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Murray RL, Alexandris P, Baldwin D, Brain K, Britton J, Crosbie PAJ, Gabe R, Lewis S, Parrott S, Quaife SL, Tam HZ, Wu Q, Beeken R, Copeland H, Eckert C, Hancock N, Lindop J, McCutchan G, Marshall C, Neal RD, Rogerson S, Quinn Scoggins HD, Simmonds I, Thorley R, Callister ME. Uptake and 4-week quit rates from an opt-out co-located smoking cessation service delivered alongside community-based low-dose computed tomography screening within the Yorkshire Lung Screening Trial. Eur Respir J 2024; 63:2301768. [PMID: 38636970 PMCID: PMC11024392 DOI: 10.1183/13993003.01768-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/01/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Up to 50% of those attending for low-dose computed tomography screening for lung cancer continue to smoke and co-delivery of smoking cessation services alongside screening may maximise clinical benefit. Here we present data from an opt-out co-located smoking cessation service delivered alongside the Yorkshire Lung Screening Trial (YLST). METHODS Eligible YLST participants were offered an immediate consultation with a smoking cessation practitioner (SCP) at their screening visit with ongoing smoking cessation support over subsequent weeks. RESULTS Of 2150 eligible participants, 1905 (89%) accepted the offer of an SCP consultation during their initial visit, with 1609 (75%) receiving ongoing smoking cessation support over subsequent weeks. Uptake of ongoing support was not associated with age, ethnicity, deprivation or educational level in multivariable analyses, although men were less likely to engage (adjusted OR (ORadj) 0.71, 95% CI 0.56-0.89). Uptake was higher in those with higher nicotine dependency, motivation to stop smoking and self-efficacy for quitting. Overall, 323 participants self-reported quitting at 4 weeks (15.0% of the eligible population); 266 were validated by exhaled carbon monoxide (12.4%). Multivariable analyses of eligible smokers suggested 4-week quitting was more likely in men (ORadj 1.43, 95% CI 1.11-1.84), those with higher motivation to quit and previous quit attempts, while those with a stronger smoking habit in terms of cigarettes per day were less likely to quit. CONCLUSIONS There was high uptake for co-located opt-out smoking cessation support across a wide range of participant demographics. Protected funding for integrated smoking cessation services should be considered to maximise programme equity and benefit.
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Affiliation(s)
| | - Panos Alexandris
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - David Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - John Britton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Rhian Gabe
- Barts Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Steve Parrott
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Samantha L Quaife
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Hui Zhen Tam
- Barts Clinical Trials Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Qi Wu
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Rebecca Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Harriet Copeland
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Eckert
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Neil Hancock
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Grace McCutchan
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | | | - Richard D Neal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Harriet D Quinn Scoggins
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Irene Simmonds
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rebecca Thorley
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Matthew E Callister
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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2
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Milanese G, Silva M, Ledda RE, Iezzi E, Bortolotto C, Mauro LA, Valentini A, Reali L, Bottinelli OM, Ilardi A, Basile A, Palmucci S, Preda L, Sverzellati N. Study rationale and design of the PEOPLHE trial. LA RADIOLOGIA MEDICA 2024; 129:411-419. [PMID: 38319494 PMCID: PMC10943160 DOI: 10.1007/s11547-024-01764-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Lung cancer screening (LCS) by low-dose computed tomography (LDCT) demonstrated a 20-40% reduction in lung cancer mortality. National stakeholders and international scientific societies are increasingly endorsing LCS programs, but translating their benefits into practice is rather challenging. The "Model for Optimized Implementation of Early Lung Cancer Detection: Prospective Evaluation Of Preventive Lung HEalth" (PEOPLHE) is an Italian multicentric LCS program aiming at testing LCS feasibility and implementation within the national healthcare system. PEOPLHE is intended to assess (i) strategies to optimize LCS workflow, (ii) radiological quality assurance, and (iii) the need for dedicated resources, including smoking cessation facilities. METHODS PEOPLHE aims to recruit 1.500 high-risk individuals across three tertiary general hospitals in three different Italian regions that provide comprehensive services to large populations to explore geographic, demographic, and socioeconomic diversities. Screening by LDCT will target current or former (quitting < 10 years) smokers (> 15 cigarettes/day for > 25 years, or > 10 cigarettes/day for > 30 years) aged 50-75 years. Lung nodules will be volumetric measured and classified by a modified PEOPLHE Lung-RADS 1.1 system. Current smokers will be offered smoking cessation support. CONCLUSION The PEOPLHE program will provide information on strategies for screening enrollment and smoking cessation interventions; administrative, organizational, and radiological needs for performing a state-of-the-art LCS; collateral and incidental findings (both pulmonary and extrapulmonary), contributing to the LCS implementation within national healthcare systems.
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Affiliation(s)
- Gianluca Milanese
- Unit of Radiological Sciences, University Hospital of Parma, University of Parma, Parma, Italy
| | - Mario Silva
- Unit of Radiological Sciences, University Hospital of Parma, University of Parma, Parma, Italy
| | - Roberta Eufrasia Ledda
- Unit of Radiological Sciences, University Hospital of Parma, University of Parma, Parma, Italy
| | | | - Chandra Bortolotto
- Diagnostic Imaging Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy
- Radiology Unit-Diagnostic Imaging I, Department of Diagnostic Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Letizia Antonella Mauro
- Radiology Unit 1, University Hospital Policlinico G. Rodolico-San Marco, Catania, Catania, Italy
| | - Adele Valentini
- Radiology Unit-Diagnostic Imaging I, Department of Diagnostic Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Linda Reali
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, University Hospital Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Olivia Maria Bottinelli
- Diagnostic Imaging Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy
| | - Adriana Ilardi
- Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, University Hospital Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Antonio Basile
- Radiology Unit 1-Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, University Hospital Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Stefano Palmucci
- UOSD I.P.T.R.A.-Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, University Hospital Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Lorenzo Preda
- Diagnostic Imaging Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy
- Radiology Unit-Diagnostic Imaging I, Department of Diagnostic Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicola Sverzellati
- Unit of Radiological Sciences, University Hospital of Parma, University of Parma, Parma, Italy.
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3
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Verdone JE, Marciniak ET, Deepak J. Tobacco treatment in the setting of lung cancer screening. Curr Opin Pulm Med 2024; 30:3-8. [PMID: 37933671 DOI: 10.1097/mcp.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PURPOSE OF REVIEW Lung cancer screening by low-dose CT is an increasingly implemented preventive medicine tool. Screening for lung cancer is incomplete without addressing problematic tobacco use, the greatest modifiable risk factor in the development of lung cancer. This review describes recent work related to lung cancer screening and treatment of tobacco use in that context. RECENT FINDINGS Implementation of lung cancer screening demonstrates socioeconomic disparities in terms of adherence to screening as well as likelihood of successful tobacco dependence treatment. Active tobacco dependence is a common comorbidity for patients undergoing lung cancer screening. The optimal implementation of tobacco dependence treatment in the context of lung cancer screening is still an area of active investigation. SUMMARY Treatment of tobacco dependence at time of lung cancer screening is a major opportunity for clinicians to intervene to reduce the major modifiable risk factor for lung cancer, tobacco use. Providing comprehensive tobacco dependence treatment is most effective using combination pharmacologic and behavioral interventions. Practices providing comprehensive treatment will benefit from accurate documentation for billing and coding and supplementing with external resources such as state Quit Lines.
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Affiliation(s)
- James E Verdone
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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4
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Kim Y, Lee J, Lee E, Lim J, Kim Y, Lee CT, Jang SH, Paek YJ, Lee WC, Lee CW, Kim HY, Goo JM, Choi KS, Park B, Lee DH, Seo HG. Strategies to Improve Smoking Cessation for Participants in Lung Cancer Screening Program: Analysis of Factors Associated with Smoking Cessation in Korean Lung Cancer Screening Project (K-LUCAS). Cancer Res Treat 2024; 56:92-103. [PMID: 37562437 PMCID: PMC10789955 DOI: 10.4143/crt.2022.1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/05/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Smoking cessation intervention is one of the key components of successful lung cancer screening program. We investigated the effectiveness and related factors of smoking cessation services provided to the participants in a population-based lung cancer screening trial. MATERIALS AND METHODS The Korean Lung Cancer Screening Project (K-LUCAS) is a nationwide, multi-center lung cancer screening trial that evaluates the feasibility of implementing population-based lung cancer screening. All 5,144 current smokers who participated in the K-LUCAS received a mandatory smoking cessation counseling. Changes in smoking status were followed up using a telephone survey in 6 months after lung cancer screening participation. The lung cancer screening's impact on smoking cessation is analyzed by variations in the smoking cessation interventions provided in screening units. RESULTS Among 4,136 survey responders, participant's motivation to quit smoking increased by 9.4% on average after lung cancer screening. After 6 months from the initial screening, 24.3% of participants stopped smoking, and 10.6% of participants had not smoked continuously for at least 6 months after screening. Over 80% of quitters stated that participation in lung cancer screening motivated them to quit smoking. Low-cost public smoking cessation program combined with lung cancer screening increased the abstinence rates. The smokers were three times more likely to quit smoking when the smoking cessation counseling was provided simultaneously with low-dose computed tomography screening results than when provided separately. CONCLUSION A mandatory smoking cessation intervention integrated with screening result counselling by a physician after participation in lung cancer screening could be effective for increasing smoking cessation attempts.
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Affiliation(s)
- Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jaeho Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eunju Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Juntae Lim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yonghyun Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Choon-Taek Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hun Jang
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yu-Jin Paek
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Won-Chul Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Wha Lee
- Department of Diagnostic Radiology, National Cancer Center, Goyang, Korea
| | - Hyae Young Kim
- Department of Diagnostic Radiology, National Cancer Center, Goyang, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Duk Hyoung Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hong Gwan Seo
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
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5
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Su Z, Li X, Wu H, Meng Z, Li Y, Pan H, Liang H, Wang Y, Zhao FH, Qiao Y, Zhou Q, Fan YG. The impact of low-dose CT on smoking behavior among non-smokers, former-smokers, and smokers: A population-based screening cohort in rural China. Cancer Med 2023; 12:4667-4678. [PMID: 35894767 PMCID: PMC9972152 DOI: 10.1002/cam4.5073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/14/2022] [Accepted: 07/13/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lung cancer screening may provide a "teachable moment" for the smoking cessation and relapse prevention. However, the impact of lung cancer screening on smoking initiation in non-smokers has not been reported. METHODS A baseline smoking behavior survey was conducted in 2000 participants who were screened by low-dose computed tomography (LDCT) from 2014 to 2018. All participants were re-surveyed on their smoking behavior in 2019. Of these, 312 participants were excluded, leaving 1688 participants in the final analysis. The smoking initiation rate in baseline non-smokers, the relapse rate in baseline former smokers, and the abstinence rate in baseline current smokers were calculated, respectively. The associations between screening results, demographic characteristics, and smoking behavior change were analyzed using multivariable logistic regression. RESULTS From 2014 to 2019, smoking prevalence significantly decreased from 52.6% to 49.1%. The prevalence of smoking initiation, relapse, and abstinence in baseline non-smokers, former, and current smokers was 16.8%, 22.9%, and 23.7%, respectively. The risk of smoking initiation in baseline non-smokers was significantly higher in those with negative screening result (adjusted OR = 2.97, 95% CI: 1.27-6.94). Compared to smokers who only received baseline screening, the chance of smoking abstinence in baseline current smokers was reduced by over 80% in those who attended 5 rounds of screening (adjusted OR = 0.15, 95% CI:0.08-0.27). No significant associations were found between smoking relapse and prior screening frequency, with at least one positive screening result. Age, gender, occupational exposure, income, and smoking pack years were also associated with smoking behavior changes. CONCLUSIONS The overall decreased smoking prevalence indicated an overwhelming effect of "teachable moment" on "license to smoke." A tailored smoking cessation strategy should be integrated into lung cancer screening.
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Affiliation(s)
- Zheng Su
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuebing Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Heng Wu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yang Li
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongli Pan
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Hao Liang
- Sichuan Lung Cancer Institute, Sichuan Lung Cancer Center, West China Hospital, Chengdu, Sichuan University, China
| | - Ying Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Fang-Hui Zhao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Youlin Qiao
- Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Center of Global Health, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qinghua Zhou
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.,Sichuan Lung Cancer Institute, Sichuan Lung Cancer Center, West China Hospital, Chengdu, Sichuan University, China
| | - Ya-Guang Fan
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
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Cooley ME, Castaldi PJ, Mazzola E, Blazey MU, Nayak MM, Healey MJ, Lathan CS, Borondy-Kitts A, DeMarco RF, Kim SS. Protocol for a randomized controlled trial of the Enhanced Smoking Cessation Approach to Promote Empowerment (ESCAPE) digitalized intervention to promote lung health in high-risk individuals who smoke. Contemp Clin Trials 2023; 124:107005. [PMID: 36396069 DOI: 10.1016/j.cct.2022.107005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
Low dose computed tomography (LDCT) is an effective screening test to decrease lung cancer deaths. Lung cancer screening may be a teachable moment helping people who smoke to quit, which may result in increased benefit of screening. Innovative strategies are needed to engage high-risk individuals in learning about LDCT screening. More precise methods such as polygenic risk scores quantify genetic predisposition to tobacco use, and optimize lung health interventions. We present the ESCAPE (Enhanced Smoking Cessation Approach to Promote Empowerment) protocol. This study will test a smoking cessation intervention using personal stories and a lung cancer screening decision-aide compared to standard care (brief advice, referral to a quit line, and a lung cancer screening decision-aide), examine the relationship between a polygenic risk score and smoking abstinence, and describe perceptions about integration of genomic information into smoking cessation treatment. A randomized controlled trial followed by a sequential explanatory mixed methods approach will compare the efficacy of the interventions. Interviews will add insight into the use of genomic information and risk perceptions to tailor smoking cessation treatment. Two-hundred and fifty individuals will be recruited from primary care, community-based organizations, mailing lists and through social media. Data will be collected at baseline, 1, 3 and 6-months. The primary outcomes are 7-day point prevalence smoking abstinence and stage of lung cancer screening at 6-months. The results from this study will provide information to refine the ESCAPE intervention and facilitate integration of precision health into future lung health interventions. Clinical trial registration number: NCT0469129T.
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Affiliation(s)
- Mary E Cooley
- Phyllis F. Cantor Center, Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, United States of America.
| | - Peter J Castaldi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, 450 Brookline Ave, CLSB 11007, Boston, MA 02115, United States of America.
| | - Meghan Underhill Blazey
- School of Nursing, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642, United States of America.
| | - Manan M Nayak
- Phyllis F. Cantor Center, Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02115, United States of America.
| | - Michael J Healey
- Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States of America.
| | - Christopher S Lathan
- Department of Medicine, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA 02115, United States of America.
| | | | - Rosanna F DeMarco
- Department of Nursing, Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125, United States of America.
| | - Sun S Kim
- Department of Nursing, Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125, United States of America.
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7
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Marshall HM, Vemula M, Hay K, McCaul E, Passmore L, Yang IA, Bowman RV, Fong KM. Active screening for lung cancer increases smoking abstinence in Australia. Asia Pac J Clin Oncol 2022; 19:374-384. [DOI: 10.1111/ajco.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 09/16/2022] [Accepted: 09/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Henry M. Marshall
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Mounavi Vemula
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
| | - Karen Hay
- QIMR Berghofer Medical Research Institute HerstonQueenslandAustralia
| | - Elizabeth McCaul
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Linda Passmore
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Ian A. Yang
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Rayleen V. Bowman
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
| | - Kwun M. Fong
- University of Queensland Thoracic Research Centre, Faculty of Medicine, University of Queensland Brisbane Queensland Australia
- Department of Thoracic MedicineThe Prince Charles Hospital ChermsideQueenslandAustralia
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8
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Shelley D, Wang VHC, Taylor K, Williams R, Toll B, Rojewski A, Foley KL, Rigotti N, Ostroff JS. Accelerating integration of tobacco use treatment in the context of lung cancer screening: Relevance and application of implementation science to achieving policy and practice. Transl Behav Med 2022; 12:1076-1083. [PMID: 36227937 PMCID: PMC9677484 DOI: 10.1093/tbm/ibac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Based on the findings from the National Lung Screening Trial, the U.S. Preventive Services Task Force recommends annual low dose computed tomography (LDCT) lung cancer screening (LCS) among high-risk adults. Approximately 54% of individuals seeking LCS report current cigarette smoking. Effective smoking cessation interventions, offered at the time of LCS, enhances the health benefits of screening that are attributable to reductions in lung cancer overall and tobacco-related mortality. Considering these data, the Centers for Medicare & Medicaid Services' (CMS) 2015 decision to cover LCS with LDCT required that radiology imaging facilities make tobacco cessation interventions available for people who smoke. In February 2022, CMS reversed their 2015 coverage requirement for delivering tobacco use treatment at the time of LDCT; CMS retained the requirement for counseling during the shared decision-making visit prior to the exam. The policy change does not diminish the importance of offering high-quality tobacco cessation services in conjunction with routine LDCT for LCS. However, LCS programs face a range of barriers to implementing tobacco use treatment in their settings. As a result, implementation has lagged. Closing the "evidence to practice" gap is the focus of implementation science, a field that offers a set of rigorous methods and a systematic approach to identifying and overcoming contextual barriers to implementing evidence-based guidelines in a range of clinical settings. In this paper, we describe how implementation science frameworks and methods can be used to help guide LCS programs in their efforts to integrate tobacco use treatment and discuss policy changes needed to further facilitate the delivery of TUT as an essential component of the LCS process.
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Affiliation(s)
| | | | | | | | - Benjamin Toll
- Medical University of South Carolina, Charleston, SC, USA
| | - Alana Rojewski
- Medical University of South Carolina, Charleston, SC, USA
| | - Kristie L Foley
- Wake Forest University Health Sciences, Winston-Salem, NC, USA
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9
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Lancaster HL, Heuvelmans MA, Oudkerk M. Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research. J Intern Med 2022; 292:68-80. [PMID: 35253286 PMCID: PMC9311401 DOI: 10.1111/joim.13480] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lung cancer causes more deaths than breast, cervical, and colorectal cancer combined. Nevertheless, population-based lung cancer screening is still not considered standard practice in most countries worldwide. Early lung cancer detection leads to better survival outcomes: patients diagnosed with stage 1A lung cancer have a >75% 5-year survival rate, compared to <5% at stage 4. Low-dose computed tomography (LDCT) thorax imaging for the secondary prevention of lung cancer has been studied at length, and has been shown to significantly reduce lung cancer mortality in high-risk populations. The US National Lung Screening Trial reported a 20% overall reduction in lung cancer mortality when comparing LDCT to chest X-ray, and the Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial more recently reported a 24% reduction when comparing LDCT to no screening. Hence, the focus has now shifted to implementation research. Consequently, the 4-IN-THE-LUNG-RUN consortium based in five European countries, has set up a large-scale multicenter implementation trial. Successful implementation of and accessibility to LDCT lung cancer screening are dependent on many factors, not limited to population selection, recruitment strategy, computed tomography screening frequency, lung-nodule management, participant compliance, and cost effectiveness. This review provides an overview of current evidence for LDCT lung cancer screening, and draws attention to major factors that need to be addressed to successfully implement standardized, effective, and accessible screening throughout Europe. Evidence shows that through the appropriate use of risk-prediction models and a more personalized approach to screening, efficacy could be improved. Furthermore, extending the screening interval for low-risk individuals to reduce costs and associated harms is a possibility, and through the use of volumetric-based measurement and follow-up, false positive results can be greatly reduced. Finally, smoking cessation programs could be a valuable addition to screening programs and artificial intelligence could offer a solution to the added workload pressures radiologists are facing.
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Affiliation(s)
- Harriet L Lancaster
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Marjolein A Heuvelmans
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Institute for Diagnostic Accuracy, Groningen, The Netherlands.,Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
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10
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Heffner JL, Coggeshall S, Wheat CL, Krebs P, Feemster LC, Klein DE, Nici L, Johnson H, Zeliadt SB. Receipt of Tobacco Treatment and One-Year Smoking Cessation Rates Following Lung Cancer Screening in the Veterans Health Administration. J Gen Intern Med 2022; 37:1704-1712. [PMID: 34282533 PMCID: PMC9130430 DOI: 10.1007/s11606-021-07011-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Implementation of effective smoking cessation interventions in lung cancer screening has been identified as a high-priority research gap, but knowledge of current practices to guide process improvement is limited due to the slow uptake of screening and dearth of data to assess cessation-related practices and outcomes under real-world conditions. OBJECTIVE To evaluate cessation treatment receipt and 1-year post-screening cessation outcomes within the largest integrated healthcare system in the USA-the Veterans Health Administration (VHA). Design Observational study using administrative data from electronic medical records (EMR). Patients Currently smoking Veterans who received a first lung cancer screening test using low-dose CT (LDCT) between January 2014 and June 2018. Main Outcomes Tobacco treatment received within the window of 30 days before and 30 days after LDCT; 1-year quit rates based on EMR Smoking Health Factors data 6-18 months after LDCT. Key Results Of the 47,609 current smokers screened (95.3% male), 8702 (18.3%) received pharmacotherapy and/or behavioral treatment for smoking cessation; 531 (1.1%) received both. Of those receiving pharmacotherapy, only one in four received one of the most effective medications: varenicline (12.1%) or combination nicotine replacement therapy (14.3%). Overall, 5400 Veterans quit smoking-a rate of 11.3% (missing=smoking) or 13.5% (complete case analysis). Treatment receipt and cessation were associated with numerous sociodemographic, clinical, and screening-related factors. CONCLUSIONS One-year quit rates for Veterans receiving lung cancer screening in VHA are similar to those reported in LDCT clinical trials and cohort studies (i.e., 10-17%). Only 1% of Veterans received the recommended combination of pharmacotherapy and counseling, and the most effective pharmacotherapies were not the most commonly received ones. The value of screening within VHA could be improved by addressing these treatment gaps, as well as the observed disparities in treatment receipt or cessation by race, rurality, and psychiatric conditions.
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Affiliation(s)
- Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, WA, USA.
| | - Scott Coggeshall
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
| | - Chelle L Wheat
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
| | - Paul Krebs
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Laura C Feemster
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | | | - Linda Nici
- Providence VA Medical Center, Providence, RI, USA
- Brown University, Providence, RI, USA
| | - Hannah Johnson
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Steven B Zeliadt
- VA HSR&D Center of Innovation (COIN) for Veteran Centered and Value-Driven Care, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
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11
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Caini S, Del Riccio M, Vettori V, Scotti V, Martinoli C, Raimondi S, Cammarata G, Palli D, Banini M, Masala G, Gandini S. Quitting Smoking At or Around Diagnosis Improves the Overall Survival of Lung Cancer Patients: A Systematic Review and Meta-Analysis. J Thorac Oncol 2022; 17:623-636. [PMID: 34995798 DOI: 10.1016/j.jtho.2021.12.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Lung cancer (LC) remains a disease with poor prognosis despite recent advances in treatments. Here, we aimed at summarizing the current scientific evidence on whether quitting smoking at or around diagnosis has a beneficial effect on the survival of LC patients. METHODS We searched MEDLINE and EMBASE for articles published until 31st October, 2021, that quantified the impact on LC patients' survival of quitting smoking at or around diagnosis or during treatment. Study-specific data were pooled into summary relative risk (SRR) and corresponding 95% confidence intervals (CI) using random effect meta-analysis models. RESULTS Twenty-one articles published between 1980 and 2021 were included, which encompassed a total of over 10,000 LC patients. There was substantial variability across studies in terms of design, patients' characteristics, treatments received, criteria used to define smoking status (quitters or continued), and duration of follow-up. Quitting smoking at or around diagnosis was significantly associated with improved overall survival (SRR 0.71, 95% CI 0.64-0.80), consistently among patients with non-small cell LC (SRR 0.77, 95% CI 0.66-0.90, n studies = 8), small cell LC (SRR 0.75, 95% CI 0.57-0.99, n studies = 4), or LC of both or unspecified histological type (SRR 0.81, 95% CI 0.68-0.96, n studies = 6). CONCLUSIONS Quitting smoking at or around diagnosis is associated with a beneficial effect on the survival of LC patients. Treating physicians should educate LC patients about the benefits of quitting smoking even after diagnosis and provide them with the necessary smoking cessation support.
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Affiliation(s)
- Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Marco Del Riccio
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Virginia Vettori
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Department of Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Chiara Martinoli
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Sara Raimondi
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giulio Cammarata
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Domenico Palli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Marco Banini
- Department of Biomedical, Experimental, and Clinical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Giovanna Masala
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
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12
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Behr CM, Koffijberg H, Degeling K, Vliegenthart R, IJzerman MJ. Can we increase efficiency of CT lung cancer screening by combining with CVD and COPD screening? Results of an early economic evaluation. Eur Radiol 2022; 32:3067-3075. [PMID: 34973103 PMCID: PMC9038824 DOI: 10.1007/s00330-021-08422-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 12/19/2022]
Abstract
Objectives Estimating the maximum acceptable cost (MAC) per screened individual for low-dose computed tomography (LDCT) lung cancer (LC) screening, and determining the effect of additionally screening for chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), or both on the MAC. Methods A model-based early health technology assessment (HTA) was conducted to estimate whether a new intervention could be cost-effective by calculating the MAC at a willingness-to-pay (WTP) of €20k/quality-adjusted life-year (QALY) and €80k/QALY, for a population of current and former smokers, aged 50–75 years in The Netherlands. The MAC was estimated based on incremental QALYs gained from a stage shift assuming screened individuals are detected in earlier disease stages. Data were obtained from literature and publicly available statistics and validated with experts. Results The MAC per individual for implementing LC screening at a WTP of €20k/QALY was €113. If COPD, CVD, or both were included in screening, the MAC increased to €230, €895, or €971 respectively. Scenario analyses assessed whether screening-specific disease high-risk populations would improve cost-effectiveness, showing that high-risk CVD populations were more likely to improve economic viability compared to COPD. Conclusions The economic viability of combined screening is substantially larger than for LC screening alone, primarily due to benefits from CVD screening, and is dependent on the target screening population, which is key to optimise the screening program. The total cost of breast and cervical cancer screening is lower (€420) than the MAC of Big-3, indicating that Big-3 screening may be acceptable from a health economic perspective. Key Points • Once-off combined low-dose CT screening for lung cancer, COPD, and CVD in individuals aged 50–75 years is potentially cost-effective if screening would cost less than €971 per screened individual. • Multi-disease screening requires detailed insight into the co-occurrence of these diseases to identify the optimal target screening population. • With the same target screening population and WTP, lung cancer-only screening should cost less than €113 per screened individual to be cost-effective. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-08422-7.
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Affiliation(s)
- Carina M Behr
- Health Technology and Services Research, Faculty of Behavioural and Management Science, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research, Faculty of Behavioural and Management Science, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
| | - Koen Degeling
- Cancer Health Services Research, University of Melbourne Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Melbourne, VIC 3010, Australia.,Cancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Melbourne, VIC 3010, Australia
| | - Rozemarijn Vliegenthart
- Dept of Radiology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Maarten J IJzerman
- Health Technology and Services Research, Faculty of Behavioural and Management Science, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands. .,Cancer Health Services Research, University of Melbourne Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Melbourne, VIC 3010, Australia. .,Cancer Health Services Research, Centre for Health Policy, Melbourne School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Melbourne, VIC 3010, Australia.
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13
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Comparative effect of different strategies for the screening of lung cancer: a systematic review and network meta-analysis. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Williams RM, Cordon M, Eyestone E, Smith L, Luta G, McKee BJ, Regis SM, Abrams DB, Niaura RS, Stanton CA, Parikh V, Taylor KL. Improved motivation and readiness to quit shortly after lung cancer screening: Evidence for a teachable moment. Cancer 2022; 128:1976-1986. [PMID: 35143041 PMCID: PMC9038674 DOI: 10.1002/cncr.34133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/13/2022] [Accepted: 01/18/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND For patients at high risk for lung cancer, screening using low-dose computed tomography (lung cancer screening [LCS]) is recommended. The purpose of this study was to examine whether screening may serve as a teachable moment for smoking-related outcomes. METHODS In a smoking-cessation trial, participants (N = 843) completed 2 phone interviews before randomization: before LCS (T0) and after LCS (T1). By using logistic and linear regression, the authors examined teachable moment variables (perceived risk, lung cancer worry) and outcomes (readiness, motivation, and cigarettes per day [CPD]). RESULTS Participants were a mean ± SD age of 63.7 ± 5.9 years, had 47.8 ± 7.1 pack-years of smoking, 35.2% had a high school diploma or General Educational Development (high school equivalency) degree or less, and 42.3% were undergoing their first scan. Between T0 and T1, 25.7% of participants increased readiness to quit, 9.6% decreased readiness, and 64.7% reported no change (P < .001). Motivation to quit increased (P < .05) and CPD decreased between assessments (P < .001), but only 1.3% self-reported quitting. Compared with individuals who reported no lung cancer worry/little worry, extreme worry was associated with readiness to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.1-3.0) and with higher motivation (b = 0.83; P < .001) at T1. Individuals undergoing a baseline (vs annual) scan were more ready to quit in the next 30 days (odds ratio, 1.8; 95% CI, 1.3-2.5). CONCLUSIONS During the brief window between registering for LCS and receiving the results, the authors observed that very few participants quit smoking, but a significant proportion improved on readiness and motivation to quit, particularly among individuals who were undergoing their first scan and those who were extremely worried about lung cancer. These results indicate that providing evidence-based tobacco treatment can build upon this teachable moment.
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Affiliation(s)
- Randi M Williams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Marisa Cordon
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Ellie Eyestone
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - Laney Smith
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
| | - George Luta
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, Washington, District of Columbia
| | - Brady J McKee
- Division of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Shawn M Regis
- Division of Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - David B Abrams
- New York University School of Global Public Health, New York, New York
| | - Raymond S Niaura
- New York University School of Global Public Health, New York, New York
| | | | - Vicky Parikh
- Department of Population Health, MedStar Shah Medical Group, Hollywood, Maryland
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia
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15
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Buttery SC, Williams P, Mweseli R, Philip KEJ, Sadaka A, Bartlett EJ, Devaraj A, Kemp S, Addis J, Derbyshire J, Chen M, Morris K, Laverty A, Hopkinson NS. Immediate smoking cessation support versus usual care in smokers attending a targeted lung health check: the QuLIT trial. BMJ Open Respir Res 2022; 9:9/1/e001030. [PMID: 35121633 PMCID: PMC8819808 DOI: 10.1136/bmjresp-2021-001030] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/16/2022] [Indexed: 12/22/2022] Open
Abstract
Objectives Lung cancer screening programmes offer an opportunity to address tobacco dependence in current smokers. The effectiveness of different approaches to smoking cessation in this context has not yet been established. We investigated if immediate smoking cessation support, including pharmacotherapy, offered as part of a lung cancer screening programme, increases quit rates compared to usual care (Very Brief Advice to quit and signposting to smoking cessation services). Materials and methods We conducted a single-blind randomised controlled trial of current smokers aged 55–75 years attending a Targeted Lung Health Check. On randomly allocated days smokers received either (1) immediate support from a trained smoking cessation counsellor with appropriate pharmacotherapy or (2) usual care. The primary outcome was self-reported quit rate at 3 months. We performed thematic analysis of participant interview responses. Results Of 412 people attending between January and March 2020, 115 (27.9%) were current smokers; 46% female, mean (SD) 62.4 (5.3) years. Follow-up data were available for 84 smokers. At 3 months, quit rates in the intervention group were higher 14/48 (29.2%) vs 4/36 (11%) (χ2 3.98, p=0.04). Participant interviews revealed four smoking-cessation related themes: (1) stress and anxiety, (2) impact of the COVID-19 pandemic, (3) CT scans influencing desire to quit and (4) individual beliefs about stopping smoking. Conclusion The provision of immediate smoking cessation support is associated with a substantial increase in quit rates at 3 months. Further research is needed to investigate longer-term outcomes and to refine future service delivery. Trial registration number ISRCTN12455871.
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Affiliation(s)
- Sara C Buttery
- Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College, London, UK
| | - Parris Williams
- Imperial College London, London, UK .,National Heart and Lung Institute, Imperial College London, London, UK.,NHLI Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Rebecca Mweseli
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Keir Elmslie James Philip
- Imperial College London, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK.,NHLI Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Ahmed Sadaka
- Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Alexandria University Faculty of Medicine, Alexandria, Egypt
| | | | - Anand Devaraj
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Radiology, Royal Brompton Hospital, London, UK
| | - Samual Kemp
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jamie Addis
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | | | | | - Anthony Laverty
- Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College, London, UK
| | - Nicholas S Hopkinson
- Imperial College London, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK.,NHLI Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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16
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Burzic A, O’Dowd EL, Baldwin DR. The Future of Lung Cancer Screening: Current Challenges and Research Priorities. Cancer Manag Res 2022; 14:637-645. [PMID: 35210860 PMCID: PMC8859535 DOI: 10.2147/cmar.s293877] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/30/2022] [Indexed: 11/30/2022] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide, primarily because most people present when the stage is too advanced to offer any reasonable chance of cure. Over the last two decades, evidence has accumulated to show that early detection of lung cancer, using low-radiation dose computed tomography, in people at higher risk of the condition reduces their mortality. Many countries are now making progress with implementing programmes, although some have concerns about cost-effectiveness. Lung cancer screening is complex, and many factors influence clinical and cost-effectiveness. It is important to develop strategies to optimise each element of the intervention from selection and participation through optimal scanning, management of findings and treatment. The overall aim is to maximise benefits and minimise harms. Additional integrated interventions must include at least smoking cessation. In this review, we summarize the evidence that has accumulated to guide optimisation of lung cancer screening, discuss the remaining open questions about the best approach and identify potential barriers to successful implementation.
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Affiliation(s)
- Amna Burzic
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
| | - Emma L O’Dowd
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
- Division of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, UK
- Division of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
- Correspondence: David R Baldwin, Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Nottingham, NG5 1PB, UK, Tel +44 115 9691169, Fax +44 115 9627723, Email
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17
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Mazzone PJ, Silvestri GA, Souter LH, Caverly TJ, Kanne JP, Katki HA, Wiener RS, Detterbeck FC. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest 2021; 160:e427-e494. [PMID: 34270968 PMCID: PMC8727886 DOI: 10.1016/j.chest.2021.06.063] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/11/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Low-dose chest CT screening for lung cancer has become a standard of care in the United States, in large part because of the results of the National Lung Screening Trial (NLST). Additional evidence supporting the net benefit of low-dose chest CT screening for lung cancer, and increased experience in minimizing the potential harms, has accumulated since the prior iteration of these guidelines. Here, we update the evidence base for the benefit, harms, and implementation of low-dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not. METHODS Approved panelists reviewed previously developed key questions using the Population, Intervention, Comparator, Outcome format to address the benefit and harms of low-dose CT screening, and key areas of program implementation. A systematic literature review was conducted using MEDLINE via PubMed, Embase, and the Cochrane Library on a quarterly basis since the time of the previous guideline publication. Reference lists from relevant retrievals were searched, and additional papers were added. Retrieved references were reviewed for relevance by two panel members. The quality of the evidence was assessed for each critical or important outcome of interest using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Meta-analyses were performed when enough evidence was available. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and ungraded statements were drafted, voted on, and revised until consensus was reached. RESULTS The systematic literature review identified 75 additional studies that informed the response to the 12 key questions that were developed. Additional clinical questions were addressed resulting in seven graded recommendations and nine ungraded consensus statements. CONCLUSIONS Evidence suggests that low-dose CT screening for lung cancer can result in a favorable balance of benefit and harms. The selection of screen-eligible individuals, the quality of imaging and image interpretation, the management of screen-detected findings, and the effectiveness of smoking cessation interventions can impact this balance.
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Affiliation(s)
| | | | | | - Tanner J Caverly
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI
| | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA; Boston University School of Medicine, Boston, MA
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18
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Luo SJ, Choi E, Aredo JV, Wilkens LR, Tammemägi MC, Le Marchand L, Cheng I, Wakelee HA, Han SS. Smoking Cessation After Lung Cancer Diagnosis and the Risk of Second Primary Lung Cancer: The Multiethnic Cohort Study. JNCI Cancer Spectr 2021; 5:pkab076. [PMID: 34611582 PMCID: PMC8487318 DOI: 10.1093/jncics/pkab076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/28/2021] [Accepted: 08/18/2021] [Indexed: 12/23/2022] Open
Abstract
Background Smoking cessation reduces lung cancer mortality. However, little is known about whether diagnosis of lung cancer impacts changes in smoking behaviors. Furthermore, the effects of smoking cessation on the risk of second primary lung cancer (SPLC) have not been established yet. This study aims to examine smoking behavior changes after initial primary lung cancer (IPLC) diagnosis and estimate the effect of smoking cessation on SPLC risk following IPLC diagnosis. Methods The study cohort consisted of 986 participants in the Multiethnic Cohort Study who were free of lung cancer and active smokers at baseline (1993-1996), provided 10-year follow-up smoking data (2003-2008), and were diagnosed with IPLC in 1993-2017. The primary outcome was a change in smoking status from “current” at baseline to “former” at 10-year follow-up (ie, smoking cessation), analyzed using logistic regression. The second outcome was SPLC incidence after smoking cessation, estimated using cause-specific Cox regression. All statistical tests were 2-sided. Results Among 986 current smokers at baseline, 51.1% reported smoking cessation at 10-year follow-up. The smoking cessation rate was statistically significantly higher (80.6%) for those diagnosed with IPLC between baseline and 10-year follow-up vs those without IPLC diagnosis (45.4%) during the 10-year period (adjusted odds ratio = 5.12, 95% confidence interval [CI] = 3.38 to 7.98; P < .001). Incidence of SPLC was statistically significantly lower among the 504 participants who reported smoking cessation at follow-up compared with those without smoking cessation (adjusted hazard ratio = 0.31, 95% CI = 0.14 to 0.67; P = .003). Conclusion Lung cancer diagnosis has a statistically significant impact on smoking cessation. Quitting smoking after IPLC diagnosis may reduce the risk of developing a subsequent malignancy in the lungs.
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Affiliation(s)
- Sophia J Luo
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Eunji Choi
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Lynne R Wilkens
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Loïc Le Marchand
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Heather A Wakelee
- Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Summer S Han
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA.,Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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19
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Deros DE, Hagerman CJ, Kramer JA, Anderson ED, Regis S, McKee AB, McKee BJ, Stanton CA, Niaura R, Abrams DB, Ramsaier M, Fallon S, Harper H, Taylor KL. Change in amount smoked and readiness to quit among patients undergoing lung cancer screening. J Thorac Dis 2021; 13:4947-4955. [PMID: 34527333 PMCID: PMC8411192 DOI: 10.21037/jtd-20-3267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
Background There is mixed evidence regarding whether undergoing computed tomography lung cancer screening (LCS) can serve as a "teachable moment" that impacts smoking behavior and attitudes. The study aim was to assess whether the standard procedures of undergoing LCS and receiving free and low-cost evidence-based cessation resources impacted short-term smoking-related outcomes. Methods Participants were smokers (N=87) who were registered to undergo lung screening and were enrolled in a cessation intervention trial. We conducted two phone interviews, both preceding trial randomization: the first interview was conducted prior to lung screening, and the second interview followed lung screening (median =12.5 days post-screening) and participants' receipt of their screening results. The interviews assessed demographic characteristics, interest in evidence-based cessation intervention methods, and tobacco-related characteristics, including cigarettes per day and readiness to quit. Participants received minimal evidence-based cessation resources following the pre-lung screening interview. Results Participants were 60.3 years old, 56.3% female, and reported a median of 40 pack-years. Participants were interested in using several evidence-based strategies, including counseling from a healthcare provider (76.7%) and receiving nicotine replacement therapy (69.8%). Pre-lung screening, 25.3% smoked ≤10 cigarettes per day, and 29.9% were ready to quit in the next 30 days. We conducted two McNemar binomial distribution tests to assess change from pre- to post-screening. At the post-lung screening assessment, approximately three-quarters reported no change on these variables. However, 23.3% reported smoking fewer cigarettes per day, whereas 4.7% reported smoking more cigarettes per day (McNemar P=0.002), and 17.2% reported increased readiness to quit, whereas 6.9% reported decreased readiness to quit (McNemar P=0.078). Conclusions Following receipt of cessation resources and completion of lung screening, most participants reported no change in smoking outcomes. However, there was a significant reduction in cigarettes per day, and there was a trend for increased readiness to quit. This setting may provide a potential "teachable moment" and an opportunity to assist smokers with quitting. However, more proactive and intensive interventions will be necessary to capitalize on these changes and to support abstinence in the long-term.
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Affiliation(s)
- Danielle E Deros
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Charlotte J Hagerman
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Jenna A Kramer
- Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | - Eric D Anderson
- Medstar Georgetown University Medical Center, Washington, DC, USA
| | - Shawn Regis
- Sophia Gordon Cancer Center, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Andrea B McKee
- Sophia Gordon Cancer Center, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Brady J McKee
- Sophia Gordon Cancer Center, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Cassandra A Stanton
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Westat, Inc. Rockville, MD, USA
| | - Ray Niaura
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
| | - David B Abrams
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.,Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
| | - Michael Ramsaier
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Shelby Fallon
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
| | - Harry Harper
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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20
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Lam S, Tammemagi M. Contemporary issues in the implementation of lung cancer screening. Eur Respir Rev 2021; 30:30/161/200288. [PMID: 34289983 DOI: 10.1183/16000617.0288-2020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/08/2021] [Indexed: 12/24/2022] Open
Abstract
Lung cancer screening with low-dose computed tomography can reduce death from lung cancer by 20-24% in high-risk smokers. National lung cancer screening programmes have been implemented in the USA and Korea and are being implemented in Europe, Canada and other countries. Lung cancer screening is a process, not a test. It requires an organised programmatic approach to replicate the lung cancer mortality reduction and safety of pivotal clinical trials. Cost-effectiveness of a screening programme is strongly influenced by screening sensitivity and specificity, age to stop screening, integration of smoking cessation intervention for current smokers, screening uptake, nodule management and treatment costs. Appropriate management of screen-detected lung nodules has significant implications for healthcare resource utilisation and minimising harm from radiation exposure related to imaging studies, invasive procedures and clinically significant distress. This review focuses on selected contemporary issues in the path to implement a cost-effective lung cancer screening at the population level. The future impact of emerging technologies such as deep learning and biomarkers are also discussed.
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Affiliation(s)
- Stephen Lam
- British Columbia Cancer Agency, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Martin Tammemagi
- Dept of Health Sciences, Brock University, St Catharines, ON, Canada
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21
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Mazzone PJ, Silvestri GA, Souter LH, Caverly TJ, Kanne JP, Katki HA, Wiener RS, Detterbeck FC. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report - Executive Summary. Chest 2021; 160:1959-1980. [PMID: 34270965 DOI: 10.1016/j.chest.2021.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Low-dose chest CT screening for lung cancer has become a standard of care in the United States, in large part due to the results of the National Lung Screening Trial. Additional evidence supporting the net benefit of low-dose chest CT screening for lung cancer, as well as increased experience in minimizing the potential harms, has accumulated since the prior iteration of these guidelines. Here, we update the evidence base for the benefit, harms, and implementation of low-dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not. METHODS Approved panelists reviewed previously developed key questions using the PICO (population, intervention, comparator, and outcome) format to address the benefit and harms of low-dose CT screening, as well as key areas of program implementation. A systematic literature review was conducted using MEDLINE via PubMed, Embase, and the Cochrane Library on a quarterly basis since the time of the previous guideline publication. Reference lists from relevant retrievals were searched, and additional papers were added. Retrieved references were reviewed for relevance by two panel members. The quality of the evidence was assessed for each critical or important outcome of interest using the GRADE approach. Meta-analyses were performed where appropriate. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and un-graded statements were drafted, voted on, and revised until consensus was reached. RESULTS The systematic literature review identified 75 additional studies that informed the response to the 12 key questions that were developed. Additional clinical questions were addressed resulting in 7 graded recommendations and 9 ungraded consensus statements. CONCLUSIONS Evidence suggests that low-dose CT screening for lung cancer can result in a favorable balance of benefit and harms. The selection of screen-eligible individuals, the quality of imaging and image interpretation, the management of screen detected findings, and the effectiveness of smoking cessation interventions, can impact this balance.
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Affiliation(s)
| | | | | | - Tanner J Caverly
- Ann Arbor VA Center for Clinical Management Research and University of Michigan Medical School , Madison, WI
| | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System and Boston University School of Medicine, Boston, MA
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22
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Hunger T, Wanka-Pail E, Brix G, Griebel J. Lung Cancer Screening with Low-Dose CT in Smokers: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11061040. [PMID: 34198856 PMCID: PMC8228723 DOI: 10.3390/diagnostics11061040] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/21/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
Lung cancer continues to be one of the main causes of cancer death in Europe. Low-dose computed tomography (LDCT) has shown high potential for screening of lung cancer in smokers, most recently in two European trials. The aim of this review was to assess lung cancer screening of smokers by LDCT with respect to clinical effectiveness, radiological procedures, quality of life, and changes in smoking behavior. We searched electronic databases in April 2020 for publications of randomized controlled trials (RCT) reporting on lung cancer and overall mortality, lung cancer morbidity, and harms of LDCT screening. A meta-analysis was performed to estimate effects on mortality. Forty-three publications on 10 RCTs were included. The meta-analysis of eight studies showed a statistically significant relative reduction of lung cancer mortality of 12% in the screening group (risk ratio = 0.88; 95% CI: 0.79-0.97). Between 4% and 24% of screening-LDCT scans were classified as positive, and 84-96% of them turned out to be false positive. The risk of overdiagnosis was estimated between 19% and 69% of diagnosed lung cancers. Lung cancer screening can reduce disease-specific mortality in (former) smokers when stringent requirements and quality standards for performance are met.
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23
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Goudemant C, Durieux V, Grigoriu B, Berghmans T. [Lung cancer screening with low dose computed tomography : a systematic review]. Rev Mal Respir 2021; 38:489-505. [PMID: 33994043 DOI: 10.1016/j.rmr.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/26/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bronchial cancer, often diagnosed at a late stage, is the leading cause of cancer death. As early detection could potentially lead to curative treatment, several studies have evaluated low-dose chest CT (LDCT) as a screening method. The main objective of this work is to determine the impact of LDCT screening on overall mortality of a smoking population. METHODS Systematic review of randomised controlled screening trials comparing LDCT with no screening or chest x-ray. RESULTS Thirteen randomised controlled trials were identified, seven of which reported mortality results. NSLT showed a significant reduction of 6.7% in overall mortality and 20% in lung cancer mortality after 6.5 years of follow-up. NELSON showed a significant reduction in lung cancer mortality of 24% at 10 years among men. LUSI and MILD showed a reduction in lung cancer mortality of 69% at 8 years among women and 39% at 10 years, respectively. CONCLUSION Screening for bronchial cancer is a complex issue. Clarification is needed regarding the selection of individuals, the definition of a positive result and the attitude towards a suspicious nodule.
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Affiliation(s)
- C Goudemant
- Département des soins intensifs & urgences oncologiques et clinique d'oncologie thoracique, institut Jules-Bordet, Rue Héger-Bordet 1, 1000 Bruxelles, Belgique.
| | - V Durieux
- Bibliothèque des Sciences de la Santé, Université libre de Bruxelles
| | - B Grigoriu
- Département des soins intensifs & urgences oncologiques et clinique d'oncologie thoracique, institut Jules-Bordet, Rue Héger-Bordet 1, 1000 Bruxelles, Belgique
| | - T Berghmans
- Département des soins intensifs & urgences oncologiques et clinique d'oncologie thoracique, institut Jules-Bordet, Rue Héger-Bordet 1, 1000 Bruxelles, Belgique
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24
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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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25
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Jonas DE, Reuland DS, Reddy SM, Nagle M, Clark SD, Weber RP, Enyioha C, Malo TL, Brenner AT, Armstrong C, Coker-Schwimmer M, Middleton JC, Voisin C, Harris RP. Screening for Lung Cancer With Low-Dose Computed Tomography: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:971-987. [PMID: 33687468 DOI: 10.1001/jama.2021.0377] [Citation(s) in RCA: 207] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Lung cancer is the leading cause of cancer-related death in the US. OBJECTIVE To review the evidence on screening for lung cancer with low-dose computed tomography (LDCT) to inform the US Preventive Services Task Force (USPSTF). DATA SOURCES MEDLINE, Cochrane Library, and trial registries through May 2019; references; experts; and literature surveillance through November 20, 2020. STUDY SELECTION English-language studies of screening with LDCT, accuracy of LDCT, risk prediction models, or treatment for early-stage lung cancer. DATA EXTRACTION AND SYNTHESIS Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings. Data were not pooled because of heterogeneity of populations and screening protocols. MAIN OUTCOMES AND MEASURES Lung cancer incidence, lung cancer mortality, all-cause mortality, test accuracy, and harms. RESULTS This review included 223 publications. Seven randomized clinical trials (RCTs) (N = 86 486) evaluated lung cancer screening with LDCT; the National Lung Screening Trial (NLST, N = 53 454) and Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON, N = 15 792) were the largest RCTs. Participants were more likely to benefit than the US screening-eligible population (eg, based on life expectancy). The NLST found a reduction in lung cancer mortality (incidence rate ratio [IRR], 0.85 [95% CI, 0.75-0.96]; number needed to screen [NNS] to prevent 1 lung cancer death, 323 over 6.5 years of follow-up) with 3 rounds of annual LDCT screening compared with chest radiograph for high-risk current and former smokers aged 55 to 74 years. NELSON found a reduction in lung cancer mortality (IRR, 0.75 [95% CI, 0.61-0.90]; NNS to prevent 1 lung cancer death of 130 over 10 years of follow-up) with 4 rounds of LDCT screening with increasing intervals compared with no screening for high-risk current and former smokers aged 50 to 74 years. Harms of screening included radiation-induced cancer, false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, and increases in distress. For every 1000 persons screened in the NLST, false-positive results led to 17 invasive procedures (number needed to harm, 59) and fewer than 1 person having a major complication. Overdiagnosis estimates varied greatly (0%-67% chance that a lung cancer was overdiagnosed). Incidental findings were common, and estimates varied widely (4.4%-40.7% of persons screened). CONCLUSIONS AND RELEVANCE Screening high-risk persons with LDCT can reduce lung cancer mortality but also causes false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, increases in distress, and, rarely, radiation-induced cancers. Most studies reviewed did not use current nodule evaluation protocols, which might reduce false-positive results and invasive procedures for false-positive results.
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Affiliation(s)
- Daniel E Jonas
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University, Columbus
| | - Daniel S Reuland
- Department of Medicine, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Shivani M Reddy
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Max Nagle
- Michigan Medicine, University of Michigan, Ann Arbor
| | - Stephen D Clark
- Department of Internal Medicine, Virginia Commonwealth University, Richmond
| | - Rachel Palmieri Weber
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Charli Armstrong
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Manny Coker-Schwimmer
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Jennifer Cook Middleton
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Christiane Voisin
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Russell P Harris
- Department of Medicine, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
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26
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Madoc-Jones I, Wadd S, Elliott L, Whittaker A, Adnum L, Close C, Seddon J, Dutton M, McCann M, Wilson F. Factors influencing routine cognitive impairment screening in older at-risk drinkers: Findings from a qualitative study in the United Kingdom. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:344-352. [PMID: 32662912 DOI: 10.1111/hsc.13093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/22/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
Cognitive Impairment (CI) screening is recommended for those engaged in harmful levels of alcohol use. However, there is a lack of evidence on implementation. This paper explores the barriers and facilitators to CI screening experienced across a service specifically for older drinkers. The findings draw on data gathered as part of an evaluation of a multilevel programme to reduce alcohol-related harm in adults aged 50 and over in five demonstration areas across the United Kingdom. It is based on qualitative interviews and focus groups with 14 service providers and 22 service users. Findings are presented thematically under the section headings: acceptability of screening, interpretation and making sense of screening and treatment options. It is suggested that engagement with CI screening is most likely when its fit with agency culture and its purpose is clear; where service providers have the technical skills to administer and discuss the results of screening with service users; and where those undertaking screening have had the opportunity to reflect on their own experience of being screened. Engagement with CI screening is also most likely where specific intervention pathways and engagement practices can be accessed to respond to assessed need.
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Affiliation(s)
| | - Sarah Wadd
- University of Bedfordshire, Bedfordshire, UK
| | | | | | | | | | | | | | | | - Fiona Wilson
- Wrexham Glyndwr University Plas Coch campus, Wrexham, UK
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27
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Real-World Lung Cancer CT Screening Performance, Smoking Behavior, and Adherence to Recommendations: Lung-RADS Category and Smoking Status Predict Adherence. AJR Am J Roentgenol 2021; 216:919-926. [PMID: 32755178 DOI: 10.2214/ajr.20.23637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND. Low-dose CT (LDCT) lung cancer screening (LCS) has been shown to decrease mortality in persons with a significant smoking history. However, adherence in real-world LCS programs is significantly lower than in randomized controlled trials. OBJECTIVE. The purpose of this article is to assess real-world LDCT LCS performance and factors predictive of adherence to LCS recommendations. METHODS. We retrospectively identified all persons who underwent at least two LCS examinations from 2014 to 2019. Patient demographics, smoking history and behavior changes, Lung-RADS category, PPV, NPV, and adherence to screening recommendations were recorded. Predictors of adherence were assessed via univariate comparisons and multivariate logistic regression. RESULTS. A total of 260 persons returned for follow-up LDCT (57.7% had two, 34.2% had three, 7.7% had four, and 0.4% had five LDCT examinations). A total of 43 of 260 (16.5%) had positive (Lung-RADS category 3 or above) scans, of which 27 of 260 persons (10.3%) were graded as Lung-RADS category 3, eight of 260 (3.1%) were category 4A, six of 260 (2.3%) were category 4B, and two of 260 (0.8%) were category 4X. Cancer was diagnosed in four of the 260 (three with lung cancer and one with metastatic melanoma). A total of 143 of 260 (55.0%) persons were current smokers at baseline and 121 of 260 (46.5%) were current smokers at the last round of LCS. LCS had sensitivity of 100.0%, specificity of 84.8%, PPV of 9.3%, and NPV of 100%. Overall adherence was 43.0% but increased progressively with higher Lung-RADS category (Lung-RADS 1: 33.2%; Lung-RADS 2: 46.3%; Lung-RADS 3: 53.8%; Lung-RADS 4A: 77.8%; Lung-RADS 4B: 83.3%; Lung-RADS 4X: 100%; p < .001). was also higher in former versus current smokers (50.0% vs 36.2%; p < .001). Being a former smoker and having a nodule that is Lung-RADS category 3 or greater were the only significant independent predictors of adherence. CONCLUSION. Our real-world LCS program showed very high sensitivity and NPV, but moderate specificity and very low PPV. Adherence to LCS recommendations increased with former versus current smokers and in those with positive (Lung-RADS categories 3, 4A, 4B, or 4X) LCS examinations. Adherence was less than 50.0% in current smokers and persons with negative (Lung-RADS categories 1 or 2) LCS examinations. CLINICAL IMPACT. Our results offer a road map for targeted performance improvement by focusing on LCS subjects less likely to remain in the program, such as persons with negative LCS examinations and persons who continue to smoke, potentially improving LCS cost effectiveness and maximizing its societal benefits.
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28
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Moldovanu D, de Koning HJ, van der Aalst CM. Lung cancer screening and smoking cessation efforts. Transl Lung Cancer Res 2021; 10:1099-1109. [PMID: 33718048 PMCID: PMC7947402 DOI: 10.21037/tlcr-20-899] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Randomized-controlled trials have confirmed substantial reductions in lung cancer mortality with low-dose computed tomography (LDCT) screening. Evidence on how to integrate smoking cessation support in lung cancer screening is however scarce. This represents a significant gap in the literature, as a combined strategy of lung cancer screening and smoking cessation greatly reduces the mortality risk due to lung cancer and other related comorbidities. In this review, a literature search in MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trials and Google Scholar was performed to identify randomized-controlled and observational studies investigating the effect of lung cancer screening trials and integrated cessation interventions on smoking cessation. Of the 236 identified records, we included 32 original publications. Smoking cessation rates in lung cancer screening trials are promising. Especially findings suspicious for lung cancer and referral to a physician might function as a teachable moment to motivate smoking abstinence in current smokers or recent quitters. More intensive, personalized and multi-modality smoking cessation interventions delivered by a clinician appear to be the most successful in influencing smoking behavior. While it is evident that smoking cessation should be incorporated in lung cancer screening, further research is required to ascertain the optimal treatment type, modality, timing, and content of communication including the incorporation of CT results to motivate health behavior change.
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Affiliation(s)
- Dana Moldovanu
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Carlijn M van der Aalst
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
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Peiffer G, Underner M, Perriot J, Ruppert AM, Tiotiu A. [Smoking cessation and lung cancer screening]. Rev Mal Respir 2020; 37:722-734. [PMID: 33129612 DOI: 10.1016/j.rmr.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
Several studies have shown that lung cancer screening, using annual low-dose computed tomography (CT) scan in a targeted population of smokers and ex-smokers reduces overall and lung cancer specific mortality rates. This form of screening strategy is not currently established for use in France by the French High Authority for Health. Quitting smoking is the most important measure in reducing mortality from lung cancer. The maximum benefit in reducing mortality from lung cancer should be seen through an effective combination of smoking cessation intervention and chest CT screening to identify early, curable disease. However, current data to guide clinicians in the choice of smoking cessation interventions in this specific context are limited due to the small number of randomized studies that have been carried out. The optimal approach to smoking cessation during lung cancer screening needs to be clarified by new studies comparing different motivation strategies, establishing the ideal moment to propose stopping smoking and the most effective therapies to use.
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Affiliation(s)
- G Peiffer
- Service de pneumologie, CHR de Metz-Thionville, 1, allée du Château, 57085 Metz, France.
| | - M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France
| | - J Perriot
- CLAT 63, dispensaire Emile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - A-M Ruppert
- Unité de tabacologie, service de pneumologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - A Tiotiu
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Murray RL, Brain K, Britton J, Quinn-Scoggins HD, Lewis S, McCutchan GM, Quaife SL, Wu Q, Ashurst A, Baldwin D, Crosbie PAJ, Neal RD, Parrott S, Rogerson S, Thorley R, Callister ME. Yorkshire Enhanced Stop Smoking (YESS) study: a protocol for a randomised controlled trial to evaluate the effect of adding a personalised smoking cessation intervention to a lung cancer screening programme. BMJ Open 2020; 10:e037086. [PMID: 32912948 PMCID: PMC7485260 DOI: 10.1136/bmjopen-2020-037086] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Integration of smoking cessation (SC) into lung cancer screening is essential to optimise clinical and cost effectiveness. The most effective way to use this 'teachable moment' is unclear. The Yorkshire Enhanced Stop Smoking study will measure the effectiveness of an SC service integrated within the Yorkshire Lung Screening Trial (YLST) and will test the efficacy of a personalised SC intervention, incorporating incidental findings detected on the low-dose CT scan performed as part of YLST. METHODS AND ANALYSIS Unless explicitly declined, all smokers enrolled in YLST will see an SC practitioner at baseline and receive SC support over 4 weeks comprising behavioural support, pharmacotherapy and/or a commercially available e-cigarette. Eligible smokers will be randomised (1:1 in permuted blocks of random size up to size 6) to receive either an enhanced, personalised SC support package, including CT scan images, or continued standard best practice. Anticipated recruitment is 1040 smokers (January 2019-December 2020). The primary objective is to measure 7-day point prevalent carbon monoxide (CO) validated SC after 3 months. Secondary outcomes include CO validated cessation at 4 weeks and 12 months, self-reported continuous cessation at 4 weeks, 3 months and 12 months, attempts to quit smoking and changes in psychological variables, including perceived risk of lung cancer, motivation to quit smoking tobacco, confidence and efficacy beliefs (self and response) at all follow-up points. A process evaluation will explore under which circumstances and on which groups the intervention works best, test intervention fidelity and theory test the mechanisms of intervention impact. ETHICS AND DISSEMINATION This study has been approved by the East Midlands-Derby Research Ethics Committee (18/EM/0199) and the Health Research Authority/Health and Care Research Wales. Results will be disseminated through publication in peer-reviewed scientific journals, presentation at conferences and via the YLST website. TRIAL REGISTRATION NUMBERS ISRCTN63825779, NCT03750110.
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Affiliation(s)
- Rachael L Murray
- Division of Epidemiology & Public Health, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - John Britton
- Division of Epidemiology & Public Health, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | | | - Sarah Lewis
- Division of Epidemiology & Public Health, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Grace M McCutchan
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Qi Wu
- Department of Health Sciences, University of York, York, UK
| | - Alex Ashurst
- Department of Radiology, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - David Baldwin
- Deaprtment of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Wythenshawe, UK
| | - Richard D Neal
- Institute of Health Science, University of Leeds, Leeds, United Kingdom
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Suzanne Rogerson
- Research and Innivation CSU, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Rebecca Thorley
- Division of Epidemiology & Public Health, Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Matthew Ej Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, United Kingdom
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31
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Crosbie PA, Gabe R, Simmonds I, Kennedy M, Rogerson S, Ahmed N, Baldwin DR, Booton R, Cochrane A, Darby M, Franks K, Hinde S, Janes SM, Macleod U, Messenger M, Moller H, Murray RL, Neal RD, Quaife SL, Sculpher M, Tharmanathan P, Torgerson D, Callister ME. Yorkshire Lung Screening Trial (YLST): protocol for a randomised controlled trial to evaluate invitation to community-based low-dose CT screening for lung cancer versus usual care in a targeted population at risk. BMJ Open 2020; 10:e037075. [PMID: 32912947 PMCID: PMC7485242 DOI: 10.1136/bmjopen-2020-037075] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/24/2020] [Accepted: 07/08/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Lung cancer is the world's leading cause of cancer death. Low-dose computed tomography (LDCT) screening reduced lung cancer mortality by 20% in the US National Lung Screening Trial. Here, we present the Yorkshire Lung Screening Trial (YLST), which will address key questions of relevance for screening implementation. METHODS AND ANALYSIS Using a single-consent Zelen's design, ever-smokers aged 55-80 years registered with a general practice in Leeds will be randomised (1:1) to invitation to a telephone-based risk-assessment for a Lung Health Check or to usual care. The anticipated number randomised by household is 62 980 individuals. Responders at high risk will be invited for LDCT scanning for lung cancer on a mobile van in the community. There will be two rounds of screening at an interval of 2 years. Primary objectives are (1) measure participation rates, (2) compare the performance of PLCOM2012 (threshold ≥1.51%), Liverpool Lung Project (V.2) (threshold ≥5%) and US Preventive Services Task Force eligibility criteria for screening population selection and (3) assess lung cancer outcomes in the intervention and usual care arms. Secondary evaluations include health economics, quality of life, smoking rates according to intervention arm, screening programme performance with ancillary biomarker and smoking cessation studies. ETHICS AND DISSEMINATION The study has been approved by the Greater Manchester West research ethics committee (18-NW-0012) and the Health Research Authority following review by the Confidentiality Advisory Group. The results will be disseminated through publication in peer-reviewed scientific journals, presentation at conferences and on the YLST website. TRIAL REGISTRATION NUMBERS ISRCTN42704678 and NCT03750110.
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Affiliation(s)
- Philip Aj Crosbie
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Rhian Gabe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Irene Simmonds
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Martyn Kennedy
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Suzanne Rogerson
- Department of Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nazia Ahmed
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David R Baldwin
- Department of Respiratory Medicine, City Campus, Nottingham University Hospitals, Nottingham, UK
| | - Richard Booton
- Lung Cancer and Thoracic Surgery Directorate, Heart and Lung Division, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ann Cochrane
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Michael Darby
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kevin Franks
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Sam M Janes
- Department of Respiratory Medicine, University College London, London, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
| | - Mike Messenger
- Leeds Centre for Personalised Medicine and Health, University of Leeds, Leeds, UK
| | - Henrik Moller
- Thames Cancer Registry, Kings College London, London, UK
| | - Rachael L Murray
- Division of Epidemiology and Public Health, Faculty of Medicine, University of Nottingham, Nottingham, UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Samantha L Quaife
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | | | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Matthew Ej Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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32
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Baldwin DR, Callister MEJ. An update on CT screening for lung cancer: the first major targeted cancer screening programme. Br J Radiol 2020; 93:20200636. [PMID: 32894687 DOI: 10.1259/bjr.20200636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Screening for lung cancer with low radiation dose CT has been shown to be effective in reducing lung cancer mortality by two major randomised controlled trials. Lung cancer screening is set to become the largest targeted cancer screening programme globally, but the effectiveness of the programme is dependent on many different factors. This article describes the key evidence for lung cancer screening, the key factors important for optimisation and the progress towards implementation.
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Affiliation(s)
- David R Baldwin
- Nottingham University Hospitals and Honorary Professor, University of Nottingham, Respiratory Medicine Unit, David Evans Centre, Nottingham, United Kingdom
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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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Cao P, Jeon J, Levy DT, Jayasekera JC, Cadham CJ, Mandelblatt JS, Taylor KL, Meza R. Potential Impact of Cessation Interventions at the Point of Lung Cancer Screening on Lung Cancer and Overall Mortality in the United States. J Thorac Oncol 2020; 15:1160-1169. [PMID: 32160967 PMCID: PMC7329583 DOI: 10.1016/j.jtho.2020.02.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Annual lung cancer screening with low-dose computed tomography is recommended for adults aged 55 to 80 years with a greater than or equal to 30 pack-year smoking history who currently smoke or quit within the past 15 years. The 50% who are current smokers should be offered cessation interventions, but information about the impact of adding cessation to screening is limited. METHODS We used an established lung cancer simulation model to compare the effects on mortality of a hypothetical one-time cessation intervention and annual screening versus annual screening only among screen-eligible individuals born in 1950 or 1960. Model inputs were derived from national data and included smoking history, probability of quitting with and without intervention, lung cancer risk and treatment effectiveness, and competing tobacco-related mortality. We tested the sensitivity of results under different assumptions about screening use and cessation efficacy. RESULTS Smoking cessation reduces lung cancer mortality and delays overall deaths versus screening only across all assumptions. For example, if screening was used by 30% of screen-eligible individuals born in 1950, adding an intervention with a 10% quit probability reduces lung cancer deaths by 14% and increases life years gained by 81% compared with screening alone. The magnitude of cessation benefits varied under screening uptake rates, cessation effectiveness, and birth cohort. CONCLUSIONS Smoking cessation interventions have the potential to greatly enhance the impact of lung cancer screening programs. Evaluation of specific interventions, including costs and feasibility of implementation and dissemination, is needed to determine the best possible strategies and realize the full promise of lung cancer screening.
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Affiliation(s)
- Pianpian Cao
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - David T Levy
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Jinani C Jayasekera
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Christopher J Cadham
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Jeanne S Mandelblatt
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Kathryn L Taylor
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
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Evans WK, Gauvreau CL, Flanagan WM, Memon S, Yong JHE, Goffin JR, Fitzgerald NR, Wolfson M, Miller AB. Clinical impact and cost-effectiveness of integrating smoking cessation into lung cancer screening: a microsimulation model. CMAJ Open 2020; 8:E585-E592. [PMID: 32963023 PMCID: PMC7641238 DOI: 10.9778/cmajo.20190134] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Low-dose computed tomography (CT) screening can reduce lung cancer mortality in people at high risk; adding a smoking cessation intervention to screening could further improve screening program outcomes. This study aimed to assess the impact of adding a smoking cessation intervention to lung cancer screening on clinical outcomes, costs and cost-effectiveness. METHODS Using the OncoSim-Lung mathematical microsimulation model, we compared the projected lifetime impact of a smoking cessation intervention (nicotine replacement therapy, varenicline and 12 wk of counselling) in the context of annual low-dose CT screening for lung cancer in people at high risk to lung cancer screening without a cessation intervention in Canada. The simulated population consisted of Canadians born in 1940-1974; lung cancer screening was offered to eligible people in 2020. In the base-case scenario, we assumed that the intervention would be offered to smokers up to 10 times; each intervention would achieve a 2.5% permanent quit rate. Sensitivity analyses varied key model inputs. We calculated incremental cost-effectiveness ratios with a lifetime horizon from the health system's perspective, discounted at 1.5% per year. Costs are in 2019 Canadian dollars. RESULTS Offering a smoking cessation intervention in the context of lung cancer screening could lead to an additional 13% of smokers quitting smoking. It could potentially prevent 12 more lung cancers and save 200 more life-years for every 1000 smokers screened, at a cost of $22 000 per quality-adjusted life-year (QALY) gained. The results were most sensitive to quit rate. The intervention would cost over $50 000 per QALY gained with a permanent quit rate of less than 1.25% per attempt. INTERPRETATION Adding a smoking cessation intervention to lung cancer screening is likely cost-effective. To optimize the benefits of lung cancer screening, health care providers should encourage participants who still smoke to quit smoking.
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Affiliation(s)
- William K Evans
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - Cindy L Gauvreau
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - William M Flanagan
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - Saima Memon
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - Jean Hai Ein Yong
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - John R Goffin
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - Natalie R Fitzgerald
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - Michael Wolfson
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont
| | - Anthony B Miller
- Department of Oncology (Evans, Goffin), McMaster University, Hamilton, Ont.; Canadian Partnership Against Cancer (Gauvreau, Memon, Yong, Fitzgerald), Toronto, Ont.; Statistics Canada (Flanagan); Faculties of Medicine and Law (Wolfson), University of Ottawa, Ottawa, Ont.; Department of Public Health Sciences (Miller), University of Toronto, Toronto, Ont.
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Veronesi G, Baldwin DR, Henschke CI, Ghislandi S, Iavicoli S, Oudkerk M, De Koning HJ, Shemesh J, Field JK, Zulueta JJ, Horgan D, Fiestas Navarrete L, Infante MV, Novellis P, Murray RL, Peled N, Rampinelli C, Rocco G, Rzyman W, Scagliotti GV, Tammemagi MC, Bertolaccini L, Triphuridet N, Yip R, Rossi A, Senan S, Ferrante G, Brain K, van der Aalst C, Bonomo L, Consonni D, Van Meerbeeck JP, Maisonneuve P, Novello S, Devaraj A, Saghir Z, Pelosi G. Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe. Cancers (Basel) 2020; 12:E1672. [PMID: 32599792 PMCID: PMC7352874 DOI: 10.3390/cancers12061672] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the "Initiative for European Lung Screening (IELS)"-a large international group of physicians and other experts concerned with lung cancer-agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
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Affiliation(s)
- Giulia Veronesi
- Faculty of Medicine and Surgery—Vita-Salute San Raffaele University, 20132 Milan, Italy;
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - David R. Baldwin
- Department of Respiratory Medicine, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK;
| | - Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
| | - Simone Ghislandi
- Department of Social and Political Sciences, Bocconi University, 20136 Milan, Italy; (S.G.); (L.F.N.)
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority (INAIL), 00078 Rome, Italy;
| | - Matthijs Oudkerk
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands;
| | - Harry J. De Koning
- Department of Public Health, Erasmus MC—University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.J.D.K.); (C.v.d.A.)
| | - Joseph Shemesh
- The Grace Ballas Cardiac Research Unit, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, 52621 Tel Aviv-Yafo, Israel;
| | - John K. Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool L69 3BX, UK;
| | - Javier J. Zulueta
- Department of Pulmonology, Clinica Universidad de Navarra, 31008 Pamplona, Spain;
- Visiongate Inc., Phoenix, AZ 85044, USA
| | - Denis Horgan
- European Alliance for Personalised Medicine (EAPM), Avenue de l’Armée Legerlaan 10, 1040 Brussels, Belgium;
| | - Lucia Fiestas Navarrete
- Department of Social and Political Sciences, Bocconi University, 20136 Milan, Italy; (S.G.); (L.F.N.)
| | | | - Pierluigi Novellis
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Rachael L. Murray
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham NG5 1PB, UK;
| | - Nir Peled
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, 84101 Beer-Sheva, Israel;
| | - Cristiano Rampinelli
- Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Gaetano Rocco
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | | | - Martin C. Tammemagi
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St Catharines, ON L2S 3A1, Canada;
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Natthaya Triphuridet
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
- Faculty of Medicine and Public Health, Chulabhorn Royal Academy, HRH Princess Chulabhorn College of Medical Science, Bangkok 10210, Thailand
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele (MI), Italy;
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, VU location, De Boelelaan 1117, Postbox 7057, 1007 MB Amsterdam, The Netherlands;
| | - Giuseppe Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano (MI), Italy;
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS, UK;
| | - Carlijn van der Aalst
- Department of Public Health, Erasmus MC—University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.J.D.K.); (C.v.d.A.)
| | - Lorenzo Bonomo
- Department of Bioimaging and Radiological Sciences, Catholic University, 00168 Rome, Italy;
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Jan P. Van Meerbeeck
- Thoracic Oncology, Antwerp University Hospital and Ghent University, 2650 Edegem, Belgium;
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Silvia Novello
- Department of Oncology, University of Torino, 10124 Torino, Italy; (G.V.S.); (S.N.)
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London SW3 6NP, UK;
| | - Zaigham Saghir
- Department of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark;
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Inter-Hospital Pathology Division, IRCCS MultiMedica, 20138 Milan, Italy
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Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe. Cancers (Basel) 2020; 12:0. [PMID: 32599792 PMCID: PMC7352874 DOI: 10.3390/cancers12060000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the "Initiative for European Lung Screening (IELS)"-a large international group of physicians and other experts concerned with lung cancer-agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Nardi Agmon I, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Respir J 2020; 55:13993003.00506-2019. [PMID: 32051182 DOI: 10.1183/13993003.00506-2019] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Dept of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, CH Lyon Sud, Pierre Bénite, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Dept of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Dept of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Dept of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Dept of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital Sotiria, Athens, Greece
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39
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Agmon IN, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Radiol 2020; 30:3277-3294. [PMID: 32052170 DOI: 10.1007/s00330-020-06727-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings.• For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany.
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Department of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, Sud, Pierre Bénite, Lyon, CH, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Department of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Department of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
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40
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de Koning HJ, van der Aalst CM, de Jong PA, Scholten ET, Nackaerts K, Heuvelmans MA, Lammers JWJ, Weenink C, Yousaf-Khan U, Horeweg N, van 't Westeinde S, Prokop M, Mali WP, Mohamed Hoesein FAA, van Ooijen PMA, Aerts JGJV, den Bakker MA, Thunnissen E, Verschakelen J, Vliegenthart R, Walter JE, Ten Haaf K, Groen HJM, Oudkerk M. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med 2020; 382:503-513. [PMID: 31995683 DOI: 10.1056/nejmoa1911793] [Citation(s) in RCA: 1575] [Impact Index Per Article: 393.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers. METHODS A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants. RESULTS Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 (95% confidence interval [CI], 0.61 to 0.94; P = 0.01) in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 (95% CI, 0.38 to 1.14) at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9. CONCLUSIONS In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580.).
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Affiliation(s)
- Harry J de Koning
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Carlijn M van der Aalst
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Pim A de Jong
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Ernst T Scholten
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Kristiaan Nackaerts
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Marjolein A Heuvelmans
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Jan-Willem J Lammers
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Carla Weenink
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Uraujh Yousaf-Khan
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Nanda Horeweg
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Susan van 't Westeinde
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Mathias Prokop
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Willem P Mali
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Firdaus A A Mohamed Hoesein
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Peter M A van Ooijen
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Joachim G J V Aerts
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Michael A den Bakker
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Erik Thunnissen
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Johny Verschakelen
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Rozemarijn Vliegenthart
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Joan E Walter
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Kevin Ten Haaf
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Harry J M Groen
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
| | - Matthijs Oudkerk
- From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium
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Attending community-based lung cancer screening influences smoking behaviour in deprived populations. Lung Cancer 2020; 139:41-46. [DOI: 10.1016/j.lungcan.2019.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/24/2019] [Indexed: 11/23/2022]
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Smith P, Poole R, Mann M, Nelson A, Moore G, Brain K. Systematic review of behavioural smoking cessation interventions for older smokers from deprived backgrounds. BMJ Open 2019; 9:e032727. [PMID: 31678956 PMCID: PMC6830832 DOI: 10.1136/bmjopen-2019-032727] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The associations between smoking prevalence, socioeconomic group and lung cancer outcomes are well established. There is currently limited evidence for how inequalities could be addressed through specific smoking cessation interventions (SCIs) for a lung cancer screening eligible population. This systematic review aims to identify the behavioural elements of SCIs used in older adults from low socioeconomic groups, and to examine their impact on smoking abstinence and psychosocial variables. METHOD Systematic searches of Medline, EMBASE, PsychInfo and CINAHL up to November 2018 were conducted. Included studies examined the characteristics of SCIs and their impact on relevant outcomes including smoking abstinence, quit motivation, nicotine dependence, perceived social influence and quit determination. Included studies were restricted to socioeconomically deprived older adults who are at (or approaching) eligibility for lung cancer screening. Narrative data synthesis was conducted. RESULTS Eleven studies met the inclusion criteria. Methodological quality was variable, with most studies using self-reported smoking cessation and varying length of follow-up. There were limited data to identify the optimal form of behavioural SCI for the target population. Intense multimodal behavioural counselling that uses incentives and peer facilitators, delivered in a community setting and tailored to individual needs indicated a positive impact on smoking outcomes. CONCLUSION Tailored, multimodal behavioural interventions embedded in local communities could potentially support cessation among older, deprived smokers. Further high-quality research is needed to understand the effectiveness of SCIs in the context of lung screening for the target population. PROSPERO REGISTRATION NUMBER CRD42018088956.
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Affiliation(s)
- Pamela Smith
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Ria Poole
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Mala Mann
- Specialist Unit for Review Evidence, Cardiff University, Cardiff, UK
| | - Annmarie Nelson
- Marie Curie Research Centre, Cardiff University, Cardiff, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Koegelenberg CFN, Dorfman S, Schewitz I, Richards GA, Maasdorp S, Smith C, Dheda K. Recommendations for lung cancer screening in Southern Africa. J Thorac Dis 2019; 11:3696-3703. [PMID: 31656641 DOI: 10.21037/jtd.2019.08.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer remains the leading cause of cancer-related deaths in southern Africa. Early trials of chest radiograph-based screening in males at high risk for lung cancer found no mortality benefit of a radiograph alone, or a radiograph plus sputum cytology screening strategy. Large prospective studies, including the National Lung Screening Trial, have shown an all-cause mortality benefit when low-dose computed tomography (LDCT) was used as a screening modality in patients that are at high risk of developing lung cancer. The South African Thoracic Society, based on these findings, and those from several international guidelines, recommend that annual LDCT should be offered to patients between 55-74 years of age who are current or former smokers (having quit within the preceding 15 years), with at least a 30-pack year smoking history and with no history of lung cancer. Patients should be in general good health, fit for surgery, and willing to undergo further investigations if deemed necessary. Given the high local prevalence of tuberculosis (TB) infection and post-TB lung disease, which can radiographically mimic lung cancer, a conservative threshold (nodule size ≥6 mm) should be used to determine whether the baseline LDCT screen is positive (thus nodules <6 mm require no action until the next annual screen). If a non-calcified, solid or partly solid nodule is ≥6 mm, but <10 mm with no malignant features (e.g., distinct spiculated margins), the LDCT should be repeated in 6 months. If a solid nodule or the largest component of a non-solid nodule is ≥10 or ≥6 mm and enlarging or with additional malignant features present, definitive action to exclude lung cancer is warranted. Patients should be screened annually until 15 years have elapsed from date of smoking cessation, they turn 80, become unfit for a curative operation or significant changes are observed.
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Affiliation(s)
- Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Shane Dorfman
- Diagnostic Radiological Services (DRS) Inc., Alberton, South Africa
| | - Ivan Schewitz
- Department of Cardiothoracic Surgery, Pretoria University and Steve Biko Hospital, Pretoria, South Africa
| | - Guy A Richards
- Departments of Pulmonology and Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shaun Maasdorp
- Division of Pulmonology and Critical Care, Department of Medicine, University of the Free State and Universitas Academic Hospital, Bloemfontein, South Africa
| | | | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa.,Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
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Prevention and Early Detection for NSCLC: Advances in Thoracic Oncology 2018. J Thorac Oncol 2019; 14:1513-1527. [DOI: 10.1016/j.jtho.2019.06.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/24/2019] [Accepted: 06/07/2019] [Indexed: 02/06/2023]
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Pistelli F, Aquilini F, Falaschi F, Puliti D, Ocello C, Lopes Pegna A, Carozzi FM, Picozzi G, Zappa M, Mascalchi M, Paci E, Carrozzi L, Gorini G, Manneschi G, Visioli C, Cordopatri G, Giusti F, Esposito I, Bianchi R, Ronchi C, Cini S, De Santis M, Baliva F, Chella A, Tavanti L, Grazzini M, Innocenti F, Natali I, Bartolucci M, Crisci E, De Francisci A, Falchini M, Gabbrielli S, Roselli G, Masi A, Battolla L, De Liperi A, Spinelli C, Vannucchi L, Petruzzelli A, Gadda D, Neri AT, Niccolai F, Vaggelli L, Vella A, Maddau C, Bisanzi S, Janni A, Mussi A, Lucchi M, Comin C, Fontanini G, Tognetti AR, Iacuzio L, Caldarella A, Barchielli A, Goldoni CA. Smoking Cessation in the ITALUNG Lung Cancer Screening: What Does “Teachable Moment” Mean? Nicotine Tob Res 2019; 22:1484-1491. [DOI: 10.1093/ntr/ntz148] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/15/2019] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Changes in smoking habits and predictors of smoking cessation were examined in the randomized ITALUNG lung cancer screening trial.
Methods
In three centers, eligible smokers or ex-smokers (55–69 years, ≥20 pack-years in the last 10 years) were randomized to receive annual invitation for low-dose computed tomography for 4 years or usual care. At invitation, subjects received written information for a free smoking cessation program. Quitting outcome was assessed at year 4.
Results
Among participants who completed baseline assessments and year 4 screening, higher quitting (20.8% vs. 16.7%, p = .029) and lower relapse (6.41% vs. 7.56%, p = .50) rates were observed in the active screening group as compared to the usual-care control group. Corresponding figures in the intention-to-treat analysis were as follows: 16.04% versus 14.64% (p = .059) and 4.88% versus 6.43% (p = .26). Quitting smoking was significantly associated to male gender, lower pack-years, and having pulmonary nodules at baseline. Center-specific analyses showed a threefold statistically significant higher probability to quit associated with participating in the smoking cessation program. A subsample of smokers of the scan group from one center showed higher quitting rates over 12-month follow-up as compared to matched controls from the general population who underwent the same smoking cessation program.
Conclusions
Consistently with previous reports, in the ITALUNG trial, screened subjects showed significantly higher quit rates than controls, and higher quit rates were associated with both the presence of pulmonary nodules and participating in a smoking cessation program. Maximal effect on quitting outcome was observed with the participation in the smoking cessation program.
Implications
Participating in lung cancer screening promotes smoking cessation. An effective “teachable moment” may be achieved when the smoking cessation intervention is structured as integral part of the screening clinical visits and conducted by a dedicated team of health care professionals. Standardized guidelines for smoking cessation interventions in lung cancer screening are needed.
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Affiliation(s)
- Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Ferruccio Aquilini
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Fabio Falaschi
- 2nd Radiodiagnostic Unit, Department of Diagnostic Imaging, University Hospital of Pisa, Pisa, Italy
| | - Donella Puliti
- Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Cristina Ocello
- Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Andrea Lopes Pegna
- Formerly Pneumonology Department, University Hospital Careggi, Florence, Italy
| | - Francesca Maria Carozzi
- Cancer Prevention Regional Laboratory, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Giulia Picozzi
- Clinical Breast Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy, Florence, Italy
| | - Marco Zappa
- Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Mario Mascalchi
- Formerly Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Eugenio Paci
- Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Laura Carrozzi
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa
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46
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[Lung cancer screening]. Radiologe 2019; 59:19-22. [PMID: 30542924 DOI: 10.1007/s00117-018-0478-1] [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: 10/27/2022]
Abstract
CLINICAL/METHODICAL ISSUE The National Lung Screening Trial (NLST) in 2011 was able to prove for the first time that screening with a low-dose CT can reduce lung carcinoma mortality by 20%. Despite the positive outcome of the NLST, there is-unlike in the USA-currently no systematic lung cancer screening in Europe. This is partly because several significantly smaller screening studies in Europe failed to show any improvement in lung cancer mortality. STANDARD RADIOLOGICAL METHODS On the other hand, Europe's healthcare systems differ substantially from those in the United States, so that a direct transfer of US experience to Europe is not possible. For this reason, guidelines for lung cancer screening must be developed in the individual European countries to ensure that lung cancer mortality can be reduced by means of a quality-assured and cost-effective lung cancer screening. PRACTICAL RECOMMENDATIONS The experience and the expected results of the European screening studies can provide valuable help for these purposes.
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Stevens C, Smith SG, Vrinten C, Waller J, Beeken RJ. Lifestyle changes associated with participation in colorectal cancer screening: Prospective data from the English Longitudinal Study of Ageing. J Med Screen 2019; 26:84-91. [PMID: 30336731 PMCID: PMC6484824 DOI: 10.1177/0969141318803973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/10/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Population-based cancer screening has been described as a teachable moment for behaviour change. This research examined the effect of faecal occult blood testing (FOBT) participation on smoking, alcohol consumption, fruit and vegetable consumption and physical activity. SETTING Data were from screening-naïve men within the English Longitudinal Study of Ageing, receiving their first FOBT invitation (n = 774). Four waves of data were included in analyses (wave 4, 2008/2009 - wave 7, 2014/2015). Baseline data were from the wave prior to FOBT invitation, and follow-up data were from the next consecutive wave (two years later). METHODS The effects of FOBT participation, time and group-by-time interactions on health behaviours were investigated using generalised estimating equations. Almost two-thirds of the sample (62.5%; n = 484) had participated in FOBT. RESULTS Screening participants were less likely to smoke (odds ratio (OR): 0.45, 95% confidence interval (CI): 0.29-0.68) and more likely to meet fruit and vegetable consumption guidelines (OR: 1.70, 95% CI: 1.14-2.55). Smoking decreased over time (OR: 0.74, 95% CI: 0.62-0.89), but adherence to alcohol guidelines also decreased (OR: 0.71, 95% CI: 0.53-0.91). A group-by-time interaction was found for vigorous physical activity; the odds of taking part in vigorous physical activity increased for FOBT participants, but decreased for non-participants (OR: 1.40, 95% CI: 1.01-1.95). CONCLUSIONS This research provides tentative support for FOBT as a teachable moment for increasing vigorous physical activity. However, overall, there was limited evidence for spontaneous improvement in multiple health behaviours following participation.
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Affiliation(s)
- Claire Stevens
- Department of Behavioural Science and Health, University College London, London, UK
| | - Samuel G Smith
- Department of Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Charlotte Vrinten
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Ghimire B, Maroni R, Vulkan D, Shah Z, Gaynor E, Timoney M, Jones L, Arvanitis R, Ledson M, Lukehirst L, Rutherford P, Clarke F, Gardner K, Marcus MW, Hill S, Fidoe D, Mason S, Smith SG, Quaife SL, Fitzgerald K, Poirier V, Duffy SW, Field JK. Evaluation of a health service adopting proactive approach to reduce high risk of lung cancer: The Liverpool Healthy Lung Programme. Lung Cancer 2019; 134:66-71. [PMID: 31319997 DOI: 10.1016/j.lungcan.2019.05.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/21/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This Liverpool Healthy Lung Programme is a response to high rates of lung cancer and respiratory diseases locally and aims to diagnose lung cancer at an earlier stage by proactive approach to those at high risk of lung cancer. The objective of this study is to evaluate the programme in terms of its likely effect on mortality from lung cancer and its delivery to deprived populations. METHODS Persons aged 58-75 years, with a history of smoking or a diagnosis of chronic obstructive pulmonary disease (COPD)2 according to general practice records were invited for lung health check in a community health hub setting. A detailed risk assessment and spirometry were performed in eligible patients. Those with a 5% or greater five-year risk of lung cancer were referred for a low dose CT3 scan. RESULTS A total of 4 566 subjects attended the appointment for risk assessment and 3 591 (79%) consented to data sharing. More than 80% of the patients were in the most deprived quintile of the index of multiple deprivation. Of those attending, 63% underwent spirometry and 43% were recommended for a CT scan. A total of 25 cancers were diagnosed, of which 16 (64%) were stage I. Comparison with the national stage distribution implied that the programme was reducing lung cancer mortality by 22%. CONCLUSIONS Community based proactive approaches to early diagnosis of lung cancer in health deprived regions are likely to be effective in early detection of lung cancer.
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Affiliation(s)
- Bhagabati Ghimire
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK.
| | - Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - Daniel Vulkan
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - Zoheb Shah
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - Edward Gaynor
- National Health Service (NHS) Liverpool Clinical Commissioning Group, UK
| | - Michelle Timoney
- National Health Service (NHS) Liverpool Clinical Commissioning Group, UK
| | - Lisa Jones
- National Health Service (NHS) Liverpool Clinical Commissioning Group, UK
| | - Rachel Arvanitis
- National Health Service (NHS) Liverpool Clinical Commissioning Group, UK
| | | | | | | | | | - Katy Gardner
- Macmillan General Practitioner, NHS Liverpool Clinical Commissioning Group, UK
| | - Michael W Marcus
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
| | - Sarah Hill
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
| | - Darcy Fidoe
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
| | - Sabrina Mason
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
| | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, UK
| | - Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, UK
| | - Karen Fitzgerald
- Accelerate, Coordinate, Evaluate (ACE) team, Cancer Research, UK
| | | | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - John K Field
- Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre, UK
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Balata H, Evison M, Sharman A, Crosbie P, Booton R. CT screening for lung cancer: Are we ready to implement in Europe? Lung Cancer 2019; 134:25-33. [PMID: 31319989 DOI: 10.1016/j.lungcan.2019.05.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/12/2019] [Accepted: 05/26/2019] [Indexed: 12/23/2022]
Abstract
Lung cancer screening with low-dose CT (LDCT) is already available in certain parts of the world, such as the United States, but not yet in Europe. The recently published European position statement on lung cancer screening has recommended planning for implementation of screening to start within 18-months [1]. Pilot European programmes are already underway, primarily in the United Kingdom (UK), delivering lung cancer screening to their local populations. This review article acknowledges the evidence base for LDCT screening and will discuss the challenges that still need to be overcome in an attempt to answer the question: are we ready to implement in Europe?
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Affiliation(s)
- Haval Balata
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health University of Manchester, Manchester, UK.
| | - Matthew Evison
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - Anna Sharman
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - Philip Crosbie
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
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Snowsill T, Yang H, Griffin E, Long L, Varley-Campbell J, Coelho H, Robinson S, Hyde C. Low-dose computed tomography for lung cancer screening in high-risk populations: a systematic review and economic evaluation. Health Technol Assess 2019; 22:1-276. [PMID: 30518460 DOI: 10.3310/hta22690] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diagnosis of lung cancer frequently occurs in its later stages. Low-dose computed tomography (LDCT) could detect lung cancer early. OBJECTIVES To estimate the clinical effectiveness and cost-effectiveness of LDCT lung cancer screening in high-risk populations. DATA SOURCES Bibliographic sources included MEDLINE, EMBASE, Web of Science and The Cochrane Library. METHODS Clinical effectiveness - a systematic review of randomised controlled trials (RCTs) comparing LDCT screening programmes with usual care (no screening) or other imaging screening programmes [such as chest X-ray (CXR)] was conducted. Bibliographic sources included MEDLINE, EMBASE, Web of Science and The Cochrane Library. Meta-analyses, including network meta-analyses, were performed. Cost-effectiveness - an independent economic model employing discrete event simulation and using a natural history model calibrated to results from a large RCT was developed. There were 12 different population eligibility criteria and four intervention frequencies [(1) single screen, (2) triple screen, (3) annual screening and (4) biennial screening] and a no-screening control arm. RESULTS Clinical effectiveness - 12 RCTs were included, four of which currently contribute evidence on mortality. Meta-analysis of these demonstrated that LDCT, with ≤ 9.80 years of follow-up, was associated with a non-statistically significant decrease in lung cancer mortality (pooled relative risk 0.94, 95% confidence interval 0.74 to 1.19). The findings also showed that LDCT screening demonstrated a non-statistically significant increase in all-cause mortality. Given the considerable heterogeneity detected between studies for both outcomes, the results should be treated with caution. Network meta-analysis, including six RCTs, was performed to assess the relative clinical effectiveness of LDCT, CXR and usual care. The results showed that LDCT was ranked as the best screening strategy in terms of lung cancer mortality reduction. CXR had a 99.7% probability of being the worst intervention and usual care was ranked second. Cost-effectiveness - screening programmes are predicted to be more effective than no screening, reduce lung cancer mortality and result in more lung cancer diagnoses. Screening programmes also increase costs. Screening for lung cancer is unlikely to be cost-effective at a threshold of £20,000/quality-adjusted life-year (QALY), but may be cost-effective at a threshold of £30,000/QALY. The incremental cost-effectiveness ratio for a single screen in smokers aged 60-75 years with at least a 3% risk of lung cancer is £28,169 per QALY. Sensitivity and scenario analyses were conducted. Screening was only cost-effective at a threshold of £20,000/QALY in only a minority of analyses. LIMITATIONS Clinical effectiveness - the largest of the included RCTs compared LDCT with CXR screening rather than no screening. Cost-effectiveness - a representative cost to the NHS of lung cancer has not been recently estimated according to key variables such as stage at diagnosis. Certain costs associated with running a screening programme have not been included. CONCLUSIONS LDCT screening may be clinically effective in reducing lung cancer mortality, but there is considerable uncertainty. There is evidence that a single round of screening could be considered cost-effective at conventional thresholds, but there is significant uncertainty about the effect on costs and the magnitude of benefits. FUTURE WORK Clinical effectiveness and cost-effectiveness estimates should be updated with the anticipated results from several ongoing RCTs [particularly the NEderlands Leuvens Longkanker Screenings ONderzoek (NELSON) screening trial]. STUDY REGISTRATION This study is registered as PROSPERO CRD42016048530. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Tristan Snowsill
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Huiqin Yang
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Ed Griffin
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Linda Long
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Jo Varley-Campbell
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Helen Coelho
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK.,Exeter Test Group, University of Exeter Medical School, Exeter, UK
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