Missed Opportunities? An Observational Analysis of Lung Cancer Screening Utilization Amongst Patients With Lung Cancer

Olazagasti, Coral; Ehrlich, Matthew; Kohn, Nina; Aviles, Karen; Hoilett, Aldane; Seetharamu, Nagashree

doi:10.1177/10732748221077959

Cited by 5 publications

(10 citation statements)

References 13 publications

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“…A significant association was also found between stage at diagnosis and screening with LDCT. 34 To our knowledge, this is the only other study that describes the percentage of lung cancer patients that would qualify for LCS as all other data describe LCS utilization amongst in-network populations of patients who meet eligibility criteria. In addition, factors associated with access to care such as insurance type and geographic relationship to the medical facility have been associated with the utilization of LCS.…”

Section: Discussionmentioning

confidence: 97%

Access to Care Limits Lung Cancer Screening Eligibility in an Urban Safety Net Hospital

Dollar

Neutel

Hsia

2022

J Prim Care Community Health

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Purpose: Lung cancer screening (LCS) results in earlier detection of malignancy and decreases mortality but requires access to care to benefit. We assessed factors associated with timing of lung cancer diagnosis in the absence of systematic LCS in an urban safety net hospital. Patients and Methods: Retrospective chart review was performed of patients with pathologic diagnosis and/or staging of lung cancer at our institution between 2015 and 2018. Patient socio-demographics, disease characteristics, factors associated with access to medical care, and time point and process by which the patient accessed care were collected and analyzed. Results: In total, 223 patients were identified with median age of 63 years and 57.8% male predominance. Racial distribution was 22.9%, 20.2%, 17.1%, and 9.4% for Black, White, Asian, and Hispanic, respectively. Stage at diagnosis was 8.1%, 4.5%, 17.0%, and 60.5% for stages I, II, III, and IV, respectively. Medicaid (59.6%) and Medicare/Medicaid (17.1%) were the most common insurance types, while 16.1% had no insurance. A majority (54.3%) had no established primary care provider (PCP), and only 17.9% had an in-network PCP. Patients without PCPs were more likely to have diagnostic evaluation initiated from Emergency Department or Urgent Care settings (95.0% vs 50.1%, P < .01) and present with later stage disease (92.7% vs 77.8%, P < .01). Of the 83 patients that met age and smoking history LCS criteria, only 33.7% (12.6% of total) also had an in-network PCP. Conclusion: Absence of established PCPs is associated with later stage presentation of lung cancer and may limit system- level benefits of LCS implementation.

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Section: Discussionmentioning

confidence: 97%

Access to Care Limits Lung Cancer Screening Eligibility in an Urban Safety Net Hospital

Dollar

Neutel

Hsia

2022

J Prim Care Community Health

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“…As published in our original study ( 13 ), only 4.0% and 4.8% of the subjects that fulfilled NCCN and USPSTF eligibility criteria, respectively, underwent LDCT (95% exact CI: 2.0, 7.0 and 2.2, 9.0). Ninety one percent of the subjects that had LDCT uptake in the NCCN eligible group were men ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 90%

“…For additional information regarding screening according to smoking status and staging at diagnosis, please refer to original study ( 13 ).…”

Section: Resultsmentioning

confidence: 99%

“…Regretfully, the efforts have focused mainly on this minority group and limited data exists understanding the eligibility patterns and screening uptake in the Hispanic population. In efforts to understand the patterns and the factors that contribute to these inequities, we conducted a secondary analysis of an observational study ( 13 ) to evaluate the tendencies for screening eligibility among the Hispanics population prior to their lung cancer diagnosis. To our knowledge, no previous studies have been published that highlight a potential for missed opportunities in high-risk, underserved groups such as the Hispanic populations that are eventually diagnosed with lung cancer.…”

Section: Introductionmentioning

confidence: 99%

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One size does not fit all: Evaluating disparities in lung cancer screening eligibility amongst the Hispanic population

2022

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Lung cancer (LC) is the leading cause of cancer death among Hispanic men. We assessed the tendencies for screening eligibility amongst Hispanic prior to LC diagnosis according to the NCCN and The USPSTF guidelines available at the time of diagnosis. We conducted an observational study in patients diagnosed with LC from 2016 to 2019. Charts were reviewed to assess their screening eligibility prior to LC. The chi-square test was used to examine the association between race and ethnicity with each screening criteria. A total of 530 subjects were reviewed, of which 432 were included in the analysis. One hundred fifty-three and 245 subjects were ineligible for screening under NCCN and USPSTF criteria prior to their LC diagnosis. Twenty-eight of the subjects who did not fulfill NCCN criteria identified as AA and 12 as Hispanics. Forty and 20 of the USPSTF screening ineligible subjects identified as AA and Hispanics. There was a significant association between screening eligibility criteria in Hispanics, with 52% Hispanic subjects meeting NCCN criteria compared to only 20% who met USPSTF (p=0.0184). There was also a significant association between ethnicity and USPSTF eligibility criteria (p=0.0166), as 80% of Hispanic subjects were screening ineligible under USPSTF criteria compared to 56% of non-Hispanic or other. In our study, Hispanics had significantly lower tendencies of meeting the USPSTF LC screening eligibility criteria than non-Hispanics or other. Interestingly, a proportionally higher number of Hispanics who were ineligible under USPSTF criteria met NCCN criteria. These findings suggest that leniency in the screening criteria can possibly lead to earlier detection of LC in high-risk individuals. Recently, USPSTF has modified their criteria which may benefit more of these individuals. To improve rates of screening and overall mortality of minorities, organizations should continue to re-evaluate and liberalize their screening guidelines.

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“…[3] Lung function status is not taken into consideration in current screening criteria which are based only on age and packyear smoking history. [4] It is well-recognized that individuals with smoking habits, lung cancer, or respiratory illnesses have impaired lung function. For example, TB and asthma are risk factors for lung function impairment among Korean non-smokers [5], and air pollution, even at very low levels, has adverse effects on lung function in adults.…”

Section: Introductionmentioning

confidence: 99%

Impaired lung function and lung cancer risk in 461,183 healthy individuals: a cohort study

Kyaw,

Tsai,

Wen

et al. 2023

Preprint

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BackgroundIt has been known that smoking and various lung diseases including lung cancer can cause lung function impairment. However, the impact of different types of lung function impairments, such as preserved ratio impaired spirometry (PRISm) and airflow obstruction (AO), on the incidence and mortality of lung cancer in both general and never-smoker populations remains unclear. We wished to examine the effect of lung function impairments on lung cancer risks.MethodsThis was a retrospective cohort study of individuals from a health surveillance program in Taiwan who underwent baseline spirometry tests at the entry point. PRISm was defined as an FEV1/FVC (Forced Expiratory Volume in 1 second/ Forced Vital Capacity) ratio >0.7 and FEV1 <0.8, while AO was defined as an FEV1/FVC ratio <0.7. Cox proportional hazards models and cubic spline curves were used to examine the associations between lung function impairments and lung cancer risks.ResultsThe study included 461,183 individuals, of whom 14.3% had PRISm and 7.9% had AO. A total of 4,038 cases of lung cancer and 3,314 lung cancer-related deaths were identified during the 23 years of follow-up. Individuals with PRISm and AO exhibited a higher risk of lung cancer incidence and mortality compared to those with normal lung function. The adjusted hazard ratios (aHRs) and 95% confidence intervals (95%CI) were 1.14 (1.03-1.26) and 1.23 (1.10-1.37) in the overall cohort, and 1.08 (0.93-1.24), and 1.23 (1.05-1.45) in the never-smoker cohort. The risks of both developing and dying of lung cancer increased with the severity levels of lung function impairments and lower FEV1 values.ConclusionImpaired lung function is associated with increased risks of developing lung cancer and subsequent mortality. The study highlights the importance of considering lung function in lung cancer screening for better candidate selection.WHAT IS ALREADY KNOWN ON THIS TOPICImpaired lung function is a common condition that can be observed in people with smoking habits and other respiratory illnesses including lung cancer. However, the effect of lung function impairment alone on the risks of lung cancer incidence and mortality is not clear. Early detection of lung cancer is essential for effective disease management, and lung cancer screening is a key preventive measure that can help achieve this. However, current lung cancer screening guidelines only consider age and smoking history, not lung function status.WHY THIS STUDY ADDSImpaired lung function is associated with an increased risk of lung cancer in a large Asian cohort. Nonetheless, among never-smoking individuals exhibiting spirometrically defined PRISM/AO, the observed risks were found to lack statistical significance, with the exception of lung cancer mortality within the non-smoking PRISm subgroup.HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYLung function status should be taken into consideration in lung cancer screening criteria. The importance of monitoring and addressing lung function impairment in lung cancer risk management should also be widely shared with the medical community and the public.

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Missed Opportunities? An Observational Analysis of Lung Cancer Screening Utilization Amongst Patients With Lung Cancer

Cited by 5 publications

References 13 publications

Access to Care Limits Lung Cancer Screening Eligibility in an Urban Safety Net Hospital

Access to Care Limits Lung Cancer Screening Eligibility in an Urban Safety Net Hospital

One size does not fit all: Evaluating disparities in lung cancer screening eligibility amongst the Hispanic population

Impaired lung function and lung cancer risk in 461,183 healthy individuals: a cohort study

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