1
|
Núñez ER, Zhang S, Glickman ME, Qian SX, Boudreau JH, Lindenauer PK, Slatore CG, Miller DR, Caverly TJ, Wiener RS. What Goes into Patient Selection for Lung Cancer Screening? Factors Associated with Clinician Judgments of Suitability for Screening. Am J Respir Crit Care Med 2024; 209:197-205. [PMID: 37819144 PMCID: PMC10806423 DOI: 10.1164/rccm.202301-0155oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023] Open
Abstract
Rationale: Achieving the net benefit of lung cancer screening (LCS) depends on optimizing patient selection. Objective: To identify factors associated with clinician assessments that a patient was unlikely to benefit from LCS ("LCS-inappropriate") because of comorbidities or limited life expectancy. Methods: Retrospective analysis of patients assessed for LCS at 30 Veterans Health Administration facilities from January 1, 2015 to February 1, 2021. We conducted hierarchical mixed-effects logistic regression analyses to determine factors associated with clinicians' designations of LCS inappropriateness (primary outcome), accounting for 3-year predicted probability (i.e., competing risk) of non-lung cancer death. Measurements and Main Results: Among 38,487 LCS-eligible patients, 1,671 (4.3%) were deemed LCS-inappropriate by clinicians, whereas 4,383 (11.4%) had an estimated 3-year competing risk of non-lung cancer death greater than 20%. Patients with higher competing risks of non-lung cancer death were more likely to be deemed LCS-inappropriate (odds ratio [OR], 2.66; 95% confidence interval [CI], 2.32-3.05). Older patients (ages 75-80; OR, 1.45; 95% CI, 1.18-1.78) and those with interstitial lung disease (OR, 1.98; 95% CI, 1.51-2.59) were more likely to be deemed LCS-inappropriate than would be explained by competing risk of non-lung cancer death, whereas patients currently smoking (OR, 0.65; 95% CI, 0.58-0.73) were less likely to be deemed LCS-inappropriate, suggesting that clinicians over- or underweighted these factors. The probability of being deemed LCS-inappropriate varied from 0.4% to 74%, depending on the clinician making the assessment (median OR, 3.07; 95% CI, 2.89-3.25). Conclusion: Concerningly, the likelihood that a patient is deemed LCS-inappropriate is more strongly associated with the clinician making the assessment than with patient characteristics. Patient selection may be optimized by providing decision support to help clinicians assess net LCS benefit.
Collapse
Affiliation(s)
- Eduardo R. Núñez
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- The Pulmonary Center, School of Medicine, Boston University, Boston, Massachusetts
- Department of Healthcare Delivery and Population Sciences, Chan Medical School-Baystate, University of Massachusetts, Springfield, Massachusetts
| | - Sanqian Zhang
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Mark E. Glickman
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Shirley X. Qian
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Jacqueline H. Boudreau
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences, Chan Medical School-Baystate, University of Massachusetts, Springfield, Massachusetts
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland Oregon
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon
| | - Donald R. Miller
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Massachusetts
| | - Tanner J. Caverly
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan; and
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- The Pulmonary Center, School of Medicine, Boston University, Boston, Massachusetts
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
| |
Collapse
|
2
|
Ju W, Zheng R, Wang S, Zhang S, Zeng H, Chen R, Sun K, Li L, Wei W. The occurence of cancer in ageing populations at global and regional levels, 1990 to 2019. Age Ageing 2023; 52:afad043. [PMID: 37725972 DOI: 10.1093/ageing/afad043] [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: 05/05/2022] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND population ageing contributes to increased cancer cases and deaths and has profound implications for global healthcare systems. We estimated the trends of cancer cases and deaths in ageing populations at global and regional levels. METHODS using data from the Global Burden of Disease Study 2019, we analysed the change in cancer cases and deaths associated with population ageing, population growth and epidemiological factors from 1990 to 2019 using decomposition analysis. Additionally, we estimated the proportions of people aged 65 years and over accounting for total cases and deaths, and investigated relationships between the proportions and the Sociodemographic Index (SDI) using the Pearson correlation coefficient. RESULTS from 1990 to 2019, there was an increase of 128.9% for total cases and 74.8% for total deaths in all cancers combined; the percentages of older people increased from 48.6% to 56.4% for cases and from 52.0% to 61.9% for deaths. Population ageing contributed to the largest increase in global cancer occurrence, with 56.5% for cases and 63.3% for deaths. However, the changes attributed to epidemiological factors was 5.2% for cancer cases and -33.4% for cancer deaths. The proportions of total cases and deaths of older adults were positively correlated with socioeconomic development of the country. CONCLUSION our findings revealed that the main contributor to increased cancer cases and deaths has changed from comprehensive epidemiological factors to demographic shifts. To respond to the rapidly growing occurrence of cancer in ageing populations, the global health priority should focus on meeting the rising demand for cancer diagnosis, treatment and care services for older people.
Collapse
Affiliation(s)
- Wen Ju
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Rongshou Zheng
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shaoming Wang
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Siwei Zhang
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hongmei Zeng
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ru Chen
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Kexin Sun
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Li Li
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wenqiang Wei
- Office for Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
3
|
Cancer statistics in Chinese older people, 2022: current burden, time trends, and comparisons with the US, Japan, and the Republic of Korea. SCIENCE CHINA LIFE SCIENCES 2022; 66:1079-1091. [PMID: 36543994 DOI: 10.1007/s11427-022-2218-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022]
Abstract
Largely due to population ageing, the cancer burden from older people has been rising, which imposed considerable pressure on current Chinese healthcare system. We provide comprehensive information about cancer burden of Chinese older people based on the most recent data from National Central Cancer Registry of China. The logarithmic linear regression was used to project the current cancer burden in 2022, and Joinpoint regression was used for temporal trend analysis from 2000 to 2017. We also estimated cancer statistics of older people in the US, Japan and the Republic of Korea for comparisons. It is estimated that 2.79 million cases and 1.94 million deaths occur for Chinese older people, representing 55.8% and 68.2% of cases and deaths in all population in 2022. The overall cancer incidence rate gradually increased among older women, while the mortality rates declined for both sexes. Notably, approximately 10.0% of all cases and 17.7% of all deaths are from people aged over 80 years, and cancer incidence and mortality in this age group showed upward trends for women. Lung cancer and digestive cancers are the leading cancer types for Chinese older people. Compared with other countries, China has lower incidence rates but higher mortality rates for older people. The rapidly growing burden of prostate cancer, breast cancer, colorectal cancer, and declines in esophageal cancer, stomach cancer, and liver cancer among older people indicate the cancer pattern in China is being in a transition stage to that in developed countries. Our findings imply that it should be the national health priority to meet the growing demands for cancer diagnosis, treatment and care services from the older people as the rapid population ageing in next few decades.
Collapse
|
4
|
Wood DE, Kazerooni EA, Baum SL, Eapen GA, Ettinger DS, Hou L, Jackman DM, Klippenstein D, Kumar R, Lackner RP, Leard LE, Lennes IT, Leung ANC, Makani SS, Massion PP, Mazzone P, Merritt RE, Meyers BF, Midthun DE, Pipavath S, Pratt C, Reddy C, Reid ME, Rotter AJ, Sachs PB, Schabath MB, Schiebler ML, Tong BC, Travis WD, Wei B, Yang SC, Gregory KM, Hughes M. Lung Cancer Screening, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 16:412-441. [PMID: 29632061 DOI: 10.6004/jnccn.2018.0020] [Citation(s) in RCA: 370] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appropriate Medicare beneficiaries at high risk for lung cancer if they also receive counseling and participate in shared decision-making before screening. The complete version of the NCCN Guidelines for Lung Cancer Screening provides recommendations for initial and subsequent LDCT screening and provides more detail about LDCT screening. This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for LDCT of the chest and on evaluating initial screening findings.
Collapse
|
5
|
Jungraithmayr W. Lung cancer surgery in octogenarians revisited-risk factors and survival in a long lifespan population. J Thorac Dis 2019; 10:6423-6426. [PMID: 30746180 DOI: 10.21037/jtd.2018.12.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
6
|
Vazirani J, Moraes J, Barnett S, Johnson DF, Knight S, Miller A, Wright G, Alam NZ, Conron M, Irving LB, Antippa P, Steinfort DP. Outcomes following resection of non-small cell lung cancer in octogenarians. ANZ J Surg 2018; 88:1322-1327. [DOI: 10.1111/ans.14861] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jaideep Vazirani
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Johanna Moraes
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Stephen Barnett
- Department of Cardiothoracic Surgery; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Thoracic Surgery; Austin Hospital; Melbourne Victoria Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
| | - Douglas F. Johnson
- Department of Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Simon Knight
- Department of Thoracic Surgery; Austin Hospital; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
| | - Alistair Miller
- Department of Respiratory and Sleep Medicine; Monash Health; Melbourne Victoria Australia
| | - Gavin Wright
- Department of Cardiothoracic Surgery; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
- Department of Cardiothoracic Surgery; St Vincent's Hospital; Melbourne Victoria Australia
| | - Naveed Z. Alam
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
- Department of Cardiothoracic Surgery; St Vincent's Hospital; Melbourne Victoria Australia
| | - Matthew Conron
- Department of Respiratory and Sleep Medicine; St Vincent's Hospital; Melbourne Victoria Australia
- Department of Cancer Medicine; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Louis B. Irving
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
- Department of Cancer Medicine; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
| | - Daniel P. Steinfort
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
- Department of Cancer Medicine; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| |
Collapse
|
7
|
Non-Small Cell Lung Cancer in the Elderly: a Practical Approach to Screening, Diagnosis, and Treatment. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
8
|
Nemesure B, Plank A, Reagan L, Albano D, Reiter M, Bilfinger TV. Evaluating efficacy of current lung cancer screening guidelines. J Med Screen 2017; 24:208-213. [DOI: 10.1177/0969141316689111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective Current lung cancer screening criteria based primarily on outcomes from the National Lung Screening Trial may not adequately capture all subgroups of the population at risk. We aimed to evaluate the efficacy of lung cancer screening criteria recommended by the United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and the National Comprehensive Cancer Network in identifying known cases of lung cancer. Methods An investigation of the Stony Brook Cancer Center Lung Cancer Evaluation Center's database identified 1207 eligible, biopsy-proven lung cancer cases diagnosed between January 1996 and March 2016. Age at diagnosis, smoking history, and other known risk factors for lung cancer were used to determine the proportion of cases that would have met current United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and National Comprehensive Cancer Network eligibility requirements for lung cancer screening. Results Of the 1046 ever smokers in the study, 40% did not meet the National Lung Screening Trial age requirements, 20% did not have a ≥30 pack year smoking history, and approximately one-third quit smoking >15 years before diagnosis, thus deeming them ineligible for screening. Applying the United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and National Comprehensive Cancer Network eligibility criteria to the Stony Brook Cancer Center's Lung Cancer Evaluation Center cases, 49.2, 46.3, and 69.8%, respectively, would have met the current lung cancer screening guidelines. Conclusions The United States Preventive Services Task Force and Centers for Medicare and Medicaid Services eligibility criteria for lung cancer screening captured less than 50% of lung cancer cases in this investigation. These findings highlight the need to reevaluate the efficacy of current guidelines and may have major public health implications.
Collapse
Affiliation(s)
- Barbara Nemesure
- Department of Family, Population and Preventive Medicine, Stony Brook Medicine, Stony Brook, USA
| | - April Plank
- Department of Radiology, Stony Brook Medicine, Stony Brook, USA
| | - Lisa Reagan
- Stony Brook Cancer Center, Stony Brook Medicine, Stony Brook, USA
| | - Denise Albano
- Department of Surgery, Stony Brook Medicine, Stony Brook, USA
| | - Michael Reiter
- Department of Radiology, Stony Brook Medicine, Stony Brook, USA
| | | |
Collapse
|
9
|
Abstract
Cancer screening is an important tool for reducing morbidity and mortality in the elderly. In this article, performance characteristics of commonly used screening tests for colorectal, lung, prostate, breast, and cervical cancers are discussed. Guidelines are emphasized and key issues to consider in screening older adults are highlighted.
Collapse
Affiliation(s)
- Sarah A Wingfield
- Geriatric Medicine, Duke University Medical Center, Box 3003, Durham, NC 27710, USA
| | - Mitchell T Heflin
- Department of Medicine, Division of Geriatrics, Center for the Study of Aging and Human Development, Duke University Medical Center, Duke University, Box 3003, Durham, NC 27710, USA.
| |
Collapse
|
10
|
Cascales A, Martinetti F, Belemsagha D, Le Pechoux C. Challenges in the treatment of early non-small cell lung cancer: what is the standard, what are the challenges and what is the future for radiotherapy? Transl Lung Cancer Res 2015; 3:195-204. [PMID: 25806301 DOI: 10.3978/j.issn.2218-6751.2014.08.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 07/23/2014] [Indexed: 12/25/2022]
Abstract
In the last 15 years, the use of Stereotactic Ablative Radiation Therapy (SABRT) in the management of small peripheral lung tumours has developed considerably, so that it currently represents a standard of care for inoperable stage I non-small cell lung cancer (NSCLC), offering a survival advantage over traditional radiotherapy, local control rates at 3 years around 90%, with a low risk of toxicity. Indications have extended to larger tumours up to 5 cm and centrally located tumours. In this review we will explore the role of SABRT in early stage NSCLC, the state of the art, the challenges and the future for this technique. There are ongoing studies to optimize such approaches within a multicentric setting. Trials comparing surgery to SABRT in operable or marginally operable have failed because of poor accrual. Several questions remain that need to be addressed in prospective studies.
Collapse
Affiliation(s)
- Almudena Cascales
- 1 Department of Radiation Oncology, 2 Medical Physics Unit, Gustave Roussy, Université Paris Sud, Villejuif, France
| | - Florent Martinetti
- 1 Department of Radiation Oncology, 2 Medical Physics Unit, Gustave Roussy, Université Paris Sud, Villejuif, France
| | - Deborah Belemsagha
- 1 Department of Radiation Oncology, 2 Medical Physics Unit, Gustave Roussy, Université Paris Sud, Villejuif, France
| | - Cecile Le Pechoux
- 1 Department of Radiation Oncology, 2 Medical Physics Unit, Gustave Roussy, Université Paris Sud, Villejuif, France
| |
Collapse
|
11
|
Abstract
To understand the challenges of screening for lung cancer, surgeons should be familiar with fundamental epidemiologic concepts pertaining to screening and have an understanding of the evidence regarding the various modalities used for screening lung cancer. One large, recent study has confirmed that screening for lung cancer with low-dose computed tomography decreases mortality in high-risk individuals. As a result of these findings, comprehensive screening programs are being developed. High-quality programs should be safe, cost-effective, accessible to high-risk patients, and involve the participation of a multidisciplinary team. Surgeons should be engaged in the implementation of screening programs for lung cancer.
Collapse
Affiliation(s)
- Sean C Grondin
- Department of Surgery, Foothills Medical Centre, University of Calgary, 1403 29th Street Northwest, Room G 33 D, Calgary, Alberta T2N 2T9, Canada.
| | - Janet P Edwards
- Department of Surgery, Foothills Medical Centre, University of Calgary, 1403 29th Street Northwest, Room G 33 D, Calgary, Alberta T2N 2T9, Canada
| | - Gaetano Rocco
- Division of Thoracic Surgery, Department of Thoracic Surgery and Oncology, Istituto Nazionale Tumori, Fondazione Pascale, IRCCS, Naples, Napoli, Italy
| |
Collapse
|