Lung Cancer |

Pilot Evaluation of a Pulmonary Specialty-Based Lung Cancer Screening Program FREE TO VIEW

Akshu Balwan, MBBS; Paul Han, MD; Caitlin Gutheil; Adam Black; Barbara Grillo, MHSA; Sharon Siegel, MD; Jason Yahwak, MD; Mayuko Fukunaga
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Maine Medical Center / Portland, ME, Portland, ME

Chest. 2015;148(4_MeetingAbstracts):567A. doi:10.1378/chest.2243242
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SESSION TITLE: Lung Cancer Screening & Diagnosis Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: To evaluate: 1) Feasibility and initial outcomes of a community- and pulmonary specialty-based program for lung cancer screening (LCS) using low-dose CT (LDCT). 2) Effects of LCS-shared decision making (SDM) counseling on patient knowledge and preparedness for decision making.

METHODS: A pulmonary specialty-based LCS pilot program was developed to identify, counsel and screen eligible patients. Structured SDM counseling was provided using an educational tool developed by the study team with expert input. The program was piloted among 25 patients, and its feasibility, initial outcomes, and efficacy in promoting SDM were assessed by measuring screening results, patient knowledge and preparedness for decision making before and after SDM counseling.

RESULTS: Forty-four patients were referred for LCS from April 2014 to July 2014. Sixteen patients (36%) were ineligible, 4(9%) cancelled, 25 (56%) completed screening. All patients agreed to proceed with LCS. Screened patients had an average age of 65.4 years and were predominantly male (56%) and former smokers (52%) with average smoking history of 57.2 pack-years. One patient underwent LCS despite not meeting age criteria (age 54 years, 2 months). Four (16%) patients had positive screens (nodule size >4mm). Pulmonologist-provided SDM counseling improved patient preparedness for decision making (Mean Decisional Conflict Scale score 5.5 at pre-counseling vs 9.9 at post-counseling, p<0.001). After counseling, 72% of patients overestimated the mortality benefit of LCS, while 25% underestimated its false-positive rate.

CONCLUSIONS: A sizeable proportion (36%) of patients referred for LCS were screening-ineligible. The positive screening rate was lower than National Lung Screening Trial but the small sample size limits definitive comparison. A pulmonary specialty-based LCS program is feasible but its sustainability and effectiveness need to be further evaluated. SDM counseling improved patient’s self-reported preparedness for decision making, but counseled patients had important knowledge deficits that need to be addressed.

CLINICAL IMPLICATIONS: Implementing LCS in community settings requires a comprehensive approach, effective processes and educational resources to ensure appropriate patient selection and SDM. Patient understanding of key facts about LCS needs to be improved in future SDM counseling efforts. More research is needed to address these challenges and to determine the optimal delivery models for LCS in community settings.

DISCLOSURE: The following authors have nothing to disclose: Akshu Balwan, Paul Han, Caitlin Gutheil, Adam Black, Barbara Grillo, Sharon Siegel, Jason Yahwak, Mayuko Fukunaga

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