A Community-based Pulmonary Nodule Clinic: Improving Lung Cancer Stage at Diagnosis.

Nathaniel Melton,John F Lazar,Troy A Moritz

doi:10.7759/cureus.4226

Nathaniel Melton, John F Lazar + Show 1 more

Open Access

https://doi.org/10.7759/cureus.4226

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Abstract

ObjectivePulmonary nodules (PNs) are a common incidental finding and are often how lung cancer is discovered. Our goal was to determine if establishing a pulmonary nodule clinic (PNC) in a community healthcare setting would lead to an earlier stage at diagnosis.MethodsA single healthcare system retrospective review was conducted of all PNC patients from 2010-2015 diagnosed with lung cancer. The stage at diagnosis was analyzed and compared to lung cancer patients in our healthcare system outside the PNC and to national data. Five-year survival rates for PNC patients from 2010-2012 were also analyzed.Results A total of 119 patients and 127 lung cancers were diagnosed through the PNC from 2010-2015. There were 990 lung cancers, with a known stage, diagnosed outside the PNC in our healthcare system from 2010 to 2015. Two hundred and eighty one (28.4%) cancers were Stage I, compared to 69 (54.3%) (p <0.0001) through the PNC; 110 (11.1%) cancers were diagnosed at Stage II compared to 17 (13.4%) through the PNC (0.4471); 277 (25.7%) cancers were diagnosed at Stage III, compared to 21 (16.5%) through the PNC (p 0.0060); 598 (60.4%) cancers were diagnosed at Stage IV, compared to 20 (15.7%) through the PNC (p <0.0001). Five-year survival rates for patients diagnosed in 2010 were 80% (four of five patients), 79.2% (19/24) in 2011, and 62.2% (23/37) in 2012.Conclusions Lung cancer survival is directly related to the stage at diagnosis. Establishment of our PNC has led to an earlier stage at diagnosis compared to the general lung cancer population in our community.

Highlights

Cancer is the second leading cause of death in the United States with an overall survival of less than 20%, making it a significant public health concern
A total of 119 patients and 127 lung cancers were diagnosed through the pulmonary nodule clinic (PNC) from 2010-2015
Two hundred and eighty one (28.4%) cancers were Stage I, compared to 69 (54.3%) (p

Summary

Introduction

Cancer is the second leading cause of death in the United States with an overall survival of less than 20%, making it a significant public health concern. Patients often present with advanced disease, but improved survival rates are achieved with early detection and diagnosis at an early stage [1]. Effective screening methods like colonoscopy and mammogram have led to earlier detection and improved survival in colorectal and breast cancer respectively, prompting an exhaustive search for an useful screening tool for detecting lung cancer. The rate of detection of nodules is expected to improve with the advancement in CT technology and updated guidelines for lung cancer screening [2,3]. Identification of malignant nodules could lead to early diagnosis and increased survival. We sought to determine whether the establishment of a pulmonary nodule clinic (PNC) in a community hospital setting, led by a team of thoracic surgeons, could aid in early-stage diagnosis

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