Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

Abstract

Rationale: To mitigate the potential harms of screening, professional societies recommend that lung cancer screening be conducted in multidisciplinary programs with the capacity to provide comprehensive care, from screening through pulmonary nodule evaluation to treatment of screen-detected cancers. The degree to which this standard can be met at the national level is unknown.Objectives: To assess the readiness of clinical facilities in a national healthcare system for implementation of comprehensive lung cancer screening programs, as compared with the ideal described in policy recommendations.Methods: This was a cross-sectional, self-administered survey of staff pulmonologists in pulmonary outpatient clinics in Veterans Health Administration facilities. Measurements and Main Results:The facility-level response rate was 84.1% (106 of 126 facilities with pulmonary clinics); 88.7% of facilities showed favorable provider perceptions of the evidence for lung cancer screening, and 73.6% of facilities had a favorable provider-perceived local context for screening implementation. All elements of the policyrecommended infrastructure for comprehensive screening programs were present in 36 of 106 facilities (34.0%); the most common deficiencies were the lack of on-site positron emission tomography scanners or radiation oncology services. Overall, 26.5% of Veterans Health Administration facilities were ideally prepared for lung cancer screening implementation (44.1% if the policy recommendations for on-site positron emission tomography scanners and radiation oncology services were waived).Conclusions: Many facilities may be less than ideally positioned for the implementation of comprehensive lung cancer screening programs. To ensure safe, effective screening, hospitals may need to invest resources or coordinate care with facilities that can offer comprehensive care for screening through downstream evaluation and treatment of screen-detected cancers.

Impact of an Onsite Endobronchial Ultrasound Program on the Time to Treatment of Cancer in Veterans

“…The percentage of lung cancers stage I/II and IV is similar to a previous study that demonstrated rates of 37% and 33%, respectively, prior to the implementation of lung cancer screening in a veteran population [25]. Infrastructure requirements for the establishment of a lung cancer screening program include the ability to characterize nodules with nonsurgical approaches, including bronchoscopic biopsy, and track outcomes of testing (complications and diagnosis) [26][27][28]. Thus, an onsite EBUS program facilitates the future establishment of a lung cancer screening program but may not necessarily expedite the time from detection to diagnosis.…”

Adherence to Follow-up Testing Recommendations in US Veterans Screened for Lung Cancer, 2015-2019

“…30,31 We used data from a national VHA survey conducted in 2013 to 2014 to determine whether facilities had capacity to perform thoracic surgery. 32…”

Screening for Lung Cancer

“…By contrast, surveys indicate that systems and processes of care to facilitate nodule evaluation have not been consistently adopted in US medical facilities. 119,120 Studies that include more diverse practice settings have reported higher and more variable rates of biopsy and complications. 88 8.…”