Objective Current lung cancer screening criteria based primarily on outcomes from the National Lung Screening Trial may not adequately capture all subgroups of the population at risk. We aimed to evaluate the efficacy of lung cancer screening criteria recommended by the United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and the National Comprehensive Cancer Network in identifying known cases of lung cancer. Methods An investigation of the Stony Brook Cancer Center Lung Cancer Evaluation Center's database identified 1207 eligible, biopsy-proven lung cancer cases diagnosed between January 1996 and March 2016. Age at diagnosis, smoking history, and other known risk factors for lung cancer were used to determine the proportion of cases that would have met current United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and National Comprehensive Cancer Network eligibility requirements for lung cancer screening. Results Of the 1046 ever smokers in the study, 40% did not meet the National Lung Screening Trial age requirements, 20% did not have a ≥30 pack year smoking history, and approximately one-third quit smoking >15 years before diagnosis, thus deeming them ineligible for screening. Applying the United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and National Comprehensive Cancer Network eligibility criteria to the Stony Brook Cancer Center's Lung Cancer Evaluation Center cases, 49.2, 46.3, and 69.8%, respectively, would have met the current lung cancer screening guidelines. Conclusions The United States Preventive Services Task Force and Centers for Medicare and Medicaid Services eligibility criteria for lung cancer screening captured less than 50% of lung cancer cases in this investigation. These findings highlight the need to reevaluate the efficacy of current guidelines and may have major public health implications.
Objective: Low-dose CT scanning has recently been recommended to screen patients at elevated risk of developing lung cancer, however, limited data exist describing distress experienced by this at-risk population. The objective of this study is to describe the prevalence and risk factors of high distress among patients undergoing screening for lung cancer. Methods: The validated National Comprehensive Cancer Network Distress Thermometer (DT) was used to evaluate distress prior to and following lung cancer screening among 228 patients attending the Center for Lung Cancer Screening and Prevention at the Stony Brook Cancer Center between September 30, 2013 and September 29, 2014. Clinically significant distress was defined by a score ≥ 4 on the DT instrument and logistic regression models were used to evaluate factors associated with high distress. Results: Forty-three percent of study participants experienced elevated distress prior to screening, while approximately one-third of patients reported distress scores ≥4 post-screening. Risk factors for elevated distress before screening included female gender (OR = 2.68; 95% CI [1.51, 4.77]) and having a positive family history of lung cancer (OR = 2.02 [1.04, 3.91]), while significant associations with post-screening distress were found among females (OR = 3.16 [1.73,5.80]), current smokers (1.85 [1.00, 3.42]) and those with a positive personal history of a non-cancerous lung diagnosis (OR = 1.87 [1.00, 3.51]). Conclusions: The lung cancer screening population is a vulnerable group burdened by increased levels of distress. The screening visit represents a unique opportunity to not only educate patients about lung health and smoking cessation but additionally to address issues related to psychological wellness.
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