Updated Analysis of Complication Rates Associated With Invasive Diagnostic Procedures After Lung Cancer Screening

Zhao, Hui; Xu, Ying; Huo, Jinhai; Burks, Allen Cole; Ost, David

doi:10.1001/jamanetworkopen.2020.29874

Cited by 18 publications

(13 citation statements)

References 3 publications

(10 reference statements)

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“…Even with the rate reduced to 5.3% according to Lung-RADS classification system, a substantial number of individuals would still be negatively affected by potential downstream events including invasive diagnostic procedures . For those who undergo invasive procedures, complication rates of these procedures observed in clinical practice settings were found to be higher than those documented in the NLST . Costs associated with complications can be as high as $56 845 …”

Section: Discussionmentioning

confidence: 99%

“…33 For those who undergo invasive procedures, complication rates of these procedures observed in clinical practice settings were found to be higher than those documented in the NLST. 34 Costs associated with complications can be as high as $56 845. 35 Research has shown the association between insurance and LCS among the screening-eligible population.…”

Section: Jama Network Open | Health Policymentioning

confidence: 99%

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Assessment of Uptake Appropriateness of Computed Tomography for Lung Cancer Screening According to Patients Meeting Eligibility Criteria of the US Preventive Services Task Force

et al. 2022

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ImportanceCurrently, computed tomography (CT) is used for lung cancer screening (LCS) among populations with various levels of compliance to the eligibility criteria from the US Preventive Services Task Force (USPSTF) recommendations and may represent suboptimal allocation of health care resources.ObjectiveTo evaluate the appropriateness of CT LCS according to the USPSTF eligibility criteria.Design, Setting, and ParticipantsThis cross-sectional study used the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey. Participants included individuals who responded to the LCS module administered in 20 states and had valid answers to questions regarding screening and smoking history. Data were analyzed between October 2021 and August 2022.ExposuresScreening eligibility groups were categorized according to the USPSTF 2013 recommendations, and subgroups of individuals who underwent LCS were analyzed.Main Outcomes and MeasuresMain outcomes included LCS among the screening-eligible population and the proportions of the screened populations according to compliance categories established from the USPSTF 2013 and 2021 recommendations. In addition, the association between respondents’ characteristics and LCS was evaluated for the subgroup who were screened despite not meeting any of the 3 USPSTF screening criteria: age, pack-year, and years since quitting smoking.ResultsA total of 96 097 respondents were identified for the full study cohort, and 2 subgroups were constructed: (1) 3374 respondents who reported having a CT or computerized axial tomography to check for lung cancer and (2) 33 809 respondents who did not meet any screening eligibility criteria. The proportion of participants who were under 50 years old was 53.1%; between 50 and 54, 9.1%; between 55 and 79, 33.8%; and over 80, 4.0%. A total of 51 536 (50.9%) of the participants were female. According to the USPSTF 2013 recommendation, 807 (12.8%) of the screening-eligible population underwent LCS. Among those who were screened, only 807 (20.9%) met all 3 screening eligibility criteria, whereas 538 (20.1%) failed to meet any criteria. Among respondents in subgroup 2, being of older age and having a history of stroke, chronic obstructive pulmonary disease, kidney disease, or diabetes were associated with higher likelihood of LCS.Conclusions and RelevanceIn this cross-sectional study of the BRFSS 2019 survey, the low uptake rate among screening-eligible patients undermined the goal of LCS of early detection. Suboptimal screening patterns could increase health system costs and add financial stress, psychological burden, and physical harms to low-risk patients, while failing to provide high-quality preventive services to individuals at high risk of lung cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Health Policymentioning

confidence: 99%

Assessment of Uptake Appropriateness of Computed Tomography for Lung Cancer Screening According to Patients Meeting Eligibility Criteria of the US Preventive Services Task Force

et al. 2022

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“…[5][6][7][8] The decision of whether to screen individuals at high risk of lung cancer is complex and requires that patients and physicians balance the benefits (ie, early detection of lung cancer) with potential harms (eg, complications from downstream procedures, overdiagnosis, and distress from indeterminate findings). [9][10][11] To address this concern, guidelines recommend that physicians engage in shared decision-making with patients about whether to undergo screening, and shared decisionmaking is mandated by the Centers for Medicare & Medicaid Services for reimbursement of LCS. 3,12 Some researchers have suggested that these policies endorsing shared decision-making serve as a barrier to LCS uptake, arguing that policy requires too much discussion of LCS harms that may convince patients and/or the physicians counseling them that LCS is not worth pursuing.…”

Section: Introductionmentioning

confidence: 99%

“…The decision of whether to screen individuals at high risk of lung cancer is complex and requires that patients and physicians balance the benefits (ie, early detection of lung cancer) with potential harms (eg, complications from downstream procedures, overdiagnosis, and distress from indeterminate findings) . To address this concern, guidelines recommend that physicians engage in shared decision-making with patients about whether to undergo screening, and shared decision-making is mandated by the Centers for Medicare & Medicaid Services for reimbursement of LCS .…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Declining Lung Cancer Screening After Discussion With a Clinician in a Cohort of US Veterans

et al. 2022

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ImportanceLung cancer screening (LCS) is underused in the US, particularly in underserved populations, and little is known about factors associated with declining LCS. Guidelines call for shared decision-making when LCS is offered to ensure informed, patient-centered decisions.ObjectiveTo assess how frequently veterans decline LCS and examine factors associated with declining LCS.Design, Setting, and ParticipantsThis retrospective cohort study included LCS-eligible US veterans who were offered LCS between January 1, 2013, and February 1, 2021, by a physician at 1 of 30 Veterans Health Administration (VHA) facilities that routinely used electronic health record clinical reminders documenting LCS eligibility and veterans’ decisions to accept or decline LCS. Data were obtained from the Veterans Affairs (VA) Corporate Data Warehouse or Medicare claims files from the VA Information Resource Center.Main Outcomes and MeasuresThe main outcome was documentation, in clinical reminders, that veterans declined LCS after a discussion with a physician. Logistic regression analyses with physicians and facilities as random effects were used to assess factors associated with declining LCS compared with agreeing to LCS.ResultsOf 43 257 LCS-eligible veterans who were offered LCS (mean [SD] age, 64.7 [5.8] years), 95.9% were male, 84.2% were White, and 37.1% lived in a rural zip code; 32.0% declined screening. Veterans were less likely to decline LCS if they were younger (age 55-59 years: odds ratio [OR], 0.69; 95% CI, 0.64-0.74; age 60-64 years: OR, 0.80; 95% CI, 0.75-0.85), were Black (OR, 0.80; 95% CI, 0.73-0.87), were Hispanic (OR, 0.62; 95% CI, 0.49-0.78), did not have to make co-payments (OR, 0.92; 95% CI, 0.85-0.99), or had more frequent VHA health care utilization (outpatient: OR, 0.70; 95% CI, 0.67-0.72; emergency department: OR, 0.86; 95% CI, 0.80-0.92). Veterans were more likely to decline LCS if they were older (age 70-74 years: OR, 1.27; 95% CI, 1.19-1.37; age 75-80 years: OR, 1.93; 95% CI, 1.73-2.17), lived farther from a VHA screening facility (OR, 1.06; 95% CI, 1.03-1.08), had spent more days in long-term care (OR, 1.13; 95% CI, 1.07-1.19), had a higher Elixhauser Comorbidity Index score (OR, 1.04; 95% CI, 1.03-1.05), or had specific cardiovascular or mental health conditions (congestive heart failure: OR, 1.25; 95% CI, 1.12-1.39; stroke: OR, 1.14; 95% CI, 1.01-1.28; schizophrenia: OR, 1.87; 95% CI, 1.60-2.19). The physician and facility offering LCS accounted for 19% and 36% of the variation in declining LCS, respectively.Conclusions and RelevanceIn this cohort study, older veterans with serious comorbidities were more likely to decline LCS and Black and Hispanic veterans were more likely to accept it. Variation in LCS decisions was accounted for more by the facility and physician offering LCS than by patient factors. These findings suggest that shared decision-making conversations in which patients play a central role in guiding care may enhance patient-centered care and address disparities in LCS.

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“…The NLST has reported a 9.4% complication rate in the study setting, but in real life circumstances, it may be much higher and has been reported to be between 16.8% and 22.8% in different studies, including a 1.6% severe complication rate. 22 Artificial intelligence or machine learning algorithms using radiomics and other data are being developed to more accurately classify malignant from nonmalignant nodules and to predict their aggressiveness. A large number of such algorithms have been published, and in particular, the ones based on deep learning or convolutional or related neural networks are promising.…”

Section: Lung Cancer Screening Trialsmentioning

confidence: 99%

Screening for Lung Cancer in Individuals Who Never Smoked: An International Association for the Study of Lung Cancer Early Detection and Screening Committee Report

Yang

Zulueta²,

Viola³

et al. 2022

Journal of Thoracic Oncology

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Updated Analysis of Complication Rates Associated With Invasive Diagnostic Procedures After Lung Cancer Screening

Abstract: This case-control study compares complication rates associated with invasive diagnostic procedures before and after Medicare and Medicaid coverage of lung cancer screening tests.

Cited by 18 publications

References 3 publications

Assessment of Uptake Appropriateness of Computed Tomography for Lung Cancer Screening According to Patients Meeting Eligibility Criteria of the US Preventive Services Task Force

Assessment of Uptake Appropriateness of Computed Tomography for Lung Cancer Screening According to Patients Meeting Eligibility Criteria of the US Preventive Services Task Force

Factors Associated With Declining Lung Cancer Screening After Discussion With a Clinician in a Cohort of US Veterans

Screening for Lung Cancer in Individuals Who Never Smoked: An International Association for the Study of Lung Cancer Early Detection and Screening Committee Report

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