No abstract

The United States Preventative Services Taskforce (USPSTF) recommends Lung Cancer Screening (LCS) with annual low-dose computed tomography for all adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Successful institutional implementation of appropriate LCS can be challenging and if not done well, may have large downsides. LCS programs play a key role in improving early detection while mitigating the downsides by ensuring implementation of the components required for successful LCS including adherence to appropriate candidate selection. In this retrospective chart review, we analyzed the adherence to 2013 USPSTF guidelines for LCS in an institution without a dedicated and centralized LCS program. METHODS:We completed a retrospective chart review on a list of individuals obtained from our Radiology Department for all ordered and completed chest computerized tomography (CT) at a tertiary Veterans Affairs Medical Center and affiliated community based outreach clinic (CBOC) for a 6-month period prior to our institution having a formal centralized LCS Program (8/1/2019 to 1/31/2020). We then excluded all scans not ordered from a Primary Care or Pulmonary Clinic location and randomly audited some of the ordered scans to see which CT Chest order listed ordering reason as "Lung Cancer Screening." A chart analysis was then completed on all these identified individuals to assess their appropriateness for lung cancer screening including age, smoking history, and co-morbidities.RESULTS: A total of 4971 Chest CTs were completed during the time frame. We audited 228 (13.8%) of the 1664 scans ordered from a Primary Care or Pulmonary Clinic. In our review, 56 (24.6%) of the audited 228 CT scans listed ordering reason as "Lung Cancer Screening." 23 of the 56 (41%) that had a chest CT for LCS were deemed not appropriate candidates for LCS based on 2013 USPSTF criteria. The reason they were deemed inappropriate were as follows: 3 were not 55-80 years of age; 8 did not meet the required 30 pack years; 6 quit smoking more than 15 years ago; 10 had significant competing causes of death or deemed unlikely to tolerate curative surgical treatment due to their chronic hypoxic respiratory failure, advanced chronic kidney disease, and even active non-lung cancer. CONCLUSIONS:In this retrospective analysis of an institution without a dedicated and centralized LCS program, a large percentage of the CT scans for LCS were done on inappropriate candidates.CLINICAL IMPLICATIONS: Further analysis should be considered to assess whether a dedicated and centralized LCS program can improve adherence to USPSTF guideline based criteria.