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Backhus LM, Chang CF, Sakoda LC, Chambers SR, Henderson LM, Henschke CI, Hollenbeck GJ, Jacobson FL, Martin LW, Proctor ED, Schiller JH, Siegfried JM, Wisnivesky JP, Wolf AS, Jemal A, Kelly K, Sandler KL, Watkins PN, Smith RA, Rivera MP. The American Cancer Society National Lung Cancer Roundtable strategic plan: Lung cancer in women. Cancer 2024. [PMID: 39302237 DOI: 10.1002/cncr.35083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Lung cancer in women is a modern epidemic and represents a global health crisis. Cigarette smoking remains the most important risk factor for lung cancer in all patients and, among women globally, rates of smoking continue to increase. Although some data exist supporting sex-based differences across the continuum of lung cancer, there is currently a dearth of research exploring the differences in risk, biology, and treatment outcomes in women. Consequently, the American Cancer Society National Lung Cancer Roundtable recognizes the urgent need to promote awareness and future research that will close the knowledge gaps regarding lung cancer in women. To this end, the American Cancer Society National Lung Cancer Roundtable Task Group on Lung Cancer in Women convened a summit undertaking the following to: (1) summarize existing evidence and identify knowledge gaps surrounding the epidemiology, risk factors, biologic differences, and outcomes of lung cancer in women; (2) develop and prioritize research topics and questions that address research gaps and advance knowledge to improve quality of care of lung cancer in women; and (3) propose strategies for future research. PLAIN LANGUAGE SUMMARY: Lung cancer is the leading cause of cancer mortality in women, and, despite comparatively lower exposures to occupational and environmental carcinogens compared with men, disproportionately higher lung cancer rates in women who ever smoked and women who never smoked call for increased awareness and research that will close the knowledge gaps regarding lung cancer in women.
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Affiliation(s)
- Leah M Backhus
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University, Stanford, California, USA
| | - Ching-Fei Chang
- Department of Pulmonary, Critical Care, and Sleep Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Lori C Sakoda
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Shonta R Chambers
- Department of Health Equity, Patient Advocate Foundation, Hampton, Virginia, USA
| | - Louise M Henderson
- Department of Radiology, The University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Claudia I Henschke
- Department of Radiology, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Phoenix Veterans Affairs Health Care System, Phoenix, Arizona, USA
| | | | - Francine L Jacobson
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Linda W Martin
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Elridge D Proctor
- Government Affairs, GO2 Foundation for Lung Cancer, Washington, District of Columbia, USA
| | | | - Jill M Siegfried
- Department of Pharmacology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Juan P Wisnivesky
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrea S Wolf
- Department Thoracic Surgery, The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Karen Kelly
- Department of Internal Medicine, Division of Hematology and Oncology, The University of California at Davis, Sacramento, California, USA
| | - Kim L Sandler
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Robert A Smith
- Center for Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
| | - M Patricia Rivera
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Wilmot Cancer Institute, The University of Rochester Medical Center, Rochester, New York, USA
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Lewis JA, Klein DE, Eberth JM, Carter-Bawa L, Studts JL, Tong BC, Smith RA, Kazerooni EA, Houston TP. The American Cancer Society National Lung Cancer Roundtable strategic plan: Provider engagement and outreach. Cancer 2024. [PMID: 39302232 DOI: 10.1002/cncr.34555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
The American Cancer Society National Lung Cancer Roundtable strategic plan for provider engagement and outreach addresses barriers to the uptake of lung cancer screening, including lack of provider awareness and guideline knowledge about screening, concerns about potential harms from false-positive examinations, lack of time to implement workflows within busy primary care practices, insufficient infrastructure and administrative support to manage a screening program and patient follow-up, and implicit bias based on sex, race/ethnicity, social class, and smoking status. Strategies to facilitate screening include educational programming, clinical reminder systems within the electronic medical record, decision support aids, and tools to track nodules that can be implemented across a diversity of practices and health care organizational structures. PLAIN LANGUAGE SUMMARY: The American Cancer Society National Lung Cancer Roundtable strategic plan to reduce deaths from lung cancer includes strategies designed to support health care professionals, to better understand lung cancer screening, and to support adults who are eligible for lung cancer screening by providing counseling, referral, and follow-up.
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Affiliation(s)
- Jennifer A Lewis
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, Nashville, Tennessee, USA
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Ingram Cancer Center, Nashville, Tennessee, USA
| | - Deborah E Klein
- Swedish Primary Care, Swedish Medical Center, Seattle, Washington, USA
| | - Jan M Eberth
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lisa Carter-Bawa
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jamie L Studts
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Betty C Tong
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert A Smith
- Center for Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ella A Kazerooni
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas P Houston
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Lewis JA, Samuels LR, Weems J, Park D, Winter R, Lindsell CJ, Callaway-Lane C, Audet C, Slatore CG, Wiener RS, Dittus RS, Kripalani S, Yankelevitz DF, Henschke CI, Moghanaki D, Matheny ME, Vogus TJ, Roumie CL, Spalluto LB. The Association of Organizational Readiness With Lung Cancer Screening Utilization. Am J Prev Med 2023; 65:844-853. [PMID: 37224985 PMCID: PMC10592591 DOI: 10.1016/j.amepre.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Lung cancer screening is widely underutilized. Organizational factors, such as readiness for change and belief in the value of change (change valence), may contribute to underutilization. The aim of this study was to evaluate the association between healthcare organizations' preparedness and lung cancer screening utilization. METHODS Investigators cross-sectionally surveyed clinicians, staff, and leaders at10 Veterans Affairs from November 2018 to February 2021 to assess organizational readiness to implement change. In 2022, investigators used simple and multivariable linear regression to evaluate the associations between facility-level organizational readiness to implement change and change valence with lung cancer screening utilization. Organizational readiness to implement change and change valence were calculated from individual surveys. The primary outcome was the proportion of eligible Veterans screened using low-dose computed tomography. Secondary analyses assessed scores by healthcare role. RESULTS The overall response rate was 27.4% (n=1,049), with 956 complete surveys analyzed: median age of 49 years, 70.3% female, 67.6% White, 34.6% clinicians, 61.1% staff, and 4.3% leaders. For each 1-point increase in median organizational readiness to implement change and change valence, there was an associated 8.4-percentage point (95% CI=0.2, 16.6) and a 6.3-percentage point increase in utilization (95% CI= -3.9, 16.5), respectively. Higher clinician and staff median scores were associated with increased utilization, whereas leader scores were associated with decreased utilization after adjusting for other roles. CONCLUSIONS Healthcare organizations with higher readiness and change valence utilized more lung cancer screening. These results are hypothesis generating. Future interventions to increase organizations' preparedness, especially among clinicians and staff, may increase lung cancer screening utilization.
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Affiliation(s)
- Jennifer A Lewis
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Medical Service, VA Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, Tennessee; Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
| | - Lauren R Samuels
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jacy Weems
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel Park
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Winter
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carol Callaway-Lane
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Medical Service, VA Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carolyn Audet
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care (CIVIC), Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon; Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, Oregon; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; VA National Center for Lung Cancer Screening (NCLCS), Veterans Health Administration, Washington, District of Columbia
| | - Renda Soylemez Wiener
- VA National Center for Lung Cancer Screening (NCLCS), Veterans Health Administration, Washington, District of Columbia; Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Robert S Dittus
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F Yankelevitz
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia I Henschke
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; VA Phoenix Health Care System, Phoenix, Arizona
| | - Drew Moghanaki
- Radiation Oncology Service, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Michael E Matheny
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Timothy J Vogus
- Owen Graduate School of Management, Vanderbilt University, Nashville, Tennessee
| | - Christianne L Roumie
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| | - Lucy B Spalluto
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
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4
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Lewis JA, Bonnet K, Schlundt DG, Byerly S, Lindsell CJ, Henschke CI, Yankelevitz DF, York SJ, Hendler F, Dittus RS, Vogus TJ, Kripalani S, Moghanaki D, Audet CM, Roumie CL, Spalluto LB. Rural barriers and facilitators of lung cancer screening program implementation in the veterans health administration: a qualitative study. FRONTIERS IN HEALTH SERVICES 2023; 3:1209720. [PMID: 37674596 PMCID: PMC10477991 DOI: 10.3389/frhs.2023.1209720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/04/2023] [Indexed: 09/08/2023]
Abstract
Introduction To assess healthcare professionals' perceptions of rural barriers and facilitators of lung cancer screening program implementation in a Veterans Health Administration (VHA) setting through a series of one-on-one interviews with healthcare team members. Methods Based on measures developed using Reach Effectiveness Adoption Implementation Maintenance (RE-AIM), we conducted a cross-sectional qualitative study consisting of one-on-one semi-structured telephone interviews with VHA healthcare team members at 10 Veterans Affairs medical centers (VAMCs) between December 2020 and September 2021. An iterative inductive and deductive approach was used for qualitative analysis of interview data, resulting in the development of a conceptual model to depict rural barriers and facilitators of lung cancer screening program implementation. Results A total of 30 interviews were completed among staff, providers, and lung cancer screening program directors and a conceptual model of rural barriers and facilitators of lung cancer screening program implementation was developed. Major themes were categorized within institutional and patient environments. Within the institutional environment, participants identified systems-level (patient communication, resource availability, workload), provider-level (attitudes and beliefs, knowledge, skills and capabilities), and external (regional and national networks, incentives) barriers to and facilitators of lung cancer screening program implementation. Within the patient environment, participants revealed patient-level (modifiable vulnerabilities) barriers and facilitators as well as ecological modifiers (community) that influence screening behavior. Discussion Understanding rural barriers to and facilitators of lung cancer screening program implementation as perceived by healthcare team members points to opportunities and approaches for improving lung cancer screening reach, implementation and effectiveness in VHA rural settings.
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Affiliation(s)
- Jennifer A. Lewis
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Nashville, TN, United States
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt-Ingram Cancer Center, Nashville, TN, United States
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN, United States
- Qualitative Research Core, Vanderbilt University Medical Center, Nashville, TN, United States
| | - David G. Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, United States
- Qualitative Research Core, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Susan Byerly
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Christopher J. Lindsell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, NY, New York, United States
- Veterans Health Administration—Phoenix VA Health Care System, Radiology Service, Phoenix, AZ, United States
| | - David F. Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, NY, New York, United States
| | - Sally J. York
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Nashville, TN, United States
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt-Ingram Cancer Center, Nashville, TN, United States
| | - Fred Hendler
- Rex Robley VA Medical Center, Medicine Service, Louisville, KY, United States
| | - Robert S. Dittus
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Timothy J. Vogus
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Owen Graduate School of Management, Vanderbilt University, Nashville, TN, United States
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Drew Moghanaki
- Veterans Health Administration—Greater Los Angeles Veterans Affairs Medical Center, Radiation Oncology Service, Los Angeles, CA, United States
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Carolyn M. Audet
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Christianne L. Roumie
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lucy B. Spalluto
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt-Ingram Cancer Center, Nashville, TN, United States
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
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Robinson E, Trivedi P, Neifert S, Eromosele O, Liu BY, Housman B, Ilonen I, Taioli E, Flores R. Surgical markup in lung cancer resection, 2015-2020. JTCVS OPEN 2023; 14:538-545. [PMID: 37425438 PMCID: PMC10329030 DOI: 10.1016/j.xjon.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 07/11/2023]
Abstract
Objective The objective of this study was to assess procedure markup (charge-to-cost ratio) across lung resection procedures and examine variability by geographic region. Methods Provider-level data for common lung resection operations was obtained from the 2015 to 2020 Medicare Provider Utilization and Payment Data datasets using Healthcare Common Procedure Coding System codes. Procedures studied included wedge resection; video-assisted thoracoscopic surgery; and open lobectomy, segmentectomy, and mediastinal and regional lymphadenectomy. Procedure markup ratio and coefficient of variation (CoV) was assessed and compared across procedure, region, and provider. The CoV, a measure of dispersion defined as the ratio of the SD to the mean, was likewise compared across procedure and region. Results Median markup ratio across all procedures was 3.56 (interquartile range, 2.87-4.59) with right skew (mean, 4.13). Median markup ratio was 3.59 for lymphadenectomy (CoV, 0.51), 3.13 for open lobectomy (CoV, 0.45), 3.55 for video-assisted thoracoscopic surgery lobectomy (CoV, 0.59), 3.77 for segmentectomy (CoV, 0.74), and 3.80 for wedge resection (CoV, 0.67). Increased beneficiaries, services, and Healthcare Common Procedure Coding System score (total) were associated with a decreased markup ratio (P < .0001). Markup ratio was highest in the Northeast at 4.14 (interquartile range, 3.09-5.56) and lowest in the South (Markup ratio 3.26; interquartile range, 2.68-4.02). Conclusions We observe geographic variation in surgical billing for thoracic surgery.
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Affiliation(s)
- Eric Robinson
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
| | - Parth Trivedi
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
| | - Sean Neifert
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
| | - Omeko Eromosele
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
| | - Benjamin Y. Liu
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
| | - Brian Housman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
| | - Ilkka Ilonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Emanuela Taioli
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Health System, New York, NY
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai Health System, New York, NY
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6
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Smeltzer MP, Liao W, Faris NR, Fehnel C, Goss J, Shepherd CJ, Ramos R, Qureshi T, Mukhopadhyay A, Ray MA, Osarogiagbon RU. Potential Impact of Criteria Modifications on Race and Sex Disparities in Eligibility for Lung Cancer Screening. J Thorac Oncol 2023; 18:158-168. [PMID: 36208717 DOI: 10.1016/j.jtho.2022.09.220] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Low-dose computed tomography (LDCT) screening reduces lung cancer mortality, but current eligibility criteria underestimate risk in women and racial minorities. We evaluated the impact of screening criteria modifications on LDCT eligibility and lung cancer detection. METHODS Using data from a Lung Nodule Program, we compared persons eligible for LDCT by the following: U.S. Preventive Services Task Force (USPSTF) 2013 criteria (55-80 y, ≥30 pack-years of smoking, and ≤15 y since cessation); USPSTF2021 criteria (50-80 y, ≥20 pack-years of smoking, and ≤15 y since cessation); quit duration expanded to less than or equal to 25 years (USPSTF2021-QD25); reducing the pack-years of smoking to more than or equal to 10 years (USPSTF2021-PY10); and both (USPSTF2021-QD25-PY10). We compare across groups using the chi-square test or analysis of variance. RESULTS The 17,421 individuals analyzed were of 56% female sex, 69% white, 28% black; 13% met USPSTF2013 criteria; 17% USPSTF2021; 18% USPSTF2021-QD25; 19% USPSTF2021-PY10; and 21% USPSTF2021-QD25-PY10. Additional eligible individuals by USPSTF2021 (n = 682) and USPSTF2021-QD25-PY10 (n = 1402) were 27% and 29% black, both significantly higher than USPSTF2013 (17%, p < 0.0001). These additional eligible individuals were 55% (USPSTF2021) and 55% (USPSTF2021-QD25-PY10) of female sex, compared with 48% by USPSTF2013 (p < 0.05). Of 1243 persons (7.1%) with lung cancer, 22% were screening eligible by USPSTF13. USPSTF2021-QD25-PY10 increased the total number of persons with lung cancer by 37%. These additional individuals with lung cancer were of 57% female sex (versus 48% with USPSTF2013, p = 0.0476) and 24% black (versus 20% with USPSTF2013, p = 0.3367). CONCLUSIONS Expansion of LDCT screening eligibility criteria to allow longer quit duration and fewer pack-years of exposure enriches the screening-eligible population for women and black persons.
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Affiliation(s)
- Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Wei Liao
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Carrie Fehnel
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Jordan Goss
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Catherine J Shepherd
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Rodolfo Ramos
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Talat Qureshi
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Ayesha Mukhopadhyay
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Meredith A Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
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Silva M, Milanese G, Ledda RE, Nayak SM, Pastorino U, Sverzellati N. European lung cancer screening: valuable trial evidence for optimal practice implementation. Br J Radiol 2022; 95:20200260. [PMID: 34995141 PMCID: PMC10993986 DOI: 10.1259/bjr.20200260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 11/05/2022] Open
Abstract
Lung cancer screening (LCS) by low-dose computed tomography is a strategy for secondary prevention of lung cancer. In the last two decades, LCS trials showed several options to practice secondary prevention in association with primary prevention, however, the translation from trial to practice is everything but simple. In 2020, the European Society of Radiology and European Respiratory Society published their joint statement paper on LCS. This commentary aims to provide the readership with detailed description about hurdles and potential solutions that could be encountered in the practice of LCS.
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Affiliation(s)
- Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery
(DiMeC), University of Parma,
Parma, Italy
| | - Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery
(DiMeC), University of Parma,
Parma, Italy
| | - Roberta E Ledda
- Scienze Radiologiche, Department of Medicine and Surgery
(DiMeC), University of Parma,
Parma, Italy
| | - Sundeep M Nayak
- Department of Radiology, Kaiser Permanente Northern
California, San Leandro,
California, USA
| | - Ugo Pastorino
- Section of Thoracic Surgery, IRCCS Istituto Nazionale
Tumori, Milano,
Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery
(DiMeC), University of Parma,
Parma, Italy
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8
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McIntire RK, Lewis E, Zeigler-Johnson C, Shusted C, Barta J, Juon HS, Keith SW, Klein G. Estimating Eligibility for Lung Cancer Screening by Neighborhood in Philadelphia Using Previous and Current USPSTF Guidelines. Popul Health Manag 2022; 25:254-263. [PMID: 35442796 DOI: 10.1089/pop.2021.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The National Lung Screening Trial established the benefits of low-dose computed tomography for lung cancer screening (LCS) to identify lung cancer at earlier stages. In February 2021, the US Preventive Services Task Force (USPSTF) revised the eligibility recommendations to increase the number of high-risk individuals eligible for LCS and, in effect, expand screening eligibility for vulnerable populations. One strategy for facilitating LCS is to implement targeted screening in geographic areas with the greatest need. In Philadelphia, although neighborhood smoking rates have been defined, it is not known which neighborhoods have the greatest number of people eligible for LCS. In this study, the authors estimate eligibility for LCS within Philadelphia neighborhoods using both previous and current USPSTF guidelines. They used the Public Health Management Corporation's Household Health Survey from 2010, 2012, and 2015 to identify the number of people within ever-smoker groups (current every day, current occasional, and former smokers) by neighborhood in Philadelphia. Using the 2015 National Health Interview Survey (NHIS) Cancer Supplement, they identified the percentages within ever-smoker groups that were LCS eligible using the previous and current USPSTF guidelines. Finally, they applied the percentages eligible for the ever-smoker groups from the NHIS to the numbers in these groups within Philadelphia neighborhoods. They found that the number of Philadelphians eligible for LCS increased from 41,946 to 89,231 after the revised USPSTF guidelines. The current USPSTF guidelines increased eligibility for LCS within all Philadelphia neighborhoods, with the greatest increases in the River Wards planning district. Local providers should use these results to prioritize LCS services within neighborhoods with greatest eligibility.
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Affiliation(s)
- Russell K McIntire
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Public Health Management Corporation, Philadelphia, Pennsylvania, USA
| | - Eleanor Lewis
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Charnita Zeigler-Johnson
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christine Shusted
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University and Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Julie Barta
- The Jane and Leonard Korman Respiratory Institute at Thomas Jefferson University, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Hee-Soon Juon
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott W Keith
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gary Klein
- Public Health Management Corporation, Philadelphia, Pennsylvania, USA
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9
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Fedewa SA, Kazerooni EA, Studts JL, Smith RA, Bandi P, Sauer AG, Cotter M, Sineshaw HM, Jemal A, Silvestri GA. State Variation in Low-Dose Computed Tomography Scanning for Lung Cancer Screening in the United States. J Natl Cancer Inst 2021; 113:1044-1052. [PMID: 33176362 PMCID: PMC8328984 DOI: 10.1093/jnci/djaa170] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 08/10/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Annual lung cancer screening (LCS) with low-dose chest computed tomography in older current and former smokers (ie, eligible adults) has been recommended since 2013. Uptake has been slow and variable across the United States. We estimated the LCS rate and growth at the national and state level between 2016 and 2018. METHODS The American College of Radiology's Lung Cancer Screening Registry was used to capture screening events. Population-based surveys, the US Census, and cancer registry data were used to estimate the number of eligible adults and lung cancer mortality (ie, burden). Lung cancer screening rates (SRs) in eligible adults and screening rate ratios with 95% confidence intervals (CI) were used to measure changes by state and year. RESULTS Nationally, the SR was steady between 2016 (3.3%, 95% CI = 3.3% to 3.7%) and 2017 (3.4%, 95% CI = 3.4% to 3.9%), increasing to 5.0% (95% CI = 5.0% to 5.7%) in 2018 (2018 vs 2016 SR ratio = 1.52, 95% CI = 1.51 to 1.62). In 2018, several southern states with a high lung-cancer burden (eg, Mississippi, West Virginia, and Arkansas) had relatively low SRs (<4%) among eligible adults, whereas several northeastern states with lower lung cancer burden (eg, Massachusetts, Vermont, and New Hampshire) had the highest SRs (12.8%-15.2%). The exception was Kentucky, which had the nation's highest lung cancer mortality rate and one of the highest SRs (13.7%). CONCLUSIONS Fewer than 1 in 20 eligible adults received LCS nationally, and uptake varied widely across states. LCS rates were not aligned with lung cancer burden across states, except for Kentucky, which has supported comprehensive efforts to implement LCS.
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Affiliation(s)
- Stacey A Fedewa
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Ella A Kazerooni
- Departments of Radiology and Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Jamie L Studts
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert A Smith
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Priti Bandi
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Ann Goding Sauer
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Megan Cotter
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Helmneh M Sineshaw
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Ahmedin Jemal
- Office of the Chief and Scientific Medical Officer, Cancer Society, Atlanta, GA, USA
| | - Gerard A Silvestri
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA
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10
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"It's Really Like Any Other Study": Rural Radiology Facilities Performing Low-Dose Computed Tomography for Lung Cancer Screening. Ann Am Thorac Soc 2021; 18:2058-2066. [PMID: 34129451 DOI: 10.1513/annalsats.202103-333oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE The majority of eligible people have not been screened for lung cancer. There is emerging evidence that there are location-based disparities applicable to lung cancer screening. OBJECTIVE Describe lung cancer screening radiologic services in rural Oregon and understand the barriers and facilitators to implementation of lung cancer screening using LDCT. METHODS A mixed-methods descriptive study utilizing surveys and semi-structured interviews of key informants. We approached representatives from all 37 small and rural hospitals in Oregon. We purposively interviewed key informants from a sub-set based on LDCT implementation outcomes. RESULTS We surveyed representatives from 29 radiology facilities and qualitatively interviewed 18 key informants from 19 facilities (representing 12 health care systems). Among the surveyed radiology facilities, 59% were performing LDCT for lung cancer screening. Key informants reported that facilities which performed this service were often motivated by community needs, less by financial gain or evidence strength and all described the importance of a champion. Key informants described that implementing lung cancer screening programmatic components that were within their normal scope of practice (e.g. specifying the LDCT parameters) were burdensome to establish but were surmountable barriers. Most informants reported they did not perform other components of high-quality programs (e.g. ensuring adherence to recommended follow-up testing) and suggested these steps were important but the responsibility of primary care providers. CONCLUSIONS Many rural hospital facilities in Oregon offer LDCT for lung cancer screening, but do not perform all the recommended components of a screening program. Disparities in lung cancer screening utilization and adherence are unlikely to be solved by an exclusive focus at the radiology facility level and may require additional interventions at the primary care level.
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11
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Spalluto LB, Lewis JA, Stolldorf D, Yeh VM, Callaway-Lane C, Wiener RS, Slatore CG, Yankelevitz DF, Henschke CI, Vogus TJ, Massion PP, Moghanaki D, Roumie CL. Organizational Readiness for Lung Cancer Screening: A Cross-Sectional Evaluation at a Veterans Affairs Medical Center. J Am Coll Radiol 2021; 18:809-819. [PMID: 33421372 PMCID: PMC8180484 DOI: 10.1016/j.jacr.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Lung cancer has the highest cancer-related mortality in the United States and among Veterans. Screening of high-risk individuals with low-dose CT (LDCT) can improve survival through detection of early-stage lung cancer. Organizational factors that aid or impede implementation of this evidence-based practice in diverse populations are not well described. We evaluated organizational readiness for change and change valence (belief that change is beneficial and valuable) for implementation of LDCT screening. METHODS We performed a cross-sectional survey of providers, staff, and administrators in radiology and primary care at a single Veterans Affairs Medical Center. Survey measures included Shea's validated Organizational Readiness for Implementing Change (ORIC) scale and Shea's 10 items to assess change valence. ORIC and change valence were scored on a scale from 1 to 7 (higher scores representing higher readiness for change or valence). Multivariable linear regressions were conducted to determine predictors of ORIC and change valence. RESULTS Of 523 employees contacted, 282 completed survey items (53.9% overall response rate). Higher ORIC scores were associated with radiology versus primary care (mean 5.48, SD 1.42 versus 5.07, SD 1.22, β = 0.37, P = .039). Self-identified leaders in lung cancer screening had both higher ORIC (5.56, SD 1.39 versus 5.11, SD 1.26, β = 0.43, P = .050) and change valence scores (5.89, SD 1.21 versus 5.36, SD 1.19, β = 0.51, P = .012). DISCUSSION Radiology health professionals have higher levels of readiness for change for implementation of LDCT screening than those in primary care. Understanding health professionals' behavioral determinants for change can inform future lung cancer screening implementation strategies.
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Affiliation(s)
- Lucy B Spalluto
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee; Vice Chair of Health Equity, Associate Director, Diversity and Inclusion Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
| | - Jennifer A Lewis
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Co-Director, Veterans Administration Tennessee Valley Healthcare System Lung Cancer Screening Program, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Deonni Stolldorf
- Chair, Vanderbilt University School of Nursing PhD Program Evaluation Committee, Chair, Vanderbilt University Competency Exam Committee, School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Vivian M Yeh
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Carol Callaway-Lane
- Co-Director, Veterans Administration Tennessee Valley Healthcare System Lung Cancer Screening Program, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee; Associate Director, Tennessee Valley Healthcare System Veterans Administration Quality Scholars Program, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Renda Soylemez Wiener
- Associate Director, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, Co-Chair, VISN1 Lung Cancer Screening Council, Deputy Chair, Pulmonary Field Advisory Committee, Veterans Health Administration, Boston Massachusetts; The Pulmonary Center, Boston University Medical Center, Boston, Massachusetts
| | - Christopher G Slatore
- Medical Director, Portland VA Medical Center Unsuspected Radiologic Findings System, Health Services Research and Development, Portland Veterans Affairs Medical Center, Portland, Oregon; Co-Director, Portland VA Medical Center Lung Cancer Screening Program, Section of Pulmonary and Critical Care Medicine, Portland Veterans Affairs Medical Center, Portland, Oregon; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - David F Yankelevitz
- Director, Lung Biopsy Service, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia I Henschke
- Phoenix Veterans Health Care System, Phoenix, Arizona; Director of the Early Lung and Cardiac Action Program, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Timothy J Vogus
- Deputy Director of Business Innovation, Frist Center for Autism and Innovation, Vanderbilt University, Faculty Director, Leadership Development, Owen Graduate School of Management, Vanderbilt University, Nashville, Tennessee
| | - Pierre P Massion
- Director, Cancer Early Detection and Prevention Initiative at Vanderbilt-Ingram Cancer Center, Co-Leader, Cancer Health Outcomes and Control Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Healthcare System, Medical Service, Nashville, Tennessee
| | - Drew Moghanaki
- Section Chief, Department of Radiation Oncology, Atlanta VA Medical Center, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Christianne L Roumie
- Deputy Director, VA Tennessee Valley Healthcare System VA Quality Scholars Program, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee; Director, Vanderbilt Master of Public Health Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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12
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Lewis JA, Spalluto LB, Henschke CI, Yankelevitz DF, Aguayo SM, Morales P, Avila R, Audet CM, Prusaczyk B, Lindsell CJ, Callaway-Lane C, Dittus RS, Vogus TJ, Massion PP, Limper HM, Kripalani S, Moghanaki D, Roumie CL. Protocol to evaluate an enterprise-wide initiative to increase access to lung cancer screening in the Veterans Health Administration. Clin Imaging 2021; 73:151-161. [PMID: 33422974 PMCID: PMC8479827 DOI: 10.1016/j.clinimag.2020.11.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/21/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The Veterans Affairs Partnership to increase Access to Lung Screening (VA-PALS) is an enterprise-wide initiative to implement lung cancer screening programs at VA medical centers (VAMCs). VA-PALS will be using implementation strategies that include program navigators to coordinate screening activities, trainings for navigators and radiologists, an open-source software management system, tools to standardize low-dose computed tomography image quality, and access to a support network. VAMCs can utilize strategies according to their local needs. In this protocol, we describe the planned program evaluation for the initial 10 VAMCs participating in VA-PALS. MATERIALS AND METHODS The implementation of programs will be evaluated using the Consolidated Framework for Implementation Research to ensure broad contextual guidance. Program evaluation measures have been developed using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Adaptations of screening processes will be assessed using the Framework for Reporting Adaptations and Modifications to Evidence Based Interventions. Measures collected will reflect the inner settings, estimate and describe the population reached, adoption by providers, implementation of the programs, report clinical outcomes and maintenance of programs. Analyses will include descriptive statistics and regression to evaluate predictors and assess implementation over time. DISCUSSION This theory-based protocol will evaluate the implementation of lung cancer screening programs across the Veterans Health Administration using scientific frameworks. The findings will inform plans to expand the VA-PALS initiative beyond the original sites and can guide implementation of lung cancer screening programs more broadly.
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Affiliation(s)
- Jennifer A Lewis
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States of America; Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America; Vanderbilt Ingram Cancer Center, Nashville, TN, United States of America.
| | - Lucy B Spalluto
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States of America; Vanderbilt Ingram Cancer Center, Nashville, TN, United States of America; Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America; Phoenix VA Health Care System, Phoenix, AZ, United States of America
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America; Phoenix VA Health Care System, Phoenix, AZ, United States of America
| | - Samuel M Aguayo
- Phoenix VA Health Care System, Phoenix, AZ, United States of America
| | | | - Rick Avila
- Paraxial LLC, Halfmoon, NY, United States of America
| | - Carolyn M Audet
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Beth Prusaczyk
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Carol Callaway-Lane
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States of America; VA Tennessee Valley Healthcare System, Medicine Service, Nashville, TN, United States of America
| | - Robert S Dittus
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States of America; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Timothy J Vogus
- Owen Graduate School of Management, Vanderbilt University, Nashville, TN, United States of America
| | - Pierre P Massion
- Vanderbilt Ingram Cancer Center, Nashville, TN, United States of America; VA Tennessee Valley Healthcare System, Medicine Service, Nashville, TN, United States of America; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Heather M Limper
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Sunil Kripalani
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Drew Moghanaki
- Radiation Oncology, Atlanta VA Medical Center, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Christianne L Roumie
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States of America; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
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13
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Zgodic A, Zahnd WE, Advani S, Eberth JM. Low-dose CT lung cancer screening uptake: A rural-urban comparison. J Rural Health 2021; 38:40-53. [PMID: 33734492 DOI: 10.1111/jrh.12568] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The US Preventive Services Task Force recommends lung cancer screening with Low-Dose Computed Tomography (LDCT) in high-risk individuals. Our objective was to identify demographic, health, and financial factors associated with screening uptake, with a focus on urban-rural differences. METHODS We analyzed data from the 2018 and 2019 Behavioral Risk Factor Surveillance System and its optional Lung Cancer Screening Module to examine factors associated with screening uptake among 20 states that administered the optional module. We compared differences in factors associated with uptake overall and by geographical regions and conducted multivariable logistic mixed-effects regression, accounting for participant clustering by state to assess the impact of these factors on uptake. FINDINGS Overall 1,268 participants underwent LDCT screening with no significant differences observed between rural (16.3%) and urban residents (17.7%, p = 0.67). In multivariable models, rural residents did not differ significantly in their LDCT screening uptake (OR = 0.85; 95% CI: 0.67-1.09, p = 0.20), but uptake was significantly higher for participants with underlying chronic respiratory conditions, veterans, those with higher pack-year history, and those with poor/fair general health and prior history of cancer. Uptake declined with age, higher education level, concerns about paying for medical care, and lack of primary care. CONCLUSIONS Modifiable targets can be leveraged to increase LDCT screening. Based on significant predictors of screening uptake, clinicians should prioritize interventions that effectively consider smoking history as well as those identified as effective in veterans' health settings. Additionally, reducing structural barriers to care related to insurance and income will be key to reducing disparities.
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Affiliation(s)
- Anja Zgodic
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Shailesh Advani
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.,Department of Oncology, Georgetown University School of Medicine, Georgetown University, Washington, DC, USA
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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14
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Henschke CI, Yankelevitz DF, Jirapatnakul A, Yip R, Reccoppa V, Benjamin C, Llamo T, Williams A, Liu S, Max D, Aguayo SM, Morales P, Igel BJ, Abbaszadegan H, Fredricks PA, Garcia DP, Permana PA, Fawcett J, Sultan S, Murphy LA. Implementation of low-dose CT screening in two different health care systems: Mount Sinai Healthcare System and Phoenix VA Health Care System. Transl Lung Cancer Res 2021; 10:1064-1082. [PMID: 33718045 PMCID: PMC7947390 DOI: 10.21037/tlcr-20-761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/10/2020] [Indexed: 12/18/2022]
Abstract
Implementation of lung screening (LS) programs is challenging even among health care organizations that have the motivation, the resources, and more importantly, the goal of providing for life-saving early detection, diagnosis, and treatment of lung cancer. We provide a case study of LS implementation in different healthcare systems, at the Mount Sinai Healthcare System (MSHS) in New York City, and at the Phoenix Veterans Affairs Health Care System (PVAHCS) in Phoenix, Arizona. This will illustrate the commonalities and differences of the LS implementation process in two very different health care systems in very different parts of the United States. Underlying the successful implementation of these LS programs was the use of a comprehensive management system, the Early Lung Cancer Action Program (ELCAP) Management SystemTM. The collaboration between MSHS and PVAHCS over the past decade led to the ELCAP Management SystemTM being gifted by the Early Diagnosis and Treatment Research Foundation to the PVAHCS, to develop a "VA-ELCAP" version. While there remain challenges and opportunities to continue improving LS and its implementation, there is an increasing realization that most patients who are diagnosed with lung cancer as a result of annual LS can be cured, and that of all the possible risks associated with LS, the greater risk of all is for heavy cigarette smokers not to be screened. We identified 10 critical components in implementing a LS program. We provided the details of each of these components for the two healthcare systems. Most importantly, is that continual re-evaluation of the screening program is needed based on the ongoing quality assurance program and database of the actual screenings. At minimum, there should be an annual review and updating. As early diagnosis of lung cancer must be followed by optimal treatment to be effective, treatment advances for small, early lung cancers diagnosed as a result of screening also need to be assessed and incorporated into the entire screening and treatment program.
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Affiliation(s)
- Claudia I. Henschke
- Mount Sinai Healthcare System, New York, NY, USA
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - David F. Yankelevitz
- Mount Sinai Healthcare System, New York, NY, USA
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - Artit Jirapatnakul
- Mount Sinai Healthcare System, New York, NY, USA
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - Rowena Yip
- Mount Sinai Healthcare System, New York, NY, USA
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | | | | | | | | | - Simon Liu
- Mount Sinai Healthcare System, New York, NY, USA
| | - Daniel Max
- Mount Sinai Healthcare System, New York, NY, USA
| | | | | | - Brian J. Igel
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | | | | | | | | | - Janet Fawcett
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - Samir Sultan
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
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15
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Preventza O, Backhus L. US women in thoracic surgery: reflections on the past and opportunities for the future. J Thorac Dis 2021; 13:473-479. [PMID: 33569234 PMCID: PMC7867830 DOI: 10.21037/jtd.2020.04.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/24/2020] [Indexed: 11/28/2022]
Abstract
Herein, we examine the state of women in thoracic surgery from the United States (US) perspective in terms of our past, present, and opportunities for the future. We explore the achievements of the first three women certified in thoracic surgery in 1961 and describe the progress made resulting in the current state. Women constitute slightly more than 50% of all medical students in the US, yet women remain underrepresented in thoracic surgery. The disparity is most notable for female representation in senior academic leadership positions, reflecting stagnation in progress. The lack of gender equity has important implications for projected workforce shortages and patient safety in cardiothoracic surgery. Recent organized efforts in scholarships and leadership training, as well as increasing awareness and mentorship, may herald progress on the horizon. Ultimately, however, engagement of leadership and top-down change are needed to achieve equity and, thereby, to improve patient health and satisfaction.
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Affiliation(s)
- Ourania Preventza
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Leah Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA
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16
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Lung cancer screening by nodule volume in Lung-RADS v1.1: negative baseline CT yields potential for increased screening interval. Eur Radiol 2020; 31:1956-1968. [PMID: 32997182 PMCID: PMC7979670 DOI: 10.1007/s00330-020-07275-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/21/2020] [Accepted: 09/09/2020] [Indexed: 12/17/2022]
Abstract
Objectives The 2019 Lung CT Screening Reporting & Data System version 1.1 (Lung-RADS v1.1) introduced volumetric categories for nodule management. The aims of this study were to report the distribution of Lung-RADS v1.1 volumetric categories and to analyse lung cancer (LC) outcomes within 3 years for exploring personalized algorithm for lung cancer screening (LCS). Methods Subjects from the Multicentric Italian Lung Detection (MILD) trial were retrospectively selected by National Lung Screening Trial (NLST) criteria. Baseline characteristics included selected pre-test metrics and nodule characterization according to the volume-based categories of Lung-RADS v1.1. Nodule volume was obtained by segmentation with dedicated semi-automatic software. Primary outcome was diagnosis of LC, tested by univariate and multivariable models. Secondary outcome was stage of LC. Increased interval algorithms were simulated for testing rate of delayed diagnosis (RDD) and reduction of low-dose computed tomography (LDCT) burden. Results In 1248 NLST-eligible subjects, LC frequency was 1.2% at 1 year, 1.8% at 2 years and 2.6% at 3 years. Nodule volume in Lung-RADS v1.1 was a strong predictor of LC: positive LDCT showed an odds ratio (OR) of 75.60 at 1 year (p < 0.0001), and indeterminate LDCT showed an OR of 9.16 at 2 years (p = 0.0068) and an OR of 6.35 at 3 years (p = 0.0042). In the first 2 years after negative LDCT, 100% of resected LC was stage I. The simulations of low-frequency screening showed a RDD of 13.6–21.9% and a potential reduction of LDCT burden of 25.5–41%. Conclusions Nodule volume by semi-automatic software allowed stratification of LC risk across Lung-RADS v1.1 categories. Personalized screening algorithm by increased interval seems feasible in 80% of NLST eligible. Key Points • Using semi-automatic segmentation of nodule volume, Lung-RADS v1.1 selected 10.8% of subjects with positive CT and 96.87 relative risk of lung cancer at 1 year, compared to negative CT. • Negative low-dose CT by Lung-RADS v1.1 was found in 80.6% of NLST eligible and yielded 40 times lower relative risk of lung cancer at 2 years, compared to positive low-dose CT; annual screening could be preference sensitive in this group. • Semi-automatic segmentation of nodule volume and increased screening interval by volumetric Lung-RADS v1.1 could retrospectively suggest a 25.5–41% reduction of LDCT burden, at the cost of 13.6–21.9% rate of delayed diagnosis. Electronic supplementary material The online version of this article (10.1007/s00330-020-07275-w) contains supplementary material, which is available to authorized users.
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Silva M, Milanese G, Kauczor HU, Revel MP, Sverzellati N. Milestones towards lung cancer screening implementation. Clin Radiol 2020; 75:881-885. [PMID: 32863024 DOI: 10.1016/j.crad.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023]
Abstract
The European Society of Radiology (ESR) and European Respiratory Society (ERS) published their joint statement paper on lung cancer screening (LCS), on 12 February 2020. This document joins and completes previous recommendations on LCS with specific emphasis on the analysis of issues encountered in the practical implementation of LCS in the community. Major milestones to enable the most efficient and equal dissemination of LCS are recognised as engagement of all stakeholders (e.g. candidate/participant, general practitioners, up to the specialised LCS facility), quality assurance, and primary prevention in the form of provision of counselling for smoking cessation.
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Affiliation(s)
- M Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Italy.
| | - G Milanese
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Italy
| | - H-U Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - M-P Revel
- Radiology Department, Cochin Hospital, APHP, Paris, France
| | - N Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Italy
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Bivariate Spatial Pattern between Smoking Prevalence and Lung Cancer Screening in US Counties. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103383. [PMID: 32413964 PMCID: PMC7277441 DOI: 10.3390/ijerph17103383] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/05/2020] [Accepted: 05/10/2020] [Indexed: 11/24/2022]
Abstract
Objectives: Lung cancer screening (LCS) with low-dose computed tomography (LDCT) has been a reimbursable preventive service covered by Medicare since 2015. Geographic disparities in the access to LDCT providers may contribute to the low uptake of LCS. We evaluated LDCT service availability for older adults in the United States (US) based on Medicare claims data and explored its ecological correlation with smoking prevalence. Materials and Methods: We identified providers who provided at least 11 LDCT services in 2016 using the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File. We constructed a 30-mile Euclidian distance buffer around each provider’s location to estimate individual LDCT coverage areas. We then mapped the county-level density of LDCT providers and the county-level prevalence of current daily cigarette smoking in a bivariate choropleth map. Results: Approximately 1/5 of census tracts had no LDCT providers within 30 miles and 46% of counties had no LDCT services. At the county level, the median LDCT density was 0.5 (interquartile range (IQR): 0–5.3) providers per 1000 Medicare fee-for-service beneficiaries, and cigarette smoking prevalence was 17.5% (IQR: 15.2–19.8%). High LDCT service availability was most concentrated in the northeast US, revealing a misalignment with areas of high current smoking prevalence, which tended to be in the central and southern US. Conclusions: Our maps highlight areas in need for enhanced workforce and capacity building aimed at reducing disparities in the access and utilization of LDCT services among older adults in the US.
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