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C.L. Wilshire
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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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P1.03-050 - Outcomes after the Decision to Biopsy: Results from a Nurse Practitioner Run Multidisciplinary Lung Cancer Screening Program (ID 6231)
14:30 - 14:30 | Author(s): C.L. Wilshire
- Abstract
Background:
Lung cancer screening programs are increasing in popularity after results from the National Lung Screening Trial demonstrated improvement in mortality after screening with low dose computed tomography. Current guidelines recommend the availability of multidisciplinary care and evaluation; however, reported outcomes from multidisciplinary team decision making to proceed with diagnostic sampling in lung cancer screening remains sparse.
Methods:
A retrospective review of patients enrolled in the Swedish Cancer Institute Lung Cancer Screening Program from January 2013 to March 2016 was performed. The program is run by an independently practicing nurse practitioner, with a multidisciplinary team consisting of radiologists, interventional pulmonologists, and thoracic surgeons. Positive screening results (nodules >6mm) with the potential need to pursue diagnostic sampling were reviewed in a multidisciplinary fashion. Basic demographics and procedural outcomes after the decision to biopsy were obtained.
Results:
A total of 516 patients were enrolled within the lung cancer screening program from 2013 – 2016. Nodule(s) >6mm were identified in 164 (31.8%) patients. Subsequently, 25 (4.8%) patients underwent some form of invasive testing. The mean age of this population was 66.2 (SD-6.7) years with 56% (14/25) being female and mean pack years of 50.8 (SD-19.5). Percutaneous needle aspiration (n=11), endoscopic sampling (n=10), and surgical biopsy/resection (n=4) were performed as the first invasive diagnostic procedure. The outcomes of this initial sampling were cancer (n=15), non-diagnostic (n=7), benign (n=2), and infection (n=1). Three patients without an initial diagnosis underwent additional non-surgical biopsy attempts. Overall, surgical resection was performed in twelve patients (6 after previous diagnostic procedure, 2 after previous non-diagnostic procedure, and 4 as initial procedure). Final outcomes were cancer (n=16), non-diagnostic procedure (n=4), non-caseating granulomatous inflammation (n=2), benign diagnosis after wedge resection (n=2), and infection (n=1).
Conclusion:
Within a nurse practitioner led, multidisciplinary, lung cancer screening program, a small proportion of patients undergo invasive diagnostic testing, despite a rather high prevalence of potentially actionable nodules. Within the NLST population receiving computed tomography, 6.1% underwent invasive testing with 43% undergoing testing that ultimately did not result in a cancer diagnosis. Within our multidisciplinary program, 4.8% underwent invasive testing with 36% undergoing testing not ultimately resulting in a cancer diagnosis. The utilization of multidisciplinary teams during the biopsy decision-making process may help decrease the number of non-diagnostic procedures. Further research is needed to help identify tools that improve patient selection for invasive testing in lung cancer screening programs.
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P1.03-051 - Medically Underserved and Geographically Remote Individuals May Be Underrepresented in Current Lung Cancer Screening Programs (ID 6273)
14:30 - 14:30 | Author(s): C.L. Wilshire
- Abstract
Background:
The National Lung Screening Trial demonstrated a 20% reduction in lung cancer mortality and ushered in lung cancer screening (LCS). Study centers included 33 academic, mostly urban-based sites, which may underrepresent low socioeconomic remote populations with minimal health care access. United States Census Bureau 2014 data demonstrated that smoking is concentrated among adults with low income and education, and without private medical insurance; components of medically underserved/shortage area designations. We sought to assess the representation of underserved communities in our hospital-based Lung Cancer Screening Program (LCSP).
Methods:
We reviewed individuals referred to our LCSP from 2012-2016, consisting of two separate screening sites located within metropolitan King County, Washington. Each individual’s county and distance from the LCS site was calculated. Individual’s residence designation as a geographic medically underserved/shortage area was determined. Definitions include: medically underserved area [MUA; healthcare resources deficient region], medically underserved population [MUP; area with economic/cultural/linguistic barriers to primary care services], health professional shortage area [HPSA; primary care physician shortage].
Results:
We identified 599 referred individuals, median age 64, from 13/39 counties (King County and 12 clustered, surrounding counties). Overall, <20% of the referred population resided in underserved/shortage areas and <55% of the designated geographic underserved/shortage areas in the 13 counties had patient referrals (Table). Of those referred, 85% resided in King County, 17% in a MUA and 65% of the MUAs had patient referrals. Two percent of the referral population resided in a remote county, Clallam, where ≥70% of referred households were in underserved/shortage areas. Figure 1
Conclusion:
The majority of individuals referred reside within 10 miles of the LCS site. Less than 20% reside in designated underserved/shortage areas and <55% of underserved/shortage areas are represented. Creative and coordinated approaches, like Telemedicine, will be required to address the potential lack of LCS services in underserved/shortage areas and facilitate individuals remaining in their communities.
