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Kim L. Sandler



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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: 1
    • Moderators:
    • Coordinates: 9/25/2018, 15:15 - 16:45, Room 206 F
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      MA20.05 - Who Gets Screened for Lung Cancer? A Simple Adjustment to Current Guidelines to Reduce Racial Disparities (ID 13992)

      15:45 - 15:50  |  Author(s): Kim L. Sandler

      • Abstract
      • Presentation
      • Slides

      Background

      Background. The United States Preventive Services Task Force (USPSTF) recommends low-dose computed tomography screening for lung cancer in current or former smokers age 55-80 years with a minimum 30 pack-year history and having quit no more than 15 years ago. However, these guidelines were developed in the predominantly white population of the National Lung Screening Trial and therefore may not be generalizable to African Americans who have different smoking patterns. We evaluated USPSTF lung cancer screening guidelines in a predominantly African American prospective cohort with an elevated incidence of lung cancer.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Methods. The Southern Community Cohort Study (SCCS) is a prospective observational cohort of approximately 86,000 adults (two-thirds African American) aged 40-79 years enrolled primarily at community health centers from 2002-2009 across 12 Southern U.S. states. Former and current smokers were included in the present study and were followed for up to 9 years. We examined the impact of race and smoking history on eligibility for lung cancer screening using USPSTF guidelines.

      4c3880bb027f159e801041b1021e88e8 Result

      Results. Among N=50,524 adult (67% African American, 33% white) ever smokers at baseline (64% current smokers, median age 50 years at enrollment) in the SCCS, we identified 1,359 incident lung cancers. Among lung cancer patients, 32% of African Americans were eligible for screening following USPTSF criteria compared with 55% of whites (p<0.001). The lower percentage of eligible African Americans was primarily due to African Americans having smoked fewer pack-years than whites (14 vs 27 median pack-years, respectively, p<0.001). Lowering the smoking pack-year eligibility criteria to a minimum 20-29 pack-year history, increased the number of African Americans eligible for screening by 38%. With a lower smoking pack-year criterion for African Americans, sensitivity increased from 32% to 50% and specificity decreased from 87% to 78% yielding sensitivity and specificity values that were similar to whites (55% sensitivity, 75% specificity) using the USPSTF guidelines.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Conclusion. Current lung cancer screening guidelines are too conservative for African Americans. A greater percentage of African Americans are excluded from screening opportunities primarily due to lower smoking histories. Adjustment of pack-years in lung cancer screening guidelines by race will result in more equitable screening for smokers at high risk for lung cancer.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.10 - Prevention and Tobacco Control (Not CME Accredited Session) (ID 959)

    • 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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      P2.10-05 - Provider Medical Specialty Influences Smoking Cessation Counseling at an Academic Medical Center and Veterans Affairs in U.S. Mid-South (ID 12820)

      16:45 - 18:00  |  Author(s): Kim L. Sandler

      • Abstract
      • Slides

      Background

      Tobacco accounts for 11.5% of deaths worldwide and approximately 30% of U.S. cancer deaths. Smoking cessation counseling using the 5 A’s (Ask, Advise, Assess, Assist, Arrange) is standard-of-care for all smokers. We tested the hypothesis that certain provider characteristics (general internal medicine [GIM], those with lung cancer screening [LCS] knowledge, and those who perceive smoking cessation as very effective) would be associated with smoking cessation counseling.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We surveyed all GIM, pulmonology, hematology/oncology, and gynecology providers (physicians/advanced practice providers) at a large academic institution in the Mid-South and affiliated VA from February to May 2017. The primary predictor variables were provider characteristics including: specialty, LCS guideline knowledge (high knowledge=identified start age 55, 30 pack-years, current & former smokers), and perceived effectiveness of smoking cessation, colonoscopy, and pap smear at reducing cancer mortality (very/moderately/minimally/not effective). The primary outcome was self-reported smoking cessation counseling using the 5 A’s within the past year. Data were summarized using counts, proportions, and medians. We used multivariable logistic regression adjusted for years in practice and healthcare system to evaluate the association of medical specialty with counseling. Logistic regressions of perceived effectiveness and LCS guideline knowledge as predictors of counseling were further adjusted for specialty.

      4c3880bb027f159e801041b1021e88e8 Result

      Of 625 providers invited, 407 (65%) responded, 378 (60.5%) questionnaires were analyzed, of which 58% were GIM, 19% hematology/oncology, 13% gynecology, 10% pulmonology. There were 255 of 350 providers (73%) who reported performing smoking cessation counseling within the past year (77% GIM vs 77% pulmonology vs 57% hematology/oncology vs 72% gynecology, χ2 p=0.013). In adjusted multivariable logistic regression, GIM (aOR 2.52 95% CI 1.40,4.54;p=0.002) and pulmonology (aOR 2.52 95% CI 1.00,6.36;p=0.05) providers were more likely to perform smoking cessation counseling than hematology/oncology providers.

      41% vs 59% of those who provided counseling had high LCS knowledge vs low LCS knowledge. Fewer providers (71%) reported smoking cessation as very effective at reducing cancer-specific mortality compared to colonoscopy (77%) and pap-smear (74%). Perceived effectiveness and high LCS guideline knowledge did not predict smoking cessation counseling (aOR 1.1 95% CI 0.64,1.8;p=0.78;aOR 1.2 95% CI 0.72,2.0 p=0.47 respectively).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Providers in general internal medicine and pulmonology were more likely than those in hematology/oncology to report performing smoking cessation counseling. Perceived effectiveness and LCS guideline knowledge did not predict smoking cessation counseling. Targeted interventions, especially in hematology/oncology, are needed to increase smoking cessation counseling using the 5 A’s. Future education should also address knowledge gaps in smoking cessation effectiveness and LCS guidelines.

      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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      P3.11-23 - Adherence to Annual Low-Dose CT Lung Cancer Screening at a Large Academic Institution (ID 12997)

      12:00 - 13:30  |  Author(s): Kim L. Sandler

      • Abstract
      • Slides

      Background

      Annual low-dose computed tomography (LDCT) is standard-of-care in the high-risk population for lung cancer screening. We assessed adherence to annual LDCT screening in a large academic institution.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We assembled a retrospective cohort of patients who underwent LDCT between January 1, 2014 and September 30, 2016.

      We included patients with baseline LungRads 1 or 2 with 12-month follow-up recommendation. We excluded those who died before the time of recommended follow-up. The time interval between the recommended follow-up study date and the actual follow-up study was calculated. Patient adherence at time of due follow-up was defined by this time interval: <=90 days (adherent) and >90 days (non-adherent).

      Primary analysis was change in adherence over time. Secondary analysis included descriptive statistics of demographics.

      4c3880bb027f159e801041b1021e88e8 Result

      lcs adherence.jpg

      395 patients had baseline LDCT screening. We found a persistent, significant increase in adherence: 11% (2/18) in the 1st quarter 2015 and 70% (46/66) in the 3rd quarter 2017 (Pearson’s chi-squared test p=.008). We also identified racial disparity in patients enrolling in our Lung Screening Program (93% white).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Adherence to annual LDCT screening significantly increased from 2015 to 2017. Improvement may be due to changes in national policy and/or implementation of a dedicated program physician director and program coordinator. Future work should address racial disparities and barriers to and facilitators of annual LDCT screening.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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