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Real-world Clinical Implementation of Lung Cancer Screening-Evaluating Processes to Improve Screening
Nikki M Carroll1, Andrea N Burnett-Hartman2, Caroline A Joyce2
1Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA. nikki.m.carroll@kp.org.
Journal of General Internal Medicine
|January 25, 2020
Summary
Process modifications significantly improved lung cancer screening (LCS) eligibility adherence, increasing it to 92.7%. Real-world LCS showed higher cancer detection rates and comorbidity burdens compared to the National Lung Screening Trial (NLST).
Area of Science:
- Pulmonology
- Oncology
- Radiology
Background:
- Lung cancer screening (LCS) implementation involves complex patient identification, follow-up, and management processes.
- Uncertainty exists regarding whether real-world LCS programs achieve the same benefits as the National Lung Screening Trial (NLST).
Purpose of the Study:
- To assess the impact of process modifications on adherence to LCS guidelines.
- To compare patient characteristics and outcomes in a real-world LCS program with those from the NLST.
Main Methods:
- A retrospective cohort study was conducted at Kaiser Permanente Colorado (KPCO).
- 3375 patients undergoing baseline lung cancer screening low-dose computed tomography (S-LDCT) between May 2014 and June 2017 were analyzed.
- Eligibility criteria adherence, patient demographics, and outcomes were compared pre- and post-process modification and against NLST data.
Main Results:
- Following process modifications, guideline-adherent patients increased from 45.6% to 92.7% (P < 0.001).
- KPCO LCS patients were older and had higher rates of current smoking and pulmonary disease compared to NLST participants.
- The lung cancer detection rate in patients with a positive S-LDCT was higher at KPCO (9.4%) than in NLST (3.8%), associated with prior pulmonary disease.
Conclusions:
- Effective LCS adherence relies on robust eligibility confirmation procedures.
- Real-world LCS cohorts exhibit higher comorbidity burdens and lung cancer detection rates than observed in the NLST.
- Further investigation into long-term outcomes for patients in real-world LCS settings is warranted.
