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P. Molina
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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: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-038 - Appropriateness of Lung Cancer Screening with Low Dose Computed Tomography (ID 5647)
14:30 - 14:30 | Author(s): P. Molina
- Abstract
Background:
Based on results of the National Lung Screening Trial, several expert U.S. groups now recommend lung cancer screening (LCS) with annual low-dose computed tomography (LDCT). The extent to which LCS is performed according to guidelines is unknown. We evaluated the appropriateness of LCS performed at a US academic medical center.
Methods:
Chart abstractions were performed for all patients (N=174) undergoing LCS at an academic medical center between 2/5/2015 and 4/30/2016. During the data collection period, an active quality improvement (QI) project, aimed at improving appropriate implementation of LCS, was underway in the internal medicine (IM) department. Appropriate screening was defined as: 1) patient age 55-77 years; 2) smoking history of 30+ pack-years; 3) current smoker or quit less than 16 years ago; 4) asymptomatic for lung cancer; 5) not on daytime oxygen; 6) documentation of shared decision making (SDM); 7) no severe COPD; and 8) no heart failure. We evaluated characteristics associated with LCS using multivariate logistic regression and report odds ratios (OR) and 95% confidence intervals (95%CI).
Results:
The study population was between 44 and 85 years, was 68% white, 28% black, and 4% other race, and the majority (56%) were male. Fifty-six percent of patients were former smokers, and most (83%) had smoked at least 30 pack-years. The majority of screenings were ordered by family medicine and IM practitioners. Seventy percent of screenings were classified as inappropriate. The most frequent reasons for inappropriate screening were: inadequate or no SDM documentation (47%), patient being symptomatic (19%), too low or missing pack-year data (17%), patient quit smoking more than 15 years ago (13%), and having severe COPD (13%). Thirty-five percent were classified as inappropriate based on two or more criteria. The proportion appropriately screened increased from 10% during the first third of 2015 to 34% in the first third of 2016. After adjusting for patient race and sex, predictors of appropriate screening were having the order from an IM versus family medicine provider (OR=3.8, 95%CI:1.5-9.6) and having a more recent order date (order from first third of 2016 versus the first third of 2015 (OR=5.4, 95%CI:1.1-26.8)).
Conclusion:
Although a significant proportion of patients screened for lung cancer do not meet U.S. appropriate eligibility criteria, this is improving. The QI project in the IM clinic addressed key factors affecting implementation of LCS, such as collection of complete smoking history and training of nurses and providers, resulting in improvements to the rate of appropriate LCS.
