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Heidi Schmidt



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    MA20 - Implementation of Lung Cancer Screening (ID 923)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Screening and Early Detection
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/25/2018, 15:15 - 16:45, Room 206 F
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      MA20.06 - Lung Cancer Screening Pilot for People at High Risk: Early Results on Cancer Detection and Staging (ID 13890)

      15:50 - 15:55  |  Author(s): Heidi Schmidt

      • Abstract
      • Presentation
      • Slides

      Background

      In June 2017, Cancer Care Ontario initiated organized lung cancer screening for people at high risk of developing lung cancer, using annual low-dose computed tomography (LDCT), at three pilot sites in Ontario. A key indicator of pilot success is detection of lung cancers at early stages. Ontario Cancer Registry (OCR) is used to track lung cancer diagnosis, stage and histology.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Patient abstracts were created using Registry Plus CDC abstracting software for pilot participants and patient-level data were collected from hospital data submissions, hospital electronic medical records via remote access, OCR pathology database (eMaRC) and OCR clinical source records (Resolink). Confirmed lung cancer cases were reviewed by a team of cancer staging analysts to achieve consensus on stage group using AJCC TNM 8th edition. A post-staging review was conducted for all staged cases to ensure accuracy and completeness.

      4c3880bb027f159e801041b1021e88e8 Result

      As of February 2018, 1086 participants received a baseline LDCT scan. 37% (n=404) of participants had Lung-RADS™ scores of 1; 45% (n=487) had Lung-RADS™ scores of 2; 10% (n=112) had Lung-RADS™ scores of 3; and 8% (n=83) had Lung-RADS™ scores of 4A, 4B or 4X, which triggered additional follow-up or diagnostic workup. 18 lung cancers were confirmed and 11 were fully staged.

      Of the 11 staged cases: 45% (n=5) was stage I; 9% (n=1) stage II; 9% (n=1) stage III; and 36% (n=4) stage IV. This represents a statistically significant increase in the proportion of early stage lung cancers (stage I and II) compared to historical proportions (p<0.05). 73% (n=8) were adenocarcinoma. The median risk score (i.e., PLCOm2012 risk prediction model probability of developing lung cancer in 6 years) was 8.1%, considerably higher than the median risk score of the overall pilot cohort (2.9%). 82% (n=9) had baseline Lung-RADS™ scores of 4X and 18% (n=2) had 4B. The average age at diagnosis was 67. 45% (n=5) were male; 55% (n=6) were current smokers; and 55% (n=6) had high school education or less. In addition, the screening pilot facilitated the successful transition by the OCR from AJCC TNM 7th to TNM 8th edition in lung cancer staging. Results will be updated in the conference presentation.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Early pilot results demonstrate success in detecting early stage lung cancers and a statistically significant stage shift to earlier cancer stages. We anticipate a greater proportion of early stage lung cancers on annual recall LDCT scans. The OCR efficiently enabled capturing important incidence, staging and histological pilot data.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      MA20.12 - Discussant - MA 20.09, MA 20.10 (ID 14635)

      16:25 - 16:40  |  Presenting Author(s): Heidi Schmidt

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

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    P2.11 - Screening and Early Detection (Not CME Accredited Session) (ID 960)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.11-23 - Risk Perception Among a Lung Cancer Screening Population (ID 13045)

      16:45 - 18:00  |  Author(s): Heidi Schmidt

      • Abstract
      • Slides

      Background

      To make lung cancer screening feasible, populations with the highest risk of developing cancer need to be targeted. Furthermore, factors which motivate individuals to participate in lung cancer screening programs should be integrated into recruitment strategies. Among these motivators, an individual’s perception of their lung cancer risk is an important consideration. This paper analyzes factors associated with risk perception in subjects enrolled in the Pan-Canadian Early Detection of Lung Cancer Study (PanCan), and assesses the relationship between subjects’ risk perception and actual calculated risk.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The PanCan low-dose screening CT study recruited individuals from the general population who were current or former smokers age 50-75 having at least a 2% risk of developing lung cancer over 6 years as calculated by the PanCan model. Risk perception was captured at baseline with a 5-point Likert scale question asking the subject to assess their personal chances of being diagnosed with lung cancer compared with other smokers of the same age. Multivariate linear regression analysis was used to assess the relationship between risk factors and risk perception. Baseline risk variables in the model include demographics, smoking history, symptoms, medications, occupation, previous chest imaging, history of COPD, medical comorbidities, and family history of cancer.

      4c3880bb027f159e801041b1021e88e8 Result

      2514 patients were included in the analysis. Median age was 62.3, 55.3% were male, median pack-year smoking history was 50 years (range 2.2-230), and median calculated lung cancer risk was 3.4% over 6 years (range 2-38.2). Calculated lung cancer risk increased by 0.08% (SE 0.02, p-value=0.001) for each increase in Likert risk perception category. On multivariable analysis, the following variables were associated with risk perception category: cigarettes smoked per day (+0.003 increase in category / cigarette, p=0.083), presence of dyspnea (+0.192), presence of wheeze (+0.272), known COPD (+0.110), no family history of cancer (-0.476) and no family history of lung cancer (-0.385) (all p<0.001). Increased perception of risk was associated with intent to quit smoking within 6 months (p<0.001).

      8eea62084ca7e541d918e823422bd82e Conclusion

      In this lung cancer screening study, risk perception was positively associated with calculated risk for lung cancer, despite a minimum 2% risk in the cohort. Individual factors and family history of cancer predicted risk perception. Risk perception was also associated with a willingness to quit smoking. Self-risk perception and associated factors could be used to tailor recruitment strategies to screening programs. The link between risk perception and willingness to quit smoking could aid integrated tobacco cessation programs.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.11 - Screening and Early Detection (Not CME Accredited Session) (ID 977)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.11-21 - The Development of a Robust Radiology Quality Assurance (QA) Program in a Provincial High-Risk Lung Cancer Screening Pilot (HRLCSP) (ID 13811)

      12:00 - 13:30  |  Presenting Author(s): Heidi Schmidt

      • Abstract
      • Slides

      Background

      Lung cancer is the leading cause of cancer death in Ontario, with an estimated 7100 patient deaths occurring in 2016 (Canadian Cancer Society, 2016). Based on results from the National Institute of Health’s National Lung Screening Trial, Cancer Care Ontario (CCO) implemented the HRLCSP in 2017 to determine feasibility of provincial scale roll-out of an organized lung cancer screening program. An integral component of the HRLCSP is to ensure low-dose computed tomography (LDCT) scans would be performed, interpreted and reported in a standardized, and high-quality manner.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The HRLCSP project team coordinated with CCO’s Cancer Imaging Program (CIP) to gain insight into cancer imaging practices and protocols, and recruited clinical expertise through a Radiology QA Clinical Lead (RQACL). In collaboration with pilot site radiologists, a comprehensive QA program was developed to encompass all aspects of radiology including facility, educational, and reporting standards, in addition to defining quality improvement criteria.

      4c3880bb027f159e801041b1021e88e8 Result

      To ensure pilot centres were able to deliver high-quality LDCTs, the RQACL, site participants and clinical experts collaborated to define and implement quality parameters. Equipment standards were defined in The Radiology QA Program Manual, and agreement from pilot sites was confirmed. Collaboration with reading radiologists led to tailored educational workshops designed to ensure consistency in the reporting of lung nodules based on the Lung-RADS™ scoring criteria, adapted from the American College of Radiology. Scan interpretation considerations, scoring criteria, and reporting templates were implemented. Annual assessments have ensured compliance across pilot sites. A working group aiming to determine an algorithm to examine incidental findings is being created. LDCT scan Double Read minimums and Peer Review adjudication processes were developed to ensure expert opinion availability with radiologist discrepancies to ensure high quality scan interpretation.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The design of the HRLCSP offered opportunities for implementing high quality standards around the LDCT scans. Implementation of a robust quality assurance program can ensure that the radiology component is delivered in a high-quality manner. Radiologist training programs, centre minimum requirements, and standardized reporting can ensure standards remain high. Lessons learned through the development of this comprehensive radiology QA program in the HRLCSP will allow for adoption of high-quality radiology standards on a larger provincial scale.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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