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P1.11 - Screening and Early Detection (Not CME Accredited Session) (ID 943)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Presentations: 1
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
P1.11-11 - Comparing Lung Cancer Diagnosed by Low Dose CT (LDCT), Incidental Lung Nodule Program (ILNP), and Non-Program-Based Detection (ID 14379)
16:45 - 18:00 | Author(s): Jennifer Kethireddy
The aggregate 5-year survival of lung cancer patients is <20%, partly because most patients present with advanced disease. LDCT screening and algorithmic management of patients with incidentally-detected nodules are two methods for early detection, but rigorous evaluation is needed for effective implementation. We compared patients with lung cancer diagnosed via LDCT vs. ILNP vs. neither in a lung cancer-endemic US region.a9ded1e5ce5d75814730bb4caaf49419 Method
We compared demographic, clinical, and treatment characteristics of patients diagnosed via LDCT and ILNP with those treated in a multidisciplinary program (MDP) who were not diagnosed through either early detection program. LDCT screening was implemented in 2015 using Medicare eligibility criteria. In the ILNP, navigators and a multidisciplinary team prospectively tracked patients with suspicious findings flagged by radiologists, using Natural Language Processing software. All patients were diagnosed within the same healthcare system from 2015-2018. Statistical comparisons used chi-square, Fishers Exact, and ANOVA.4c3880bb027f159e801041b1021e88e8 Result
Lung cancer diagnoses included 111 from 5,954 ILNP scans, 11 from 400 LDCT scans (1.9% v 2.8%, p=0.21), and 273 from MDC. An additional 40 (10%) LDCT scans were Lung RADS 3 or 4. Average ages were 70/68/68 years for ILNP/LDCT/MDC and patients were 43%/64%/48% male. African Americans were underrepresented in both early detection groups (23%/9%/36%; p=0.0111); Medicare patients were over-represented (83%/91%/42%, p<0.001). Active smoking was highest in LDCT (73%, 79 pack-year average), but similar between ILNP and MDC (39%, 50 pack-year average vs 36%, 63 pack-year average).
Early detection cases were more frequently adenocarcinoma (61%/ 55%/48%; p=0.0595) with smaller lesions (2.2cm/1.0cm/4.2cm; p<0.001). Stage I/II cancers were more likely with early detection (71%/89%/42%; p<0.001), leading to substantially higher rates of surgical resection (75%/73%/31%; p<0.001). Median time from lesion detection to treatment initiation was similar between groups (61/74/58 days, p=0.48).
62% of patients with lung cancers diagnosed by ILNP and 57% by MDC were not eligible for LDCT screening. The most common disqualifying criteria were a 30 pack-year smoking history (unmet: 41% ILNP/ 41% MDC) and active smoking within 15 years (unmet: 41% ILNP/ 27% MDC).8eea62084ca7e541d918e823422bd82e Conclusion
Lung cancers diagnosed by ILNP and LDCT had better prognosis than the MDC population, with smaller tumors, earlier stage, and more treatment with surgical resection. African Americans were underrepresented in these groups. Less than half of ILNP and MDC cases had enough smoking exposure to qualify for LDCT screening. ILNP is a critical component of early detection programs, reaching an element of the population that did not qualify for LDCT screening.6f8b794f3246b0c1e1780bb4d4d5dc53