Lung cancer screening at the VA: Past, present and future

Maurice, Nicholas M.; Tanner, Nichole T.

doi:10.1053/j.seminoncol.2022.06.001

Cited by 10 publications

(7 citation statements)

References 69 publications

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“…In addition, the application of the other radiation method such as isotope implants can also reduce radiation damage and improve the safety of treatment (Kim et al ., 2018; Lin et al ., 2020). On the other hand, screening regularly is regarded as an effective measure to detect onset of SPCs at an earlier stage and prolong lifetime of breast cancer patients (Bedell et al , 2020; Ding et al , 2022; Maurice and Tanner, 2022). In terms of SLC, a previous study reported that although differences in stage at diagnosis of lung cancer and treatment selection were observed between patients with and without a history of breast cancer, there were no statistically significant differences in genomic or monogenic pathway alterations between the two groups, which suggests that SLC in patients who previously had breast cancer may not be affected at the genomic level by the previous breast cancer (Nobel et al ., 2021).…”

Section: Discussionmentioning

confidence: 99%

Association of radiotherapy for stage I–III breast cancer survivors and second primary malignant cancers: a population-based study

Shi,

Liu,

Tian

et al. 2023

European Journal of Cancer Prevention

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Purpose: With life span extending, breast cancer survivors may face the possibility of developing second primary cancers (SPCs). The objective of this research is to investigate the risk factors, risk attribute to radiotherapy and the survivalship for SPCs. Methods: A total of 445 523 breast cancer patients were enrolled from Surveillance, Epidemiology, and End Results database in 2000–2018. The risk factors for SPCs development were confirmed by competing risk model, and then were integrated to the nomogram establishment. The cumulative incidence of SPCs including SBC (second breast cancer), SGC (second gynecological cancer), and SLC (second lung cancer) were estimated. The radiotherapy-associated risk for SPCs were evaluated by Poisson regression in radiotherapy and no-radiotherapy. Propensity score matching was used to reduce possible bias for survival comparison. Results: There were 57.63% patients in radiotherapy. The risk factors for developing SPCs were age, year, race, tumor size, stage, radiotherapy, grade, surgery, and histology. The cumulative incidence of SPCs was 7.75% in no-radiotherapy and 10.33% in radiotherapy. SLC, SBC, and SGC also appeared the similar results. The increased risk of developing SPCs were associated with radiotherapy in majority subgroups. The dynamic radiotherapy-associated risk for SPCs by age slightly increased risk was observed. Regardless radiotherapy or no-radiotherapy, the 10-year overall survival for SBC (radiotherapy: 59.41%; no-radiotherapy: 55.53%) and SGC (radiotherapy: 48.61%; no-radiotherapy: 35.53%) were worse than that among matched patients with only primary cancers. Conclusions: Breast cancer survivors remained a high radiotherapy-associated risk for developing SPCs. The prognosis in radiotherapy was better than in no-radiotherapy for some specific SPCs. Largely attention should be paid to these patients.

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Section: Discussionmentioning

confidence: 99%

Association of radiotherapy for stage I–III breast cancer survivors and second primary malignant cancers: a population-based study

Shi,

Liu,

Tian

et al. 2023

European Journal of Cancer Prevention

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“…19,20 The VA is currently implementing centralized screening models with the Lung Precision Oncology Program and the VA partnership to increase access to lung screening (VA-PALS). 5 The centralized model, which readily supports the tracking, monitoring, and reporting needs of a screening program, also has advantages in delivering SDM because counselors have been trained in SDM, are more familiar with LCS evidence and processes, can better incorporate decision tools, and do not face the same time constraints as clinicians. 21 However, studies have shown that most patients have already decided to be screened when they show up for the SDM visit.…”

Section: Discussionmentioning

confidence: 99%

“…4 The Veterans Health Administration (VHA) recommended implementing LCS in 2017. 5 Guidelines, however, have consistently highlighted the complexity of the decision and the importance of en-gaging patients in thorough discussions about the potential benefits and harms of screening (shared decision making [SDM]). The Centers for Medicare and Medicaid Services (CMS) has issued coverage determinations mandating that eligible patients undergo a counseling visit that uses a decision aid to support SDM for LCS and addresses tobacco use.…”

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confidence: 99%

Implementing a Telehealth Shared Counseling and Decision-Making Visit for Lung Cancer Screening in a Veterans Affairs Medical Center

Hoffman

2023

Federal Practitioner

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Background: Veterans suffer substantial morbidity and mortality from lung cancer. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) can reduce mortality. Guidelines recommend counseling and shared decisionmaking (SDM) to address the benefits and harms of screening and the importance of tobacco cessation before patients undergo screening. Observations: We implemented a centralized LCS program at the Iowa City Veterans Affairs Medical Center with a nurse program coordinator (NPC)-led telephone visit. Our multidisciplinary team ensured that veterans referred from primary care met eligibility criteria, that LDCT results were correctly coded by radiology, and that pulmonary promptly evaluated abnormal LDCT. The NPC mailed a decision aid to the veteran and scheduled a SDM telephone visit. We surveyed veterans after the visit using validated measures to assess knowledge, decisional conflict, and quality of decision making.We conducted 105 SDM visits, and 91 veterans agreed to LDCT. Overall, 84% of veterans reported no decisional conflict, and 59% reported high-quality decision making. While most veterans correctly answered questions about the harms of radiation, false-positive results, and overdiagnosis, few knew when to stop screening, and most overestimated the benefit of screening and the predictive value of an abnormal scan. Tobacco cessation interventions were offered to 72 currently smoking veterans. Conclusions: We successfully implemented an LCS program that provides SDM and tobacco cessation support using a centralized telehealth model. While veterans were confident about screening decisions, knowledge testing indicated important deficits, and many did not engage meaningfully in SDM. Clinicians should frame the decision as patient centered at the time of referral, highlight the importance of SDM, and be able to provide adequate decision support.

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“…The VA is the largest nationally integrated health care system in the United States and has prioritized LCS with several initiatives. 14,15 Veterans have greater rates of cigarette smoking and more comorbid conditions than non-Veteran populations. 16 We sought to qualitatively analyze the experiences of patients with marginal anticipated net benefit from LCS, owing to multimorbidity and limited life expectancy, to explore factors that influence their decision making.…”

Section: Introductionmentioning

confidence: 99%

“It Can’t Hurt!”: Why Many Patients With Limited Life Expectancy Decide to Accept Lung Cancer Screening

Núñez,

Bolton,

Boudreau

et al. 2024

Ann Fam Med

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PURPOSE Lung cancer screening (LCS) has less benefit and greater potential for iatrogenic harm among people with multiple comorbidities and limited life expectancy. Yet, such individuals are more likely to undergo screening than healthier LCS-eligible people. We sought to understand how patients with marginal LCS benefit conceptualize their health and make decisions regarding LCS. METHODSWe interviewed 40 people with multimorbidity and limited life expectancy, as determined by high Care Assessment Need scores, which predict 1-year risk of hospitalization or death. Patients were recruited from 6 Veterans Health Administration facilities after discussing LCS with their clinician. We conducted a thematic analysis using constant comparison to explore factors that influence LCS decision making. RESULTSPatients commonly held positive beliefs about screening and perceived LCS to be noninvasive. When posed with hypothetical scenarios of limited benefit, patients emphasized the nonlongevity benefits of LCS (eg, peace of mind, planning for the future) and generally did not consider their health status or life expectancy when making decisions regarding LCS. Most patients were unaware of possible additional evaluations or treatment of screendetected findings, but when probed further, many expressed concerns about the potential need for multiple evaluations, referrals, or invasive procedures.CONCLUSIONS Patients in this study with multimorbidity and limited life expectancy were unaware of their greater risk of potential harm when accepting LCS. Given patient trust in clinician recommendations, it is important that clinicians engage patients with marginal LCS benefit in shared decision making, ensuring that their values of desiring more information about their health are weighed against potential harms from further evaluations.

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Lung cancer screening at the VA: Past, present and future

Cited by 10 publications

References 69 publications

Association of radiotherapy for stage I–III breast cancer survivors and second primary malignant cancers: a population-based study

Association of radiotherapy for stage I–III breast cancer survivors and second primary malignant cancers: a population-based study

Implementing a Telehealth Shared Counseling and Decision-Making Visit for Lung Cancer Screening in a Veterans Affairs Medical Center

“It Can’t Hurt!”: Why Many Patients With Limited Life Expectancy Decide to Accept Lung Cancer Screening

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