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James L Mulshine
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WS 01 - IASLC Supporting the Implementation of Quality Assured Global CT Screening Workshop (By Invitation Only) (ID 632)
- Event: WCLC 2017
- Type: Workshop
- Track: Radiology/Staging/Screening
- Presentations: 3
- Moderators:
- Coordinates: 10/14/2017, 08:30 - 21:00, F203 (Annex Hall)
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WS 01.01 - Welcome and Aims of Workshop (ID 10613)
08:30 - 08:40 | Presenting Author(s): James L Mulshine
- Abstract
Abstract:
On October 14th, the Fifth IASLC Strategic Screening Workshop will be held in Yokohama Convention Center with the following objectives: 1.) provide the state of art methodology for undertaking lung CT cancer screening, 2.) provide discussions and recommendations around implementation, which will have impact on all health services, 3.) develop a resource toolkit to support national screening implementation efforts when based on current knowledge and international expectations, 4.) propose recommendation for the IASLC Executive Committee to consider regarding how they can support leadership in this forefront area of lung cancer for the Association, 5.) produce a document outlining the summary status from this workshop. The IASLC has been a robust supporter of research and progress with lung cancer screening especially working to integrate tobacco control and cessation measures with low dose CT-based early detection efforts in high risk populations. As the world’s leading multi-disciplinary lung cancer care professional society and with the quality of the lung cancer screening process fundamentally linked to the proper coordination of all of the health professionals required for this service, IASLC has a critical role in facilitating rapid progress for this validated approach to reducing lung cancer mortality. This Workshop brings leading experts in screening from across the world to discuss best practices as well as to consider new collaborations to advance best practice. In light of the great demand from the IASLC membership, we have also organized a second screening forum for October 14, which is a Symposium on Advances in Lung Cancer CT Screening. In this forum, a number of international leaders will present their experiences with aspects of CT screening process. These presentations are more in-depth than in the Workshop forum but still providing ample time for interaction with the attendees. The intention is to provide the membership with a comprehensive emersion into the rapidly moving field of lung cancer screening. This is a new, complex and demanding service. Implementing a high quality screening process while maintaining low cost can be done, but many institutions have benefitted from a collaborative approach to share institutional practices. The goal of the current IASLC Workshop and Symposium is to encourage and facilitate such collaborative interactions.
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WS 01.34 - CT Screening in USA – Current Issues around Implementation – Lessons to be Learnt (ID 10679)
15:30 - 15:40 | Presenting Author(s): James L Mulshine
- Abstract
Abstract:
Lung cancer screening in a high risk cohort was validated by the National Lung Screening Trial reported in 2011( 1) and then endorsed by the United States Preventive Services Task Force in late 2013 ( 2). Under US law, this resulted in the Centers for Medicare & Medicaid Services issuing a National Coverage Decision supporting reimbursement of this screening service for federally beneficiaries on August 21, 2015(https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/mm9246.pdf). A recent letter published from the American Cancer Society Surveillance and Health Services Research group, reported that use of annual LDCT screening in the recommended target population was low and unchanged from 5 years earlier when no national endorsement of screening yet existed (3). Therefore, what is the lesson that we should share in this international forum from the US screening experience regarding key determinants of success in the process of national implementation of lung cancer screening? Implementing a new cancer screening service is a remarkably complex process as previously experienced in many countries with implementation of breast and colon cancer screening services. In the US, federal reimbursement for lung cancer screening was issued in August of 2015. It is overly optimistic to look for utilization trend changes in 2015 national survey data. However, there is progress such as with the advocacy foundation, Lung Cancer Alliance established a consortium called the National Framework of Excellence in Lung Cancer Screening and Continuum of Care in February 2012. Through this effort the foundation has worked with over 500 institutions in implemented comprehensive lung cancer screening sites according to evolving best practices. This experience has been instructive as they work to communicate about learning curve with on-boarding high quality screening practices (4). Since the launch of the National Lung Screening Trial in 2002, a vast number of screening reports have been published reporting significant progress with improving the many discrete screening steps as reflected by information submitted to this IASLC Workshop. However, there is a considerable lag in assimilating this newer information about screening into the informed decision making discussions about the risk/ benefits issues associated with this screening service. An example of the consequence of the concerns about risk/ benefit profile with lung cancer screening was demonstrated in a pilot Veterans Administration experience in which over 40% of the subjects eligible for lung cancer screening declined to participate in this service (5). The challenge is to reliably ascertain the issues that may have discouraged such a large fraction of potential candidates to opt out of the lung cancer screening process? For some it may have been related to concerns about cumulative medical radiation dose. When CT-based lung cancer screening first emerged, there was discussion about the potential for annual CT screening subjects to accrue dangerous cumulative medical radiation exposure. In light of the wide adoption of low-radiation- dose imaging techniques and CT manufacturers’ efforts to reduce the radiation dose required to obtain an informative lung cancer screening image, medical radiation is a much less significant objective source of concern as a potential harm (6). There have been concerns about the cost of providing lung cancer screening services. Pyenson and co-workers in an actuarial analysis reported that screening costs were favorable and subsequent reports have confirmed this point (7, 8). These studies also found that the cost benefit was enhanced when the screening was delivered in the conjunction with smoking cessation. The preponderance of evidence supports that lung cancer screening is at least as economical as other routinely offered health services. Further economies will be accrued as progress with improving false-positivity rate with the screening work-up, which already ranges from 3-12%, continue to evolve (9, 10). Therefore the critical lesson learned from this initial US experience is that the communications issues are a foundational in gaining broad support for the screening implementation process. The people that potentially could receive lung cancer screening services and the people who deliver the service as well as the national policy people who decide on what services are to be offered, all need to have a clear understanding of the value of screening service based on objective evidence regarding the harms and benefits of lung cancer screening. Fortunately, there are many areas of progress from enhancing the efficiency of the diagnostic screening work-ups to improving the therapeutic index with curative, minimally invasive lung cancer surgery (11, 12). The message needs to be communicated that lung cancer screening continues to be the most promising tool for reducing lung mortality today and its health benefits will be markedly enhanced as it is integrated with the administration of existing smoking cessation measures. Conclusion: Having a communications strategy to ensure that national policy leaders, care providers as well as potential screening subjects get access to objective, up-to-date evidence about the true benefit of lung cancer screening could greatly accelerate progress with reducing the mortality burden of lung cancer in an accessible and economical fashion. References: National Lung Screening Trial Research Team. Radiology. 2011 Jan;258(1):243-53. doi: 10.1148/radiol.10091808. Moyer, V.A., Ann Intern Med, 2014. 160(5): p. 330-338. Jemal A, Fedewa SA. JAMA Oncol. 2017 Feb 2. doi: 10.1001/jamaoncol.2016.6416. PMID: 28152136 Mulshine JL, Ambrose LF. J Thorac Dis. 2016 Oct;8(10):E1304-E1306. PMID: 27867613 Kinsinger LS, Anderson C, Kim J, et al. JAMA Intern Med. 2017 Mar 1; 177 (3):399-406. doi: 10.1001/jamainternmed.2016.9022. Mulshine JL, D'Amico TA. CA Cancer J Clin. 2014 Sep-Oct;64(5):352-63. doi: 10.3322/caac.21239. PMID: 24976072. Pyenson B, Sander MS, Jian Y, Mulshine JL. Health Affairs Apr;31(4):770-9,PMID: 22492894, 2012. Cressman S, Peacock SJ, Tammemägi MC et al. J Thorac Oncol. 2017 Aug;12(8):1210-1222. doi: 10.1016/j.jtho.2017.04.021. PMID: 28499861 Kazerooni EA, Armstrong MR, Amorosa JK, et al. J Am Coll Radiol. 2015 Jan;12(1):38-42. doi: 10.1016/j.jacr.2014.10.002. PMID: 25455196 Field JK, Duffy SW, Baldwin DR, Brain KE, Devaraj A, Eisen T, et al. Health Technol Assess. 2016;20(40):1-146. Henschke, C.I., R. Yip, D.F. Yankelevitz, and J.P. Smith, Ann Intern Med, 2013. 158(4): p. 246-252. White A, Swanson SJ. Oncology (Williston Park). 2016 Nov 15;30(11):982-7.
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WS 01.38 - Session 6: What Priorities and Recommendations Should the IASLC Executive Focus On: How They Can Support Leadership in this Area of Lung Cancer (Round Table Discussion) (ID 10683)
16:20 - 18:00 | Presenting Author(s): James L Mulshine
- Abstract
Abstract not provided
