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Estimating Overdiagnosis After Implementation of Lung Cancer Screening in Community-Based Healthcare Systems

Grant

Grant Information

Low-dose computed tomography (LDCT) has been accepted as an efficacious population-based approach for lung cancer screening (LCS) based on findings from the National Lung Screening Trial (NLST) which demonstrated a 20% reduction in lung cancer deaths. These findings and subsequent recommendations from the US Preventative Services Task Force in December 2013 along with expanded guidelines in 2021, resulted in LCS via LDCT being implemented in a variety of community and academic settings starting in 2014. However, as with any screening program, there are concerns about the potential for LCS to lead to overdiagnosis of lung cancer. Overdiagnosis is the detection of cancers through cancer screening that never would have been diagnosed in the absence of cancer screening and would never lead to significant patient morbidity or mortality in a patient’s lifespan if left untreated. Any diagnosis of lung cancer generally causes the patient to engage in aggressive treatment and overdiagnosis may result in anxiety, serious physical harm, unnecessary losses in quality of life, and financial health-care costs. The variability, and uncertainty over the potential LCS-related harms, has led to extensive debate regarding the balance between harms and benefits of LCS. Although the strongest evidence for overdiagnosis comes from randomized control trials (RCTs) with long-term follow- up, patients participating in RCTs are generally not representative of those in community-based settings. Compared to NLST participants, individuals participating in community based LCS settings are more likely to be older, to currently smoke, and have a high comorbid burden. Specifically, participants receiving LCS care in community-based settings were more likely to have COPD, asthma, bronchiectasis, chronic bronchitis, diabetes, and hypertension compared to NLST participants, thus increasing the likelihood of death from another disease before the lung cancer progresses. These differences suggest that the magnitude of overdiagnosis may be very different from estimates derived from RCTs. Observational studies are needed to provide a source of robust evidence to inform the existence and magnitude of overdiagnosis in lung cancer for individuals receiving LCS care outside of an RCT. As LCS participation continues to evolve, this evidence is needed to inform future clinical and policy decision making. Therefore, the primary objective of this study is to produce a range of estimates of overdiagnosis among patients diagnosed with lung cancer who participated in the LCS process in community-based healthcare settings.

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  • Date: January 2024
  • Published in: Annals of Internal Medicine

Rates of Downstream Procedures and Complications Associated With Lung Cancer Screening in Routine Clinical Practice

Publication

Authors: Rendle KA, Saia CA, Vachani A, Burnett-Hartman AN, Doria-Rose P, Beucker S, Neslund-Dudas C, Oshiro C, Kim RY, Elston-Lafata J, Honda S, Ritzwoller D, Wainwright JV, Mitra N, Greenlee RT.

Corresponding Author Email: katharine.rendle@pennmedicine.upenn.edu

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  • Date: October 10, 2023
  • Presented at: 2023 American College of Chest Physicians (CHEST 2023) Conference

Psychological Correlates of Lung Cancer Screening Intentions and Uptake

Presentation

Authors: Rendle KA, Steltz J, Beucker S, Wainwright JV, Vachani A.

Corresponding Author Email: katharine.rendle@pennmedicine.upenn.edu

Findings:

  • Positive and negative perceptions were associated with Lung Cancer Screening (LCS) intentions including an unexpected positive association between perceived (external) stigma and LCS intentions.
  • Larger studies are needed to further understand psychological correlates of LCS completion in diverse populations.
  • Psychological correlates are key to motivate individuals but should be coupled with structural strategies to ensure equitable access to LCS.
  • Clinical Implications: Emphasizing the benefits of early detection and treatment effectiveness to patients may help to increase LCS. 
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  • Date: October 8, 2023
  • Presented at: 2023 American College of Chest Physicians (CHEST 2023) Conference

Using Electronic Health Record Data to Calculate Lung Cancer Risk and Inform Lung Cancer Screening

Presentation

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

Corresponding Author Email: andrea.n.burnett-hartman@kp.org

Findings:

  • EHR data can be used to implement the PLCOm2012 lung cancer risk prediction model
  • PLCOm2012 model with a 1.5% threshold performed better than the USPSTF 2021 criteria
  • Clinical Implications: Use of EHR data for PLCOm2012 vs. USPSTF 2021 criteria for determining Lung Cancer Screening (LCS) eligibility will result in fewer individuals undergoing LCS without necessarily reducing the number of lung cancers detected.
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  • Date: October 8-11, 2023
  • Presented at: 2023 American College of Chest Physicians (CHEST 2023) Conference

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

Poster

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

Corresponding Author Email: Nikki.M.Carroll@kp.org

Findings:

  • 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.
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  • Date: September 15, 2023
  • Published in: JNCI Cancer Spectrum

The Philadelphia Lung Cancer Learning Community: A Multi-Health-System, Citywide Approach to Lung Cancer Screening

Publication

Authors: Barta JA, Erkmen CP, Shusted CS, Myers RE, Saia C, Cohen S, Wainwright J, Zeigler-Johnson C, Dako F, Wender R, Kane G, Vachani A, Rendle KA.

Corresponding Author Email: mailto:Julie.Barta@jefferson.edu

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  • Date: August 15, 2023
  • Published in: Medical Care

Individuals Eligible for Lung Cancer Screening Less Likely to Receive Screening When Enrolled in Health Plans with Deductibles

Publication

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

Corresponding Author Email: Kris.F.Wain@kp.org

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  • Date: August 7, 2023
  • Published in: JAMA Network Open

Estimating Pack-Year Eligibility for Lung Cancer Screening Using 2 Yes or No Questions

Publication - Research Letter

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

Corresponding Author Email: katharine.rendle@pennmedicine.upenn.edu

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  • Date: July 2023
  • Published in: American Journal of Preventive Medicine

Percentage Up to Date with Chest Computed Tomography Among Those Eligible for Lung Cancer Screening

Publication

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

Corresponding Author Email: Andrea.N.Burnett-Hartman@kp.org

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  • Date: June 21-23, 2023
  • Presented at: International Cancer Screening Network (ICSN) Meeting

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

Poster

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

Corresponding Author Email: katharine.rendle@pennmedicine.upenn.edu

Findings:

  • 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.
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  • Date: June 14, 2023
  • Published in: Cancer Treatment and Research Communications

Uptake of Novel Systemic Therapy: Real World Patterns Among Adults with Advanced Non-small Cell Lung Cancer

Publication

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

Corresponding Author Email: Nikki.M.Carroll@kp.org

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  • Date: May 25, 2023
  • Published in: Journal of the National Cancer Institute

Smoking Status and the Association Between Patient-Level Factors and Survival Among Lung Cancer Patients

Publication

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

Corresponding Author Email: Nikki.M.Carroll@kp.org

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  • Date: May 23, 2023
  • Published in: Journal of Clinical and Translational Science

Application of Team Science Best Practices to the Project Management of a Large, Multi-site Lung Cancer Screening Research Consortium

Publication

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

Corresponding Author Email: Julie.Steiner@kp.org

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  • Date: May 19-24, 2023
  • Presented at: 2023 American Thoracic Society (ATS 2023) Conference

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

Poster

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

Corresponding Author Email: amameng@sas.upenn.edu

Findings:

  • 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.
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  • Date: May 19-24, 2023
  • Presented at: 2023 American Thoracic Society (ATS 2023) Conference

Using Telehealth Strategies to Increase Shared Decision Making for Lung Cancer Screening: A Pilot Randomized Controlled Trial

Presentation

Authors: Rendle KA, Steltz JP, Cohen S, Saia CA, Wainwright JV, Vachani A.

Corresponding Author Email: katharine.rendle@pennmedicine.upenn.edu

Findings:

  • In comparison to patients in the primary care arm, patients randomized to the centralized arm were significantly more likely to complete shared decision making (SDM) [OR: 1.7 (95% CI: 1.2, 2.6)], but not significantly more likely to complete a low-dose CT (LDCT) scan within 6 months [OR: 1.3 (95% CI: 0.9, 1.9)].
  • In per-protocol analysis, completion of SDM [OR: 4.6 (95% CI: 1.9, 11.6)] and LDCT completion [OR: 3.5 (95% CI: 1.3, 9.2)] were both significantly higher in the centralized arm than in the primary care arm.
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  • Date: April 5, 2023
  • Published in: Respirology

Effect of an Artificial Intelligence Tool on Management Decisions for Indeterminate Pulmonary Nodules

Correspondence

Authors: Kim R, Oke JL, Dotson TL, Bellinger C, Vachani A.

Corresponding Author Email: roger.kim@pennmedicine.upenn.edu

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  • Date: March 2023
  • Published in: CHEST Journal

Patient-Oriented Tools for Communicating Lung Cancer Screening Results: The First of Many Critical Components

Publication

Authors: Rendle KA, Vachani A.

Corresponding Author Email: Katharine.Rendle@pennmedicine.upenn.edu

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  • Date: March 12-14, 2023
  • Presented at: American Society of Preventive Oncology’s (ASPO) 47th Annual Meeting

Lung Cancer Yield Among Those Undergoing Lung Cancer Screening in Community-based Healthcare Systems

Presentation

Authors: Burnett-Hartman AN, Rendle KA, Saia C, Greenlee RT, Carroll N, Honda SA, Hixon BP, Kim RY, Neslund-Dudas C, Oshiro C, Wain K, Ritzwoller DP, Vachani A.

Corresponding Author Email: andrea.n.burnett-hartman@kp.org

Findings:

  • The proportion of those diagnosed with lung cancer within 12 months of a baseline LDCT within community settings is similar to that within clinical trials settings
  • Use of Lung-RADS categorization in community settings appropriately stratifies patients into those with a low- vs. high-risk of prevalent lung cancer
  • Older age groups, those who currently smoke, and those with higher pack-years have higher cancer yield
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  • Date: February 4, 2023
  • Published in: Scientific Reports

Radiomic Phenotyping of the Lung Parenchyma in a Lung Cancer Screening Cohort

Publication

Authors: Haghighi B, Horng H, Noël PB, Cohen EA, Pantalone L, Vachani A, Rendle KA, Wainwright J, Saia C, Shinohara RT, Barbosa EM Jr, Kontos D.

Corresponding Author Email: Despina.Kontos@pennmedicine.upenn.edu

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  • Date: December 2022
  • Presented at: Cancer Research UK & UK Society for Behavioral Medicine

Advancing Equitable Eligibility, Uptake, and Adherence in Lung Cancer Screening: A US Perspective

Presentation

Authors: Rendle KA

Corresponding Author Email: Katharine.Rendle@pennmedicine.upenn.edu
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  • Date: October 27, 2022
  • Published in: American Journal of Respiratory and Critical Care Medicine (AJRCCM)

Socioeconomic Status as a Mediator of Racial Disparity in Annual Lung Cancer Screening Adherence

Publication

Authors: Kim RY, Rendle KA, Mitra N, Saia CA, Neslund-Dudas C, Greenlee RT, Burnett-Hartman AN, Honda SA, Simoff MJ, Schapira MM, Croswell JM, Meza R, Ritzwoller DP, Vachani A.

Corresponding Author Email: roger.kim@pennmedicine.upenn.edu

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  • Date: September 16-19, 2022
  • Presented at: 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved

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

Poster

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

Corresponding Author Email: Christine Neslund-Dudas, PhD

Findings:

  • 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.
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  • Date: August 7, 2022
  • Presented at: IASLC 2022 World Conference

US-Preventive Services Task Force LCS Recommendations in Community Based Health Care Systems

Presentation

Author:Rendle KA.

Corresponding Author Email: Katharine.Rendle@pennmedicine.upenn.edu

Findings:

    • USPSTF 2021 guidelines increase (relatively) known eligibility by race and sex in our systems.
    • However, absolute increase is less and known barriers at the patient, clinician, system, and policy-level contribute to inequities in LCS.
      • This may limit equity advancements that could result from expanded guidelines.
      • Need multilevel interventions to translate expanded eligibility into equitable implementation and outcomes – from assessment to care.
    • Interpretation limited by lack of data on expanded guidelines.
      • Need high quality real-world data on LCS with new criteria.
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  • Date: June 9, 2022
  • Presented at: Prevent Cancer Foundation Meeting

How the 2021 USPSTF Lung Cancer Screening Guidelines Expand Who Gets Screened and Increase Health Equity

Presentation

Author: Vachani, A.

Corresponding Author Email: avachani@pennmedicine.upenn.edu

Findings:

  • USPSTF 2021 reduces racial and sex disparities in lung cancer screening.
  • Risk models can further attenuate these disparities.
  • Many other factors that contribute to inequities in LCS (Interpretation limited by lack of data).
  • Need high quality real-world data on LCS with new criteria.
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  • Date: June 2022
  • Published in: JNCI Cancer Spectrum

A Feasible Path to Reductions in Racial and Ethnic Disparities in Lung Cancer Screening?

Commentary

Author: Ritzwoller DP

Corresponding Author Email: Debra.Ritzwoller@kp.org

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  • Date: June 2022
  • Presented at: American Society of Health Economics Conference (ASHEcon)

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

Poster

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

Corresponding Author Email: kris.f.wain@kp.org

Findings:

  • 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.
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  • Date: May 13-18, 2022
  • Presented at: 2022 American Thoracic Society (ATS) International Conference

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

Presentation

Authors: Kim, R.

Corresponding Author Email: roger.kim@pennmedicine.upenn.edu

Findings:

  • 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.
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  • Date: May 13-18, 2022
  • Presented at: 2022 American Thoracic Society (ATS) International Conference

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

Presentation

Authors: Rendle, KA.

Corresponding Author Email: katharine.rendle@pennmedicine.upenn.edu

Findings:

  • 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).
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  • Date: April 12-14, 2022
  • Presented at: 2022 Health Care Systems Research Network Conference

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

Poster

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.

Corresponding Author Email: julie.steiner@kp.org

Findings:

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
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  • Date: February 22-26, 2022
  • Presented at: IASLC Targeted Therapies of Lung Cancer Meeting 2022

Patterns of First- and Second-Line Systemic Therapy Use Among Adults with Advanced Non-Small Cell Lung Cancer in the PROSPR Consortium

Presentation

Authors: Carroll N.

Corresponding Author Email: Nikki.M.Carroll@kp.org

Findings:

  • The proportion of patients receiving both first- and second-line treatment has increased over time.
  • In particular, the proportion of patients receiving treatments that include immunotherapy and targeted agents has rapidly increased.
  • Future work includes the study of other characteristics and survival estimates to ascertain the full impact and effectiveness of these novel treatments in a community setting.
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  • Date: September 2021
  • Presented at: Jefferson Health 3rd Annual LCS Summit (2021)

Identifying and addressing disparities in lung cancer screening

Presentation

Author: Vachani A

Corresponding Author Email: avachani@pennmedicine.upenn.edu
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  • Date: June 9-10, 2021
  • Presented at: Cancer and Primary Care International Network (CaPri) Conference

The First 5 Years of a Lung Cancer Screening Program in a US Healthcare System: Lung Cancer Screening Optimization in the US (LOTUS)

Presentation

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

Corresponding Author Email: greenlee.robert@marshfieldresearch.org

Findings:

This analysis summarizes the first 5+ years of LCS in one health system (MCRI) with a decentralized screening approach. Screened population characteristics (age, sex, smoking status) and screening characteristics (ordering provider, Lung-RADS Score distribution, adherence post baseline) data are reported.

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  • Date: March 30, 2021
  • Presented at: ASPO 2021

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

Poster

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.

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  • Date: Dec. 2, 2020
  • Presented at: National Lung Cancer Roundtable Virtual Meeting

Updates and Preliminary Findings from the Population Based Research to Optimize the Screening Process (PROSPR) Lung Cancer Research Center

Presentation

Authors: Debra P. Ritzwoller, Andrea N. Burnett-Hartman, Nikki M. Carroll (Presenter), Brian Hixon, Robert Greenlee, Stacey Honda, Christine Neslund-Dudas, Katharine Rendle, Anil Vachani

Corresponding Author Email: debra.ritzwoller@kp.org

Findings:

  • We’ve assembled one of the largest lung cancer screening cohorts derived from diverse community-based settings.
  • We observed variation in the uptake of Lung Cancer Screening (LCS) and variation in the assignment of Lung-RADS.
  • We are also observing a shift in stage of lung cancer diagnosis to earlier, more treatable stages.
  • Additional multilevel analyses are currently underway that will help illuminate factors associated with these measures.
  • Our current effort associated with data collection through 2021 will allow for additional evaluations regarding the impact of the COVID-19 pandemic on LCS.
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  • Date: Oct. 24-28, 2020
  • Presented at: American Public Health Association Annual Meeting

Questions about the Application of Guidelines to Discontinue Lung Cancer Screening (LCS) in those with Limited Life Expectancy

Presentation

Authors: Erica Blum-Barnett, MSPH; Debra P. Ritzwoller, PhD; Nikki M. Carroll, MS; Robert Greenlee, PhD, MPH; Christine Neslund-Dudas, PhD; Caryn Oshiro, PhD; Katherine A. Rendle, PhD, MSW, PhD; Andrea N. Burnett-Hartman, PhD, MPH

Corresponding Author Email: debra.ritzwoller@kp.org

Findings:

  • As health systems work to follow USPSTF guidelines that recommend stopping LCS in those with limited life expectancy, they need to ensure that the implementation of LCS does not exacerbate lung cancer morbidity and mortality disparities in historically marginalized populations.
  • Consideration of ethics, personal decision-making, LCS risks, and LCS benefits is needed to implement LCS programs that are patient-centered and promote equity.
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  • Date: Dec. 9-10, 2019
  • Presented at: National Lung Cancer Roundtable

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

Poster

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

Corresponding Author Email: andrea.n.burnett-hartman@kp.org

Findings:

  • 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.
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  • Date: Nov. 8-9, 2019
  • Presented at: Kaiser Permanente Annual National Oncology Symposium

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

Poster

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

Corresponding Author Email: debra.ritzwoller@kp.org

Findings:

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
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Community-based Lung Cancer Screening Outcomes in Relation to Patient and Radiologist Characteristics

Presentation

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

Findings:

  • Patient characteristics (age, year of scan, and COPD) associated with Lung-RADS distribution.
  • Significant variation in Lung-RADS distribution by radiologist remains after controlling for patient characteristics.
  • Lung-RADS assignment is highly correlated with lung cancer detection within 12 months.
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  • Date: Oct. 19-23, 2019
  • Presented at: The American College of Chest Physicians (CHEST) Annual Meeting

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

Poster

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

Corresponding Author Email: eallema1@hfhs.org

Findings:

  • 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.
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  • Date: Sept. 23, 2019
  • Presented at: First Penn Conference on Big Data in Population Health Sciences

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

Poster

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

Corresponding Author Email: katharine.rendle@pennmedicine.upenn.edu

Findings:

  • 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.
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  • Date: May 21-23, 2019
  • Presented at: The Cancer and Primary Care Research International Network (Ca-PRI) Conference

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

Poster

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

Corresponding Author Email: greenlee.robert@marshfieldresearch.org

Findings:

  • 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.
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  • Date: May 17-22, 2019, Jun. 3-5, 2019
  • Presented at: American Thoracic Society(ATS) Conference & International Cancer Screening Network (ICSN) Conference

Understanding and Improving the Lung Cancer Screening Process Across Healthcare Systems: A Conceptual Screening Model for the PROSPR Research Center

Abstract

Authors: K. Rendle, A.N. Burnett-Hartman, C. Nesland-Dudas, R.T. Greenlee, S. Honda, J. Elston Lafata, P.M. Marcus, M.E. Cooley, R. Meza, C. Oshiro, M.D. Schnall, A. Vachani, V.P. Doria-Rose, C. Doubeni, D.P. Ritzwoller

View Abstract
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  • Date: Jan. 1, 2019
  • Presented at: LDI Health Policy Retreat

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

Poster

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

Corresponding Author Email: katharine.rendle@pennmedicine.upenn.edu

Findings:

  • 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.