LOTUS Research Products

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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

Presentation

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: 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: 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: 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: 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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  • 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.
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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 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: 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.