MANAGEMENT OF CORONARY ARTERY CALCIFICATION IN PATIENTS ENROLLED IN A LOW-DOSE COMPUTERIZED TOMOGRAPHY LUNG CANCER SCREENING PROGRAM

Abstract

TOPIC: Cardiovascular Disease TYPE: Original Investigations PURPOSE: The most common incidental finding in Griffin Hospital’s Lung Cancer Screening Program is coronary artery calcification (CAC), which serves as a sign of Coronary Artery Disease and a predictor of adverse cardiac events. We sought to assess how incidental findings of CAC are managed in patients at high risk for lung cancer. METHODS: We performed a single-center retrospective chart review of patients enrolled in a low-dose computerized tomography (LDCT) Lung Cancer Screening Program and a telephone survey including demographic characteristics, medical history, and patient perceptions of their disease and treatment. Patients were included if their initial scan showed moderate or severe CAC and if their scans were performed at least three months prior to the survey date to ensure that they were able to meet with their physicians and take any necessary actions. RESULTS: 35 of 78 patients who met inclusion criteria agreed to participate in the study. Actions directed at incidental findings of CAC were performed in only 60% (N=21) of these patients – 48% underwent coronary stress testing, 33% were prescribed aspirin and/or a statin, 24% quit or reduced smoking, 14% made modifications to their diet and exercise regimens, and 5% underwent stenting of a coronary artery; one patient had recently (< 1 year) undergone cardiac workup. The remaining 40% (N=14) of patients had no identifiable action or treatment to address CAC findings. 50% of these patients (N=7) were instructed by their physicians to make lifestyle changes but denied making those changes. The remaining 50% (N=7) deny ever discussing CAC with their physicians. Finally, when asked about their level of concern regarding CAC on a scale of 1-10 (with 10 being the greatest concern), the mean patient response was 4.9. CONCLUSIONS: Actions addressing incidental CAC were only performed in 60% of patients. 20% of patients disregarded instructions from their physicians to make lifestyle changes. Although the Lung Cancer Screening Program emphasizes the importance of incidental CAC to patients and their physicians, the remaining 20% of patients report never discussing CAC with their physicians. This apparent breakdown in communication may be a significant driver of the inaction in response to significant findings. Patients are only moderately concerned about CAC. CLINICAL IMPLICATIONS: Although LDCT screening for lung cancer often returns significant incidental CAC, these findings do not lead to changes in a large subset of patients. DISCLOSURES: No relevant relationships by Riley Kermanian, source=Web Response No relevant relationships by Jo-Ann Persson, source=Web Response No relevant relationships by Richard Salzano, source=Web Response