P1.03-036 Adherence to Eligibility Criteria for Low-Dose CT Screening in an Academic Center

Abstract

The United States Preventive Services Task Force (USPSTF), Centers for Medicare and Medicaid Services (CMS), and the National Comprehensive Cancer Network (NCCN) recommend low dose computed tomography (LDCT) lung cancer screening for high risk patients, defined as those between age 55-77 (CMS) or 55-80 (USPSTF), with ≥30 pack-year smoking history who currently smoke or quit within the past 15 years. The NCCN guidelines also recommend screening for patients over 50 years with ≥20 pack-year smoking history and at least one additional lung cancer risk factor. To better understand community practices, we describe adherence to screening eligibility criteria for the population screened at the Seattle Cancer Care Alliance (SCCA). The SCCA developed a multidisciplinary LDCT screening program that executes LDCT screening orders when patients’ regional primary care providers deem them eligible for screening, and provides follow-up evaluations based on screening results. From a prospective registry study of patients screened at the SCCA, we collected baseline sociodemographic, smoking history, and clinical data to retroactively assess patients’ screening eligibility based on USPSTF, CMS, and NCCN criteria, respectively. We define adherence as the proportion of patients meeting at least 1 set of guidelines criteria for screening and used univariate logistic regression to identify potential sociodemographic predictors of adherence, excluding age and smoking history. Of 252 patients screened between 5/8/2012 and 8/19/2015, 111 (44%) consented to participate in the study. Median age was 63, 67% were male, 89% were white, 99% were insured, median household income was $75,000, 56% were current smokers, and median cigarette use was 36 pack-years. Of 106 patients with complete eligibility data, 61 (58%), 60 (57%), and 60 (57%) met the USPSTF, CMS, and NCCN screening criteria, respectively. Seventy-nine (75%) patients met eligibility criteria for at least one guideline. Of the 27 patients ineligible by any guidelines, 17 (63%) had <20 pack-years smoking history and 5 (19%) were under age 50. White patients were more likely to meet eligibility for at least one guideline (Odds Ratio = 7.3; 95% CI = 1.9-27.8). In this single-center registry study, 25% of patients did not meet screening eligibility criteria when primary care providers were responsible for identifying screening candidates. In response to these results, the program employed a coordinator to pro-actively review screening orders to confirm guideline compliance. An opportunity exists to prioritize LDCT screening to high risk patients through patient counseling, provider education and pro-active review of screening CT orders.