LOTUS Research Products

Patterns of Recurrence Among Adults Diagnosed with Screen-Detected Lung Cancer

Authors: Carroll NM, Burnett-Hartman AN, Honda SA, Greenlee RT, Neslund-Dudas C, Rendle KA, Vachani A, Ritzwoller DP.

• The proportion of recurrence detected between Screen Detected Lung Cancer (SDLC) and Non-Screen Detected Lung Cancer (NSDLC) did not differ (p=0.90), however, more patients with NSDLC progressed to distant recurrence (p=0.046) in comparison to SDLC.
• We did not find a significant difference in Recurrence Free Survival between SDLC and NSDLC.
• Through 60 months, patients with SDLC had a 5.2 (1.8-8.6) months longer survival after definitive therapy relative to NSDLC (p <0.01).
• Among patients with a recurrence, patients with SDLC had a 3.9 (0.5-7.4) months longer survival after a recurrence relative to those with NSDLC (p=0.03) through 24 months of follow-up.
• Further study with larger sample size and longer follow-up is needed.

Predicting Pack-Year Eligibility for Lung Cancer Screening Using Two Yes/No Questions

Authors: Rendle KA, Steltz J, Cohen S, Schapira MM, Wender RC, Bekelman JE, Vachani A.

• Response to two yes/no questions showed high accuracy for predicting pack year eligibility for LCS, extending prior work and helping to advance equitable implementation of LCS through scalable approaches.
• We are currently evaluating these questions in a larger and more diverse sample. If accuracy remains high across groups, these questions have great potential to serve as a brief screener for identifying patients in routine care who should be assessed for full LCS eligibility and also as a pragmatic way to identify target audiences for widespread interventions designed to increase LCS.

Incidental Thyroid Findings In Low-Dose Computed Tomographic Scans for Lung Cancer Screening: Prevalence and Subsequent Evaluation

Authors: Meng A, Majeed A, Shusted C, Steltz J, Saia C, Rendle K, Kane G, Barta J, Vachani A.

• Clinically significant incidental thyroid findings on low-dose CT (LDCT) scans for lung cancer screening are common, although only a minority of individuals screened required an invasive biopsy and the overall risk of thyroid cancer was low.
• The potential impact of thyroid findings should be included in the LCS shared decision-making process.
• Standard approaches to the management of incidental thyroid findings should be developed.
• Radiology reports should use standardized reporting of thyroid IFs, including consistent use of descriptors and defined criteria of the “S” modifier.

Smoking Cessation and Relapse Among Black and White Patients Referred for Lung Cancer Screening

Authors: Neslund-Dudas C, Tang A, Li P, Zarins KR, Alleman ER, Holm AL, Gupta V, Simoff MJ

• Overall, we observed a 4.7% quit rate among those referred for lung cancer screening. This is similar to the general population quit rates.
• Quit rates were higher and relapse rates were lower in those that completed a screening CT and who were older.
• In multivariable findings, Black race was associated with lower quit rates in current smokers and higher relapse among former smokers referred for LCS.
• LCS programs need to provide smoking cessation support for former smokers in addition to current smokers and need to continue to look for ways to reduce disparities in cessation.

The Impact of Patient Cost-Sharing on Participation in a Lung Cancer Screening Program

Authors: Wain KF, Carroll NM, Honda S, Oshiro C, Ritzwoller DP

• Enrollment in a health plan with patient cost-sharing is associated with significant reductions in receipt of Lung Cancer Screening (LCS) services.
• No detectible difference was noted in LCS utilization for privately insured individuals self-identifying as non-white, who were enrolled in a deductible plan.

Research Project Management Strategies Utilized in a Large, Multi-site Lung Cancer Screening Consortium

Authors: Steiner J, Blum-Barnett E, Rolland B, Kraus CR, Wainwright JV, Bedoy R, Sterrett A, Hixon B, Rendle KA, Theda Martinez Y, Alleman E, Eibergen R, Saia C, Pieper LE, Vachani A, Ritzwoller DP, Burnett-Hartman A.

The PROSPR-Lung Consortium utilized evidence-based Science of Team Science (SciTS) Best Practices to:

• Implement governance policies & ensure compliance
• Provide clear direction
• Create and distribute data capture workplans
• Manage deliverables with an efficient timeline
• Remove barriers and manage challenges
• Demonstrate productivity

Lung Cancer Screening Participation in Community-based Health Systems from the PROSPR-Lung Consortium

Authors: Burnett-Hartman AN, Carroll NM, Croswell J, Greenlee RT, Honda SA, Neslund-Dudas C, Rendle KA, Vachani A, Ritzwoller DP.

Evaluating Harms Following Lung Cancer Screening Across Diverse Community-based Healthcare Systems

Authors: Greenlee RT, Rendle KA, Burnett-Hartman AN, Elston Lafata J, Honda S, Neslund-Dudas C, Oshiro C, Wainwright J, Doria-Rose VP, Vachani A.

Effect of CT Image Reconstruction Parameters on Radiomic Phenotyping of the Lung Parenchyma: A Preliminary Study in the NCI PROSPR Screening Cohort

Authors: Haghighi B, Noel PB, Cohen E, Pantalone L, Vachani A, Rendle KA, Wainwright J, Saia C, Barbosa EM, Kontos D.

Variation in Lung-RADS Assignment between Patients Receiving Lung Cancer Screening: Results from the Population-based Research to Optimize the Screening Process (PROSPR) Consortium

Authors: Burnett-Hartman A, Carroll N, Honda S, Neslund-Dudas C, Olaiya O, Rendle K, Ritzwoller D, Vachani A.

• There was significant variation between healthcare systems in the distribution of Lung RADS assignments for patients undergoing initial Lung Cancer Screening with low-dose CT scan (LCS LDCT). This variation may be driven by differences in lung nodule prevalence associated with patient demographics and other patient factors or in how providers apply the Lung-RADS classification system.
• Our future research will determine how much of the variation in the distribution of Lung RADS between healthcare systems is due to patient factors vs. practice variation in the application of Lung RADS.

Implementation of Lung Cancer Screening at Two KP Regions: Initial Outcomes from the PROSPR Lung Cancer Screening Research Center

Authors: Ritzwoller DP, Carroll NM, Burnett-Hartman AN, Honda S, Oshiro C.

Demographic & clinical differences were found for patients undergoing LCS between KP regions & relative to NLST.

KPCO Lung RADS distributed to higher categories than KPHI and NLST, yet the proportion of screened patients with a lung cancer diagnosis was significantly lower at KPCO (vs KPHI).

More research is needed on:

• identifying smoking status in underlying population
• uptake of LCS within community settings
• criteria for Lung RADS assignment
• use of follow up diagnostic tests and procedures

Impact of Current Smoking Status on Uptake of Lung Cancer Screening in a Cohort of Racially Diverse Patients

Authors: Alleman ER, Tang A, Sheehan M, Holm A, Peralta AR, Simoff MJ, Neslund-Dudas C.

• At the present time, race does not appear to be significantly associated with uptake of lung screening. However, black females were less likely (non significant) to complete screening.
• Smoking status may play a role in white patients’ decision to complete a baseline screening exam.
• These findings have implications for patient provider shared decision making in lung screening among diverse patient populations.
• Future studies are planned to further examine LDCT referral differences by race as well as adherence to annual exams and treatment patterns for those diagnosed with lung cancer.

Opportunities and Challenges of using Big Data to Evaluate Lung Cancer Screening in Diverse Healthcare Systems: The PROSPR Research Consortium

Authors: Rendle KA, Saia CA, Schnall MD, Kontos D, Ritzwoller DP, Burnett-Hartman AN, Neslund-Dudas C, Greenlee R, Honda S, Wainwright JV, Vachani A

• Annual lung cancer screening (LCS) with low dose computed tomography (LDCT) is recommended for high-risk adults that meet specific age, smoking, and health status criteria, yet implementation and uptake has been suboptimal.
• In 2018, the National Cancer Institute (NCI) funded the large multisite consortium, Population based Research to Optimize the Screening Process (PROSPR), which aims to conduct multi-site, coordinated, transdisciplinary research to evaluate and improve cervical, colorectal, and lung cancer screening processes.
• Here, we present the PROSPR lung cancer screening process model describing the interrelated steps needed to provide high quality screening in community practice and introduce our diverse Lung PROSPR Consortium. Using a variety of methods and data sources, we aim to create a robust, harmonized data ecosystem across the five diverse healthcare systems to measure utilization and outcomes of LCS in routine care and identify patients eligible for LCS. The center utilizes fully automated text mining to standardize capture of screening outcomes (determined by Lung RADS scores) and is planning on expanding these methods to capture additional details from screening reports including nodule characteristics and incidental findings.

Lung Cancer Screening (LCS) in a US Healthcare System: From Efficacy Trials to Effectiveness Research in the New PROSPR II Initiative

Authors: R.T. Greenlee, D. Multerer, K. Schoen, O. Olaiya, E. Kronholm, C. Rottscheit, T. Foss, D. Kohnhorst, D. Polacek, L. Kubacki-Meyer

• Lung Cancer Screening (LCS) patients in routine care are older and more likely to be female than LCS trial participants.
• Difference in LCS positivity rate between trial participants and patients in routine care suggests effectiveness of LCS may vary.
• Need for evaluation, interventions to optimize LCS impact.

More Than One: Evaluating Intra-System Variation in the Implementation and Impact of Lung Cancer Screening

Authors: Rendle KA, Saia C, Horst M, Barg F, Wainwright J, Kontos D, Schnall M, Vachani A

• Intra-system variation in LCS policy implementation was associated with differences in optimal adherence, not attributable to observed patient-level factors.
• As U.S. healthcare systems continue to consolidate, it is important to understand how contextual factors between and within systems impact outcomes and impact of healthcare policies.
• Further research is needed to identify effective strategies to improving screening to ensure that existing disparities are not exacerbated by LCS implementation differences.