LOTUS Research Products

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.

Evaluating a Composite Neighborhood-Level Socioeconomic Status Index as a Mediator of Racial Disparity in Annual Lung Cancer Screening Adherence

Authors: Kim, R.

• Adherence to annual Lung Cancer Screening (LCS) was reduced among Black compared to White patients.
• LCS adherence improved with increasing levels of nSES among both Black and White patients.
• Neighborhood-level SES mediated nearly 50% of the racial disparity observed in annual LCS adherence.

Incremental Rates of Imaging and Diagnostic Procedures Attributed to Lung Cancer Screening in Community Practice

Authors: Rendle, KA.

• Our results present novel assessment of imaging and diagnostic procedures attributed to Lung Cancer Screening (LCS) in community practice, adding fundamental evidence about potential downstream follow-up associated with lung cancer screening outside of trials.
• Furthermore, by reporting rates in those patients with positive baseline results, we can better compare rates to those reported in The National Lung Screening Trial (NLST).

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.

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.

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.

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

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.

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.