LUNG CANCER SCREENING PARTICIPATION IN COMMUNITY-BASED HEALTH SYSTEMS FROM THE PROSPR-LUNG CONSORTIUM

Abstract

TOPIC: Imaging TYPE: Original Investigations PURPOSE: From 2013 through 2020, the US Preventive Services Task Force recommended annual lung cancer screening (LCS) via low-dose computed tomography (LDCT) for 55- to 80-year-olds with 30+ pack-years of smoking history who currently smoke or quit smoking within the last 15 years. Because the population-level impact of LCS on reducing lung cancer mortality depends on high LCS participation among eligible populations, it is important to determine LCS participation in community settings and to track participation changes over time. METHODS: Study participants were patients ages 55-80 years old who received care within the five systems in the Population-based Research to Optimize the Screening Process (PROSPR) Lung Consortium from 2014 through 2019. Data on LCS participation and patient characteristics (age, sex, race/ethnicity, and cigarette smoking history) were obtained via electronic health records (EHR). In this population, we used smoking history according to EHR data as a proxy for LCS eligibility and calculated the percent of individuals who completed LCS via LDCT by year, overall and by health system. We also evaluated differences in the percent screened by age (55-64 years old vs. 65+), sex, and race/ethnicity using chi-square tests with the significance level of < 0.05. RESULTS: The number of patients who were ages 55-80 years old with EHR documentation of 30+ pack-years of smoking and who currently smoked or had a quit date within the past 15 years ranged from 21,234 in 2013 to 39,881 in 2019. Of these, 3% completed LCS via LDCT in 2014, 7% in 2015, 12% in 2016, 17% in 2017, 21% in 2018, and 23% in 2019. Among those with 30+ pack-years in 2019 (N=51,579), 77% had current or former smoking within the past 15 years and were considered eligible for LCS in 2019. Of these individuals, 27% overall had ever received LCS, but there was variation in the percent ever screened by health system, that ranged from 16% to 45%. Among those eligible for LCS, the percent having ever received LCS LDCT also varied by age (24% of those ages 55-64 years old vs. 29% of those ages 65-80 years old; p-value < 0.01). Within each health system, the percent of eligible individuals who received LCS LDCT was not significantly different by sex or by race/ethnicity. CONCLUSIONS: Although the percent of high-risk individuals receiving LCS via LDCT increased every year from 2014 to 2019, LCS rates in community-based healthcare settings remain well below screening rates for other types of cancer. Also, there is wide variation in LCS rates by health system. CLINICAL IMPLICATIONS: To optimize the impact of LCS for reducing lung cancer mortality in the United States, health systems will need to increase LCS participation. Additional research to understand how differences in health system implementation and maintenance of LCS programs impact LCS participation is needed. DISCLOSURES: No relevant relationships by Andrea Burnett-Hartman, source=Web Response No relevant relationships by Nikki Carroll, source=Web Response Spouse, stock holder relationship with Johnson and Johnson Please note: >10 years Added 04/28/2021 by Jennifer Croswell, source=Web Response, value=Stock No relevant relationships by Robert Greenlee, source=Web Response No relevant relationships by Stacey Honda, source=Web Response No relevant relationships by Christine Neslund-Dudas, source=Web Response No relevant relationships by Katharine Rendle, source=Web Response No relevant relationships by Debra Ritzwoller, source=Web Response Grant relationship with MagArray Inc. Please note: >$100000 by Anil Vachani, source=Web Response, value=Grant/Research Support Removed 04/17/2021 by Anil Vachani, source=Web Response Grant relationship with Broncus Medical Please note: $20001 - $100000 by Anil Vachani, source=Web Response, value=Grant/Research Support Removed 04/17/2021 by Anil Vachani, source=Web Response Scientific Medical Advisor relationship with Johnson and Johnson Please note: 2020 - present Added 04/22/2021 by Anil Vachani, source=Web Response, value=Consulting fee Grant relationship with Precyte Please note: 01/2021 to present Added 04/17/2021 by Anil Vachani, source=Web Response, value=Grant/Research Removed 04/17/2021 by Anil Vachani, source=Web Response