Young at Heart: Is That Good Enough for Computed Tomography Screening?

Abstract

When it comes to data, the National Lung Screening Trial (NLST) just keeps on giving. Following the revolutionary results that came from the main trial demonstrating an improvement in lung cancer-specific and all cause mortality of 20% and 6.7% respectively (1), a number of secondary analyses have been carried out by Tanner and colleagues looking various issues such as screening those with racial differences (2) and those who have achieved smoking abstinence (3). The same authors report a study that addresses another important, and as yet unresolved issue-screening the older patient with comorbidities (4). The United States Preventative Services Task Force (USPSTF) statement of 2013 (5) recommends an upper age limit for screening of 80, and recognises that screening may not be appropriate in older individuals with multiple comorbidities. However neither the USPSTF, nor the American College of Chest Physicians (6), or National Comprehensive Cancer Network (7) give more clear guidance on what degree of comorbidity should preclude screening. The paper by Tanner and colleagues brings us one step closer to understanding the complex interplay of factors influencing this sensitive issue. In this study, Tanner and colleagues compare outcomes of a cohort of 9476 patients from the SEER-Medicare dataset with stage 1 Non Small Cell Lung Cancer (NSCLC) aged 65-74 with NLST participants of the same age. The covariates of age, gender, smoking status, cancer stage and number of comorbidities, using the Deyo-modified Charlson Comorbidity Index (CCI), are examined against the outcomes of post-operative mortality, and 5-year lung cancer-specific and all cause survival. Importantly, they showed that surgical mortality and 5

Total and Out-of-Pocket Costs of Procedures After Lung Cancer Screening in a National Commercially Insured Population: Estimating an Episode of Care

“…Older patients are at higher lung cancer risk, with expected higher rates of downstream procedures [25]. However, older patients also carry a higher comorbidity burden, which may translate to higher rates of false-positive tests, as well as higher procedural-related morbidity and mortality [15,23,26,27]. These characteristics may translate to substantial differences between LCS in clinical trial versus clinical practice settings.…”