Context Of Lung Cancer Screening Research Articles

A protocol for a cluster randomized trial of care delivery models to improve the quality of smoking cessation and shared decision making for lung cancer screening

BackgroundPatients eligible for lung cancer screening (LCS) are those at high risk of lung cancer due to their smoking histories and age. While screening for LCS is effective in lowering lung cancer mortality, primary care providers are challenged to meet beneficiary eligibility for LCS from the Centers for Medicare & Medicaid Services, including a patient counseling and shared decision-making (SDM) visit with the use of patient decision aid(s) prior to screening. MethodsWe will use an effectiveness-implementation type I hybrid design to: 1) identify effective, scalable smoking cessation counseling and SDM interventions that are consistent with recommendations, can be delivered on the same platform, and are implemented in real-world clinical settings; 2) examine barriers and facilitators of implementing the two approaches to delivering smoking cessation and SDM for LCS; and 3) determine the economic implications of implementation by assessing the healthcare resources required to increase smoking cessation for the two approaches by delivering smoking cessation within the context of LCS. Providers from different healthcare organizations will be randomized to usual care (providers delivering smoking cessation and SDM on site) vs. centralized care (smoking cessation and SDM delivered remotely by trained counselors). The primary trial outcomes will include smoking abstinence at 12-weeks and knowledge about LCS measured at 1-week after baseline. ConclusionThis study will provide important new evidence about the effectiveness and feasibility of a novel care delivery model for addressing the leading cause of lung cancer deaths and supporting high-quality decisions about LCS. ClinicalTrials.gov protocol registrationNCT04200534 Trial registrationClinicalTrials.govNCT04200534

EP01.02-008 Pocket Nodules, An Innovative Patient Education Tool to Explain Lung Nodules

Annually, thousands of patients are told they have a pulmonary nodule within the context of lung cancer screening or as an incidental finding. Many nodules are discovered during lung cancer screening with LDCT and benign, posing a low risk of cancer. Despite the low risk of malignancy, lung nodules are a common cause of emotional distress among patients. To improve patient’s understanding, decrease distress for a lung nodule finding and engage patients in recommended follow up lung screening, Pocket Nodules is designed to enhance the discussion of pulmonary nodules during the Lung Cancer Screening Shared Decision Making consult.

ES01.03 Integration of Cessation Services in Low Dose CT Screening

Lung cancer screening with low dose computed tomography (LDCT) of the chest has picked up momentum over the last decade. The publication of results from the National Lung Screening Trial (NLST) in 2011 confirmed the mortality benefit of this intervention in high-risk tobacco smokers. Nearly a decade later, this was supported by the results of the NELSON study. Subsequent analyses have showed that in these high-risk candidates, the impact of smoking cessation could be profound. In people who already have a diagnosis of lung cancer, smoking cessation can improve outcomes. This includes prolonged survival across all stages of cancer as well as a reduction in the development of second primary lesions. Data from the NLST have shown that in those candidates who stopped smoking, the risk of dying from lung cancer fell. This reduction matched the benefit of CT screening by seven years of abstinence. The mortality benefit of LDCT screening was nearly doubled in candidates who achieved fifteen years of smoking abstinence. Despite the high impact of smoking cessation, the best way to achieve this in LDCT screening candidates has not yet been established. Many studies are now investigating this, in countries that have formally instituted lung cancer screening such as the United States and in those where national screening programs remain under consideration. In the United States, eight studies form the SCALE Collaboration (Smoking Cessation within the Context of Lung Cancer Screening) across a range of sites and institutions. Strategies include digital advice, comparisons of behavioural interventions and various nicotine replacement regimens among several thousand screening candidates. In the United Kingdom, the Yorkshire Enhanced Stop Smoking (YESS) study will test the impact of personalized interventions in screening candidates, including the use of incidental CT findings and matched CT imagery. Data from previous lung cancer screening studies support the addition of specific smoking cessation intervention in eligible candidates, including the Danish Lung Cancer Screening Trial and the UK Lung Cancer Screening Trial as well as the NLST and the NELSON. Screening candidates often have high rates of motivation to quit, higher quit rates than the background smoking population and respond to CT abnormalities with greater smoking abstinence. Smoking cessation as part of LDCT screening contributes significantly to cost-effectiveness of screening programs. In general, LDCT screening guidelines strongly support smoking cessation as part of screening programs but refrain from making specific recommendations on detailed cessation interventions. As jurisdictions around the world move to introduce formal lung cancer screening, the impact of rigorous, specific smoking cessation interventions will grow. Implementation research programs that help LDCT screening candidates quit smoking represent a major opportunity to enhance screening success.

Smoking cessation and shared decision-making practices about lung cancer screening among primary care providers.

ObjectiveWe describe primary care providers’ current practice patterns related to smoking cessation counseling and lung cancer screening (LCS).MethodsFamily, internal medicine, and pulmonary medicine providers from two medical centers were asked to complete an electronic survey to report their practice patterns.ResultsOf 52 participating providers, most reported initiating three major components of a smoking cessation intervention often or very often: advise to quit (50, 96%), assess willingness to quit (47, 90%), and assist with counseling or pharmacotherapy (49, 94%). However, other components were less commonly initiated such as arranging follow‐ups (only 11 providers indicated recommending them often or very often, 21%) and less than half of providers reported that they often or very often recommend cessation counseling or pharmacotherapy of any type (except varenicline), though family medicine providers were more likely to recommend pharmacotherapy compared to the other specialists (p < 0.01). The majority of providers (47, 92%) reported that they engage in informed/shared decision‐making about LCS, although only about one‐third (17, 33%) indicated using a patient decision aid. Pulmonary medicine providers were more likely to use decision aids than providers from internal or family medicine (p < 0.04).ConclusionsWithin the context of LCS, primary care providers report often having conversations about smoking cessation with their patients who smoke, have no clear preference for type of treatment, and rarely use follow‐up calls or visits pertaining to quitting smoking. While many providers report engaging in shared decision‐making about LCS, few use a decision aid for this conversation.

Burden of male hardcore smokers and its characteristics among those eligible for lung cancer screening

BackgroundThere are few data available about hardcore smokers and their behavioral characteristics among the lung cancer screening (LCS) population. The study investigated the burden of hardcore smokers within the LCS population, and determine the characteristics of hardcore smokers using nationally representative data in South Korea.MethodsWe used data from 2007 to 2012 from the Korean National Health and Nutrition Examination Survey. This study enrolled current male smokers aged 55–74 years. Among them, subjects eligible for LCS were defined as these populations with smoking histories of at least 30 PY. Hardcore smoking was defined as smoking >15 cigarettes per day, with no plan to quit, and having made no attempt to quit. Multivariate logistic regression analyses were used to estimate associations between hardcore smokers and various sociodemographic and other variables.ResultsThe proportion of hardcore smokers among those who met LCS eligibility criteria decreased from 2007 to 2012 (from 39.07 to 29.47% of the population) but did not change significantly thereafter (P = 0.2770), and that proportion was consistently 10–15% higher than that of hardcore smokers among all male current smokers. The proportion without any plan to quit smoking decreased significantly from 54.35% in 2007 to 38.31% in 2012. However, the smokers who had made no intentional quit attempt in the prior year accounted for more than half of those eligible for LCS, and the proportion of such smokers did not change significantly during the study period (50.83% in 2007 and 51.03% in 2012). Multivariate logistic regression analyses showed that hardcore smokers were older (OR = 1.05, 95% confidence interval [CI] 1.01–1.09) than non-hardcore smokers. Hardcore smokers exhibited higher proportion of depression (OR = 6.55, 95% CI 1.75–24.61) and experienced extreme stress more frequently (OR = 1.93, 95% CI 1.13–3.29). Smokers who did not receive smoking cessation education within the past year were significantly more likely to be hardcore smokers (OR = 4.15, 95% CI 1.30–13.22).ConclusionsIt is important to identify a subset of smokers unwilling or minimally motivated to quit within the context of lung cancer screening. Anti-smoking education should be enhanced to influence hardcore smokers’ behavior.

MS18.06 Captive Audience, Teachable Moment — Integrating Tobacco Cessation in Lung Cancer Screening

MS18.06 Captive Audience, Teachable Moment — Integrating Tobacco Cessation in Lung Cancer Screening

Tobacco Treatment in the Context of Lung Cancer Screening

Tobacco Treatment in the Context of Lung Cancer Screening

From diagnosis to therapy in lung cancer: management of CT detected pulmonary nodules, a summary of the 2015 Chinese-German Lung Cancer Expert Panel

The first Chinese-German Lung Cancer Expert Panel was held in November 2015 one day after the 7th Chinese-German Lung Cancer Forum, Shanghai. The intention of the meeting was to discuss strategies for the diagnosis and treatment of lung cancer within the context of lung cancer screening. Improved risk classification criteria and novel imaging approaches for screening populations are highly required as more than half of lung cancer cases are false positive during the initial screening round if the National Lung Screening Trial (NLST) demographic criteria [≥30 pack years (PY) of cigarettes, age ≥55 years] are applied. Moreover, if the NLST criteria are applied to the Chinese population a high number of lung cancer patients are not diagnosed due to non-smoking related risk factors in China. The primary goal in the evaluation of pulmonary nodules (PN) is to determine whether they are malignant or benign. Volumetric based screening concepts such as investigated in the Dutch-Belgian randomized lung cancer screening trial (NELSON) seem to achieve higher specificity. Chest CT is the best imaging technique to identify the origin and location of the nodule since 20% of suspected PN found on chest X-ray turn out to be non-pulmonary lesions. Moreover, novel state-of-the-art CT systems can reduce the radiation dose for lung cancer screening acquisitions down to a level of 0.1 mSv with improved image quality to novel reconstruction techniques and thus reduce concerns related to chest CT as the primary screening technology. The aim of the first part of this manuscript was to summarize the current status of novel diagnostic techniques used for lung cancer screening and minimally invasive treatment techniques for progressive PNs that were discussed during the first Chinese-German Lung Cancer. This part should serve as an educational part for the readership of the techniques that were discussed during the Expert Panel. The second part summarizes the consensus recommendations that were interdisciplinary discussed by the Expert Panel.

Lung cancer screening as a teachable moment for smoking cessation

Lung cancer screening may serve as a 'teachable moment' for smoking cessation, a brief period in which motivation to stop smoking is enhanced. Within the context of two NCI-funded randomized lung screening trials, we conducted an ancillary study to explore the impact of screening on smoking cessation and readiness to stop smoking. We accrued a sample of current and former smokers participating at the Georgetown University site of the Lung Screening Study (LSS; N=144) and of the National Lung Screening Trial (NLST; N=169). In each sample, we assessed reasons for trial participation, interest in smoking cessation interventions, motivations for stopping smoking, and the impact of undergoing screening on tobacco use and readiness to stop smoking. Telephone interviews were conducted prior to screening, and 1-month following receipt of the screening result. The samples were analyzed separately due to differences in age and level of nicotine dependence. The majority of the findings were consistent across the two samples. Frequently endorsed reasons for trial participation among both current and former smokers included psychological reasons (e.g., wanting peace of mind about lung cancer) and altruism (e.g., wanting to make a contribution to science). Nicotine replacement therapy and free counseling were the cessation methods that were of most interest, and fear of lung health problems was the most frequently endorsed motivation for quitting smoking. Regarding readiness to stop smoking, approximately 20% were ready to stop in the next 30 days, 45% were ready to stop in the next 6 months, while 35% were not thinking of stopping. At the follow-up, 7% of current smokers at baseline reported abstinence, and 4% of former smokers at baseline reported having relapsed. The findings differed across the two samples when considering the readiness to quit outcome. At the 1-month follow-up of the NLST sample, participants became more ready to stop smoking (p<.05). Screening result did not moderate this finding. In the LSS sample, among younger participants (<or=64), an abnormal screening result was significantly associated with becoming more ready to stop smoking, whereas a normal result was associated with becoming less ready to stop smoking (p=.02). The current findings demonstrated the feasibility of enrolling lung screening participants into a smoking-related research study, as well as the high level of interest in stopping smoking and in smoking cessation interventions. These data indicate that lung cancer screening may serve as a teachable moment for smoking cessation, and suggest that a smoking cessation trial within the context of lung cancer screening is feasible.