Incorporating Coexisting Chronic Illness into Decisions about Patient Selection for Lung Cancer Screening. An Official American Thoracic Society Research Statement

Rivera, M. Patricia; Tanner, Nichole T.; Silvestri, Gerard A.; Detterbeck, Frank C.; Tammemägi, Martin C.; Young, Robert P.; Slatore, Christopher G.; Caverly, Tanner J.; Boyd, Cynthia M.; Braithwaite, Dejana; Fathi, Joelle T.; Gould, Michael K.; Iaccarino, Jonathan M.; Malkoski, Stephen P.; Mazzone, Peter J.; Tanoue, L.T.; Schoenborn, Nancy L.; Zulueta, Javier; Wiener, Renda Soylemez

doi:10.1164/rccm.201805-0986st

Cited by 74 publications

(64 citation statements)

References 49 publications

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“…Calculating risk does not obviate the need to assess whether a patient is sufficiently healthy to tolerate complications from either follow-up of LCS-detected cancer or lung cancer treatment. Ideally, to be most useful for selecting optimal candidates for LCS in clinical practice, risk calculators should be coupled with modeling analysis that take into account competing risks and causes of death and the individual’s ability to undergo invasive evaluation of screen-detected nodules or lung cancer treatment ( 95 ).…”

Section: Resultsmentioning

confidence: 99%

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

Rivera¹,

Katki²,

Tanner³

et al. 2020

Am J Respir Crit Care Med

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159

143

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Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure. Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination. Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS. Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS. Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.

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Section: Resultsmentioning

confidence: 99%

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

Rivera¹,

Katki²,

Tanner³

et al. 2020

Am J Respir Crit Care Med

Self Cite

159

143

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“…Lifegained-based selection could also unify the metrics for cancer screening across stakeholders -patients, clinicians, cost-effectiveness modelers (35,36), and guidelines committees (28,37). Importantly, our proposed life-gained-based strategy could readily address two key issues facing population-wide cancer screening-ages at initiation/cessation of screening (38) and the identification of individuals for whom the benefits of screening outweigh its harms (14)(15)(16)(17). In contrast to risk-based selection, a life-gained-based selection circumvents the need for ages at initiation/cessation of screening because it naturally excludes individuals without both high-enough disease-risk to benefit from screening and high-enough lifeexpectancy to gain life-years from screening, regardless of age.…”

Section: Discussionmentioning

confidence: 99%

“…However, preventing more lung cancer deaths may not always translate to substantial gains in life-expectancy. Such risk-based screening-selection would preferentially include older heavy-smokers with multiple co-morbidities who have reduced life-expectancy, and consequently, reduced life-gained from screening (14)(15)(16)(17)(18). Indeed, recent microsimulation analyses have shown that, while using risk-prediction models can further reduce lung cancer deaths, the life-years gained may be more modest (19) and that unless high risk patients also have sufficiently long life-expectancy, patients may not experience a net benefit from screening (20).…”

Section: Introductionmentioning

confidence: 99%

Life-Gained–Based Versus Risk-Based Selection of Smokers for Lung Cancer Screening

et al. 2019

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Background: Although risk-based selection of ever-smokers for lung-cancer screening could improve efficiency over US Preventive Services Task Force (USPSTF) guidelines, it preferentially selects older ever-smokers with lower life-expectancies due to comorbidities. Objectives: To compare selecting ever-smokers for screening based on gains in life-expectancy vs. based on lung cancer risk. Design: Cohort analyses and model-based projections.

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“…The latter judgment is actually subjective and the keystone is to mimic the entry criteria of clinical trials. Models predicting competing causes of death and suggesting exclusion from screening or curative intent treatments are being developed: although they may prove useful to identify and manage (not over-treating) unlikely-to-benefit patients, they could lead to length time bias (overdiagnosis) [45][46][47].…”

Section: Selection Of High-risk Individuals For Ldct-lcsmentioning

confidence: 99%

Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe

Veronesi

Baldwin

Henschke

et al. 2020

Cancers

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Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39–61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the “Initiative for European Lung Screening (IELS)”—a large international group of physicians and other experts concerned with lung cancer—agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.

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Incorporating Coexisting Chronic Illness into Decisions about Patient Selection for Lung Cancer Screening. An Official American Thoracic Society Research Statement

Cited by 74 publications

References 49 publications

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

Addressing Disparities in Lung Cancer Screening Eligibility and Healthcare Access. An Official American Thoracic Society Statement

Life-Gained–Based Versus Risk-Based Selection of Smokers for Lung Cancer Screening

Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe

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