Improving identification of candidates for lung cancer screening in a high risk population. (October 2020)

• Record Type: Journal Article
• Authors: Waddle, Mark R.; Ko, Stephen J.; May, Jackson; Kaleem, Tasneem; Miller, Daniel H.; Stross, William C.; Malouff, Timothy D.; Wert, Katey; Cuthbert, Kristin; Landy, Robin; Strong, Gerald; Vallow, Laura A.; Johnson, Margaret M.
• Is Part Of: Lung cancer. Volume 148(2020)
• Page Start: 79
• Page End: 85
• Publication Date: 2020-10
• Subjects: Screening -- Cancer -- Lung cancer -- High risk -- CT; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2020.07.036
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: 528 patients were screened for lung cancer in a radiation oncology and ENT clinic. Screening was by questionnaire. 8.5 % of patients screened qualified for low dose CT. Patient reported smoking history forms can identify high risk patients. Abstract: Background: Low dose computerized tomography (LDCT) has been shown to reduce lung cancer specific mortality by 20 %. Despite U.S. Preventive Services Task Force (USPSTF) endorsement, screening of appropriate patients in the U.S. remains low, at 1.9 %. The goal of this study was to assess the number and type of patients that would qualify for lung cancer screening based upon recommendations by various guidelines. Methods: We prospectively collected a patient reported questionnaire, including smoking history, family history, exposure history, and demographics, from April-October 2017 from new consults in the Department of Radiation Oncology and Otolaryngology (ORL). Patients smoking status and patient factors were collected and reported. Patients qualifying for screening by USPSTF, the National Comprehensive Cancer Network (NCCN), and Tammemagi scoring criteria were identified. Multivariate analysis assessed the factors associated with positive criteria for screening and the sensitivity of each criterion was calculated. Results: There were 546 new consults during the study period and 528 successfully completed the questionnaire. A total of 104/528 (20 %) patients who completed questionnaires qualified for screening based on any guideline. After exclusion of active lung cancer (n = 19), poor prognosis (n = 24), and CT as part of surveillance (n = 16), 45 (8.5 %) patients would require LDCT. Of the entire population, 10 %, 11 % and 18 % of patients qualified based on USPSTF, NCCN, and Tammemagi, which was reduced to 4.9 %, 5.3 %, and 7.8 %, respectively after exclusions. Patients with head and neck cancer (40 %), skin cancer (27 %), and prostate cancer (11 %) accounted for the majority of patients eligible for screening after exclusions. The sensitivity of the USPSTF, NCCN, and Tammemagi criteria in patients with a diagnosis of lung cancer (n = 26) was 38.5 % (CI95 20.2 %–59.4 %), 46.2 % (CI95 26.6 %–66.6 %), and 61.5 % (CI95 40.6 %–79.8 %), respectively. Conclusions: We successfully identified 9 % of an oncology population at consultation who could benefit from lung cancer screening in survivorship. Distribution of a written or electronic questionnaire at consultation is a simple, low cost, effective method of identifying patients who would benefit from LDCT.