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J.A. Roth
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OA01 - Risk Assessment and Follow up in Surgical Patients (ID 371)
- Event: WCLC 2016
- Type: Oral Session
- Track: Surgery
- Presentations: 1
- Moderators:W. Zhong, E. Lim
- Coordinates: 12/05/2016, 11:00 - 12:30, Schubert 2
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OA01.02 - A Lung Cancer Surgical Mortality Risk-Prediction Algorithm to Inform Lung Cancer Screening Shared Decision-Making (ID 4601)
11:10 - 11:20 | Author(s): J.A. Roth
- Abstract
- Presentation
Background:
Low-dose computed tomography lung cancer screening has been demonstrated to increase detection of cases at an early-stage and reduce lung cancer mortality (vs. x-ray or no screening). However, screening benefits are greatly reduced in persons who are poor candidates for curative intent surgery in the event of screen-detected early-stage disease. To date, no practical tools have been developed to assess potential suitability for surgical treatment at the time of screening shared decision-making. The objective of this study was to use readily available socio-demographic and medical history variables to develop a prediction model that estimates the risk of 30-day mortality following surgical treatment for early-stage non-small cell lung cancer (NSCLC).
Methods:
We used logistic regression to develop a risk-prediction model for 30-day mortality following surgical treatment for Stage I/II NSCLC in patients age 65 to 79 using SEER-Medicare linked databases (2007-2012). Additionally, all patients had at least 1 year of Medicare enrollment prior to NSCLC diagnosis and received initial surgical treatment within 6 months of diagnosis. We developed the model with a training sample of 1,571 surgical cases and conducted internal validation exercises with a sample 4,632 independent surgical cases. Models included age, sex, race, country of birth, urban-rural status, and comorbidities in the year prior to NSCLC diagnosis. The Hosmer-Lemeshow test (by decile) and area under the receiver-operating characteristic curve (AUC) were assessed as measures of model calibration and discrimination, respectively.
Results:
Within the full sample of 6,203 cases, 201 deaths were identified within 30 days of surgical treatment (3.2% of sample). In the training and internal validation sets, the AUC was 0.831 and 0.734, respectively. The observed risk of 30-day mortality was 9.3-fold greater in the highest decile of predicted risk (8.3%) vs. the lowest decile (0.7%), and the Hosmer-Lemeshow test indicated satisfactory model fit (p=0.92). The model had similar performance in women, men, whites, and non-whites; and also had similar calibration and discrimination for 60- and 90-day mortality.
Conclusion:
Our risk-prediction model has good ability to identify patients at increased risk of mortality following surgical treatment for early-stage NSCLC, and pending additional development and validation, can potentially be applied in clinic to inform lung cancer screening shared decision-making with minimal time or resource impacts.
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P1.03 - Poster Session with Presenters Present (ID 455)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-060 - Lung Cancer Screening: A Qualitative Study Exploring the Decision to Opt Out of Screening (ID 4667)
14:30 - 14:30 | Author(s): J.A. Roth
- Abstract
Background:
Lung cancer screening (LCS) with annual low-dose computed tomography is relatively new for long-term smokers in the US supported by a US Preventive Services Task Force Grade B recommendation. As LCS programs are more widely implemented and providers engage patients about LCS, it is critical to understand what influences the decision to screen, or not, for lung cancer. Understanding LCS behavior among high-risk smokers who opt out provides insight, from the patient perspective, about the shared decision-making (SDM) process. This study explored LCS-eligible patients’ decision to opt out of LCS after receiving a provider recommendation. New knowledge will inform intervention development to enhance SDM processes between high-risk smokers and their provider, and decrease decisional conflict about LCS.
Methods:
Semi-structured qualitative interviews were performed with 18 LCS-eligible men and women who were members of an integrated healthcare system in Seattle about their decision to opt out of screening. Participants met LCS criteria for age, smoking and pack-year history. Audio-recorded interviews were transcribed verbatim. Two researchers with cancer screening and qualitative expertise conducted data analysis using thematic content analytic procedures.
Results:
Participant mean age was 66 years (SD 6.5). Majority were female (61%), Caucasian (83%), current smokers (61%). Five themes emerged: 1) Knowledge Avoidance; 2) Perceived Low Value; 3) False Positive Worry; 4) Practical Barriers; and 5) Misunderstanding. Representative thematic example quotes are presented in the Table below.Knowledge Avoidance “It’s fear of the unknown…if I know, you have to follow through and do more and more.” Perceived Low Value “It could show me if I had lung cancer…what are they going to do?...screening doesn’t really make any difference...” False Positive Worry “I did schedule one…then after I read the print out, I canceled it…the false positives were so high. I thought why… that would be so stressful…” Practical Barriers “I really didn’t have time to get over there.” Misunderstanding “I wasn’t hurting or having any problems breathing…wasn’t a top priority for me” [reflecting misunderstanding of the concept of screening]
Conclusion:
Many screening-eligible smokers opt out of LCS. Participants in our study provided new insights into why some patients make this choice. LCS is effective in early lung cancer detection among high-risk patients. However, LCS has associated risks and harms making the SDM process critical. Understanding why people decide not to screen will enhance future efforts to improve knowledge transfer from providers to patients about the risks and benefits of LCS and ultimately enhance SDM about screening.
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P1.03-061 - Patient Motivations for Pursuing Low-Dose CT Lung Cancer Screening in an Integrated Healthcare System: A Qualitative Evaluation (ID 4396)
14:30 - 14:30 | Author(s): J.A. Roth
- Abstract
Background:
Low-dose CT (LDCT) lung cancer screening for heavy smokers was given a ‘B’ rating by the U.S. Preventive Services Task Force (USPSTF) in 2013, and gained widespread insurance coverage in the U.S. in 2015. Little is known about patient motivations for pursuing lung cancer screening outside of clinical trials because it is a relatively new covered service. The objective of this study was to understand some of the major factors that motivated patients to pursue LDCT lung cancer screening in an integrated healthcare system.
Methods:
We conducted a semi-structured qualitative interviews with 20 adult men and women who were members of an integrated healthcare system in Washington State about their choice to receive LDCT lung cancer screening. Participants met USPSTF screening criteria for age and smoking history. Trained staff contacted a total of 25 randomly selected eligible participants and completed 20 interviews (80% response rate) in the Fall of 2015. The interviews were recorded, transcribed, and three investigators used inductive content analysis to identify themes about motivations for pursuing screening.
Results:
Participant mean age was 68 years, 40% were male, 90% were Caucasian, and 35% were current smokers. Analysis of interview transcripts identified 6 primary themes (Table 1) that were common motivations for pursuing LDCT lung cancer screening: 1) early-detection benefit, 2) limited understanding of LDCT harms, 3) relatively low radiation dose, 4) trust in the referring clinician, 5) friends and family with advanced cancer, and 6) low out-of-pocket cost. Figure 1
Conclusion:
The participants in our study were motivated to obtain lung cancer screening based on perceived benefit of early-detection, an absence of safety concerns, social factors, and low expense. Our findings provide new insights about patient motivations for pursuing LDCT screening, and can be used to improve lung cancer screening shared decision-making processes.
