patients at high risk of lung cancer. It remains unknown, however, how well these recommendations will translate to the medical community at large. Here, we report on the initial year of a statewide lung cancer-screening program implemented at Intermountain Healthcare.
Methods:
We developed a comprehensive lung cancer screening program open to patients aged 55-80 with either a 30 pack-year smoking history (USPSTF criteria) or a 20 pack-year smoking history plus a risk factor (NCCN criteria) who continue to smoke or have quit within the past 15 years. At the time of patient enrollment, a nurse coordinator was supposed to complete an electronic intake form that assessed patient screening eligibility, smoking history, symptoms, and environmental carcinogen exposure. Radiographic reporting and nodule evaluation were standardized.
Results:
From September 4, 2013 to October 1, 2014, 258 patients were referred to the lung cancer-screening program. Thirty-four patients were ineligible for screening based on the aforementioned guidelines while 17 patients declined screening. Of the 207 patients who met USPSTF or NCCN criteria, forty-five were not processed by the coordinator primarily due to physician office staff calling radiology directly. Of the 162 properly processed patients the mean age was 65.7 +/- 5.5 years, 50.6% (82) were active smokers, 45.7 %(74) had additional environmental exposures and 61.1% (74) reported symptoms at the time of intake. Of the 74 patients with symptoms 66 (89%) reported cough. Of the total of 207 who were screened 48.3%(100) had no nodules, 30.4% (63) had a nodule >6mm requiring follow up studies, 6.8% (14) had a nodule suspected of being cancer and 14.5% (30) had significant incidental findings. Eight of the 14 patients with suspicious lesions had been evaluated at the time of review. Three were found to have lung cancer (stages 1A, 2A and 4) and 2 others had a non-lung malignancy (renal, lymphoma). Three patients had benign lesions (2 hamartomas and 1 fibrosis).
Conclusion:
Despite vigorous attempts to standardize the process and broad discussion of the indications with physician groups, numerous patients who were ineligible were referred and several underwent screening when physician’s office staffs were able to bypass the coordinator step. Cough as a symptom needs further clarification as a significant majority of patients present with cough. The CMS recommendation for physician counseling is likely to have little impact as most physicians are not knowledgeable about the nuances of screening for lung cancer. For lung screening to realize its true potential these technical issues must be resolved.
