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Cherie Parungo Erkmen
MA 04 - Advocacy: Listen to the Patients (ID 655)
- Event: WCLC 2017
- Type: Mini Oral
- Track: Patient Advocacy
- Presentations: 1
MA 04.07 - Understanding Patient Barriers to Utilization of Low Dose CT Lung Cancer Screening (ID 9624)
11:00 - 12:30 | Presenting Author(s): Cherie Parungo Erkmen
Despite evidence that lung cancer disproportionately affects minority populations, there is a paucity of data describing the impact of lung cancer screening. Results of NLST may not be generalizable to all populations given that 91% of the participants were Caucasians. Further study of lung cancer screening in a diversity of racial and ethnic groups is a necessary step in the implementation of lung cancer screening. Before underrepresented populations can be screened, community perceptions about lung cancer screening must be explored and barriers to screening must be identified. The purpose of our study was to identify potentially correctable barriers to obtaining LDCT for lung cancer screening in a diverse, but predominantly African American population.
We developed a questionnaire consisting of 22 items. Five questions assessed patient demographics including socioeconomic status and insurance coverage. Two questions assessed patient access and utilization of health care. Three questions assessed smoking history and prevalence in interpersonal relationships. One questions assessed patient concern about lung cancer. Two questions measured patient knowledge about lung cancer. One question addressed patient willingness to go to a doctor’s appointment to learn more about lung cancer screening. One question elicited whether LDCT had been mentioned by a healthcare provider. Six questions assessed awareness and knowledge about LDCT lung cancer screening. One question addressed reasons for non-adherence to appointments.
The questionnare was complete by 100 patients. Almost all of our patients reported having health insurance and a primary care doctor (96%). 50% of patients are current or former smokers. 83% are current or former smokers or have friends and/or family members who are heavy/long time smokers. 90% of patients knew that smoking is the most common cause of lung cancer. 56% of patients know that lung cancer can be treated successfully at least sometimes. 81% of patients reported to be at least somewhat concerned that they or someone they know can die of lung cancer. 87% of patients are willing to go to a doctor’s appointment to learn more about lung cancer screening. 100 % of patients reported to have not heard about LDCT from their doctors. The average score was 2/6 (33%) on items accessing knowledge about lung cancer screening. Cost was the most frequently reported reason (52%) for nonadherence to appointments.
Our study was able to identify potentially correctable barriers to utilization of low dose CT lung cancer screening such a lack of primary care support and perceived cost.
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P2.13 - Radiology/Staging/Screening (ID 714)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 2
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
P2.13-005 - Early Results of Lung Cancer Screening in an African American Population (ID 9020)
09:30 - 16:00 | Presenting Author(s): Cherie Parungo Erkmen
African Americans have been underrepresented in trials showing survival benefit to lung cancer screening. We implemented a multidisciplinary lung cancer screening program in an African American population. We hypothesize that lung cancer screening in an African American population will lead to safe detection and treatment of lung cancer.
In an urban, academic medical center, we prospectively gathered information on African American patients referred to a multidisciplinary lung cancer screening program from October 2015 to December 2017 with a 6 month follow up. We studied, age, gender, smoking history and level of education. We measured lung cancer screening results using Lung-RADs categorizations, diagnosis of cancer, treatment modality and complications.
Of 160 African Americans undergoing lung cancer screening, the average age was 64.2 (SD 5.75), 95 (59.3%) were women, 111 (69.3%) were current smokers, average pack years was 47.2 (SD 17.1) and level of education was less than high school in 52 (32.5%), high school in 53 (33.1%), advanced education in 45 (28.1%) and 10 (6.2%) declined to report. LDCT results were 1 (0.6%) with Lung-RADs 0; 69 (43.1%) with Lung-RADs 1; 73 (45.6%) Lung-RADs 2; 7 (4.3%) Lung-RADs 3; 10 (6.3%). Of the 6 people undergoing invasive procedure for biopsy (3 CT guided needle biopsy, 1 transbronchial needle biopsy, 2 surgical resection) 4 were diagnosed with stage I non-small cell lung cancer. Three of these underwent surgical resection for treatment, and one underwent radiation treatment.
Lung Cancer Screening in an African American Population
Number Percent Total 160 100% Average Age 64.2 Average Pack Years 47.2 Active Smokers 111 69.4% Former Smokers 49 30.6% Gender Women 95 59.4% Men 65 40.6% Education Less Than High School 52 32.5% High School 53 33.1% Advanced Education 45 28.1% Declined to Answer 19 6.3% Lung-RADs Category Lung-RADs 0 1 0.6% Lung-RADs 1 69 43.1% Lung-RADs 2 73 45.6% Lung-RADs 3 7 4.4% 1 diagnosed with stage I lung cancer with CT guided biopsy Lung-RADs 4 10 6.3% 3 diagnosed with stage I lung cancer, 1 with CT guided biopsy, 2 with surgical biopsy Total Receiving Biopsy 6 3.8% CT Guided 3 1.9% 2 diagnosed with stage I lung cancer Transbronchial 1 0.6% Surgical Resection 2 1.3% 2 diagnosed with stage I lung cancer Lung Cancer Diagnosis 4 2.5% Stage I 4 2.5% Stage II 0 0% Stage III 0 0% Stage IV 0 0% Adenocarcinoma 4 2.5% Squamous Cell 0 0% Treatment Surgical Resection 2 1.3% Radiation 1 0.6% Complications 0 0%
Implementation of a multidisciplinary lung cancer screening program enrolling African Americans at high risk of lung cancer led to detection and treatment of lung cancer in 2.5%. Only 10.7% had positive screens (lung-RADs 3 or 4), 3.8% had an invasive biopsy and no one had complications from diagnostic procedures or treatment. Further study is necessary to understand long-term survival benefit of lung cancer screening.
P2.13-006 - Enhanced Shared Decision Making in Lung Cancer Screening: Addressing Questions of Willingness and Ability to Undergo Lung Cancer Treatment (ID 9070)
09:30 - 16:00 | Presenting Author(s): Cherie Parungo Erkmen
Lung Cancer Screening with low dose CT (LDCT) can reduce lung cancer death, but only if those found to have lung cancer proceed with lung cancer treatment. When implemented into diverse populations, lung cancer screening may prove less effective if patients are unwilling or unable to undergo lung cancer treatment. We employed an enhanced shared decision making (SDM) model to address willingness and ability to undergo lung cancer treatment before low dose CT (LDCT) scanning. We hypothesized that enhanced SDM was feasible and did not discourage patients or providers from proceeding with lung cancer screening.
We performed a prospective study of patients referred for lung cancer screening between October of 2015 and May of 2017. We measured race, gender, adherence to the consent process and questions regarding willingness and ability to undergo lung cancer treatment. Subsequent uptake of LDCT, outcomes of cancer diagnosis and failure to follow up were also studied.
Of 363 enrolled study participants, 59% were African American, 12% were Caucasian, 12% were Hispanic and 2% were Asian. The gender distribution was 186 male (51.2%) and 177 female (48.8%). All 363 patients had a documented SDM visit addressing the risks and benefits of lung cancer screening and consented to discuss lung cancer treatment if lung cancer is diagnosed. When asked if they were willing to undergo lung cancer treatment, 15 (4.1%) people responded “no”, 4 (1.1%) people responded “unknown” and 8 (2.2%) did not have a documented answer. When asked if they were able to undergo lung cancer treatment 10 (2.8%) people responded “no”, 2 (0.5%) people responded “unknown” and 8 (2.2%) people did not have a documented answer. Overall, 6 (1.7%) people were diagnosed and treated for lung cancer. Only 1 person declined screening despite being willing and able to undergo lung cancer treatment. One (0.2%) person failed to follow up on a suspicious nodule found on lung cancer screening despite reporting being willing and able to undergo lung cancer treatment.
Though SDM is essential to lung cancer screening, there are few guidelines on how to conduct this process. This study demonstrated that an enhanced SDM experience, including questions about willingness and ability to undergo lung cancer treatment, is a feasible practice that did not deter patients or providers from proceeding with lung cancer screening. Our enhanced SDM experience gave clinicians and patients a framework to emphasize the importance of appropriate follow up of positive screens.