Author of

• 25881

  +

  OA09 - Prevention and Cessation (ID 909)

  • Event: WCLC 2018
  • Type: Oral Abstract Session
  • Track: Prevention and Tobacco Control
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/24/2018, 15:15 - 16:45, Room 205 BD

  • 25885

    +

    OA09.05 - Potential Reduction in Lung Cancer Mortality in the US from 2015-2065: A Comparative Modeling Approach (ID 11662)

    16:00 - 16:10  |  Author(s): Rafael Meza
    • Abstract
    • Presentation

    Background
    

    Tobacco control efforts implemented since the 1960s in the US have led to considerable reductions in smoking and smoking-related diseases including lung cancer. It is, however, unclear to what extent tobacco use and lung cancer mortality will be further reduced during the next half century due to control efforts that have already been implemented until 2015. To address this question, we developed simulation models that explicitly relate smoking temporal patterns to future lung cancer rates.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    Four independent lung cancer natural history models were developed using US smoking (1964-2015) and lung cancer mortality (1969-2010) data. Each model projected lung cancer mortality by smoking status (ages 30-84) from 2015 to 2065 under a status quo scenario, in which current smoking patterns are assumed to continue into the future. Sensitivity analyses were conducted comparing optimistic and pessimistic assumptions relative to the status quo.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Models validated well to observed lung cancer mortality. Under the status quo scenario, age-adjusted lung cancer mortality is projected to drop 79% from 2015 to 2065. Concomitantly, the annual number of lung cancer deaths is projected to decrease from 135,000 to 50,000 (63% reduction). Despite these decreases, 4.4 millions deaths from lung cancer are projected to occur in the US from 2015-2065.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Tobacco control efforts since the 1960’s will continue to lead to reductions in lung cancer rates well into the next half century. Nonetheless, additional prevention efforts are required to sustain and expand these gains, and further reduce the lung cancer burden in the US.

    6f8b794f3246b0c1e1780bb4d4d5dc53

    Information from this presentation has been removed upon request of the author.

    Information from this presentation has been removed upon request of the author.

• 25948

  +

  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

  • 27137

    +

    P2.11-15 - Identifying Patients for Whom Lung Cancer Screening is Preference-Sensitive: A Microsimulation Study (ID 12433)

    16:45 - 18:00  |  Presenting Author(s): Rafael Meza
    • Abstract

    Background
    

    Background: Many health systems are still exploring how to implement an effective, patient-centered low-dose computed tomography (LDCT) screening program.

    Objective: Examine factors that influence when LDCT screening is preference-sensitive.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    Design: State-transition microsimulation model

    Data Sources: Two large randomized trials, published decision analyses, and the Surveillance, Epidemiology and End-Results cancer registry

    Target Population: US-representative sample of simulated patients meeting current US Preventive Services Task Force screening eligibility criteria

    Time Horizon: Lifetime

    Perspective: Individual

    Intervention: LDCT screening annually for 3 years

    Outcomes Measures: Lifetime quality-adjusted life-year gains and reduction in lung cancer mortality. To examine the effect of preferences on net benefit, we varied disutilities (i.e., negative feelings) quantifying the burden of screening and follow-up across a likely range. We also examined the effect of varying the rate of false-positive scans and overdiagnosis associated with screening.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Results of Base-Case Analysis: Moderate differences in preferences about the downsides of LDCT screening influenced whether screening was appropriate for eligible persons with < 0.3% annual lung cancer risk or life-expectancy < 10.5 years. For higher-risk eligible persons with longer life-expectancy, roughly 50% of the study population, LDCT screening overcame even highly negative views about screening and its downsides.

    Results of Sensitivity Analysis: Rates of false-positive findings and overdiagnosed lung cancers were not highly influential.

    Limitation: The quantitative thresholds we identified may vary depending on the structure of the microsimulation model.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Conclusions: Identifying circumstances under which LDCT screening is more vs. less preference-sensitive may help clinicians personalize their approach to discussing LDCT screening, tailoring to both preferences and clinical benefit.

    THIS ARTICLE HAS BEEN ACCEPTED FOR PUBLICATION IN THE ANNALS FOR INTERNAL MEDICINE. Given its relevance, we would like the opportunity to present our findings at the WCLC

    6f8b794f3246b0c1e1780bb4d4d5dc53