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Frederic Winslow Grannis



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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: 2
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.11-09 - Shared Decision Making; A Decision Aid for the Primary Practitioner (ID 12038)

      12:00 - 13:30  |  Presenting Author(s): Frederic Winslow Grannis

      • Abstract
      • Slides

      Background

      Lung cancer (LC) remains the number one cancer killer of both men and women. Despite general agreement that computerized tomographic (CT) lung cancer screening (LCS) is safe and effective, with first-dollar insurance coverage available from CMS, uptake of LCS among those at risk is currently less than 5%. Centers for Medicare and Medicaid Services (CMS) mandates shared decion making (SDM) using decision aids (DA) providing specific information. Only half of primary care practitioners (PCPs) know USPSTF guidelines and identify multiple barriers to guideline adherence. Although half of PCPs know how to work up positive test results, most prefer to refer such patients to specialists. Compounding these problems, existing DAs provide inaccurate and difficult to understand information. PCPs require accurate information to fulfill their obligation to patients in SDM.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Research and clinical results from the prospective, international, multi-institutional cohort research project, International Early Lung Cancer Action Program ( IELCAP) and National Comprehensive Cancer Network (NCCN) over 20 years was reviewed and distilled into content aimed to provide accurate, up-to-date information for PCPs to use in answering patient questions during SDM consultation. Information is summarized in "stick figure" graphics.
      100stickposter.jpg

      4c3880bb027f159e801041b1021e88e8 Result

      Multiple current LCS DAs provide gratuitously inaccurate information, e.g. that only 21% with LC in LCS survive 5-years. IELCAP and NCCN research results show that cancer detection rate with adhernce to annual CT screening is 12.5% (1 in 8) / decade in both NCCN risk groups 1 and 2. Baseline false positive rate is 10% at baseline screen; 5% during annual repeat screens. More than 80% of LC are early-stage. 10-year actuarial LC survival exceeds 80%. With guideline adherence, 10% of false positives have biopsy or surgical removal of a benign nodule and overtreatment of slow-growing, pre-invasive LC is avoidable.. Screen-detected LC are increasingly treated with minimally invasive operations, often with sub-lobar resection, with equivalent cure rates and lower morbidity. Operative mortality is less than 1%. Radiation therapy is available for treatment of early-stage LC in patients with increased surgical risk. Radiation exposure is smal; there is no evidence of substantial risk of radiation carcinogenesis in adults receiving LCS.

      8eea62084ca7e541d918e823422bd82e Conclusion

      A new DA, reflecting results in LCS from IELCAP and NCCN centers provides PCPs with accurate information for SDM sessions with patients at risk of LC. PCPs providing accurate, coherent information to patients can play a major role in prevention of many housands of unnecessary LC deaths.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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      P3.11-10 - Lung Cancer Screening Shared Decision Making: Decision-Aid for the Patient (ID 12039)

      12:00 - 13:30  |  Presenting Author(s): Frederic Winslow Grannis

      • Abstract
      • Slides

      Background

      Despite general agreement in the U.S. that lung cancer screening (LCS) is effective and safe, with availability of insurance coverage for those at high-risk, screening uptake is less than 5%. Patients in Medicare and Medicaid (CMS) must participate in "shared decision making" (SDM) with a primary care giver and a "decision-aid" (DA) used. A major potential contributor to low LCS uptake is inaccurate and difficult to understand information on LCS benefits and risks contained in currently-available DAs. A gratuitous example is the statement "4 of 5 patients slip through to die of LC". We offer a new DA that provides information required by CMS, based upon lessons learned from twenty years research and clinical experience in the International Early Lung Cancer Action Program (IELCAP), and reflected in the LCS guidelne of the National Comprehensive Cancer Network (NCCN).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Currently available DAs used in LCS were reviewed and compared with published results from LCS programs participating in IELCAP and NCCN with findings distilled to provide information required by CMS and understandable by patients of average intelligence.

      4c3880bb027f159e801041b1021e88e8 Result

      When an individual with NCCN risk criteria levels 1 or 2 receives a low-dose CT scan annually, as a participant in a screening program using the IELCAP or NCCN diagnostic guidelines, and reliably follows recommendations for further testing or treatment, benefits and risks described herein may be confidently anticipated. Based on recent data from LCS at the Lahey Clinic, with optimal uptake, 12.5% 1 in 8) of those screened will be diagnosed with LC over a decade, more than 80% in early stage. At baseline screen 10.4% will have a positive test result but not be diagnosed with LC during that screening cycle (false-positive). Subsequent annual repeat scans will have 5% false positives. In IELCAP centers actuarial ten-year LC-specific survival exceeds 80% after diagnosis of LC. Application of IELCAP's algorithm results in invasive biopsy or surgical resection of benign nodules in less than 10%. Patients diagnosed by LCS are increasingly treated with minimally-invasive, sub-lobar resections that offer equivalent survival with less morbidity. Fewer than 1% die after surgery. Benefits of screening will diminish and disappear over time if annual screening stops. Higher risks may be experienced if diagnostic and treatment decisions deviate from those recommended.

      8eea62084ca7e541d918e823422bd82e Conclusion

      If patients at high risk of LC participate in SDM using the DA presented, it can be confidently anticipated that LCS uptake will increase, with increased future survival and reduced LC mortality.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.