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  P2.11 - Screening and Early Detection (ID 178)

  • Event: WCLC 2019
  • Type: Poster Viewing in the Exhibit Hall
  • Track: Screening and Early Detection
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall

  • 31324

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    P2.11-02 - Individualized Risk-Based Lung Cancer Screening Incorporating Past Screening Findings and Changes in Smoking Behaviors (ID 1468)

    10:15 - 18:15  |  Author(s): Oguzhan Alagoz
    • Abstract
    • Slides

    Background
    

    Risk-based lung cancer screening guidelines are actively being pursued as an alternative to existing guidelines. However, current risk-based approaches do not capture the dynamic nature of the risk and ignore information collected from past screening findings.

    Method
    

    We develop and apply a novel decision tool, the Individualized Lung Screening Scheduler (ILungSS), to optimize lung cancer screening for asymptomatic ever-smoked individuals by maximizing the expected quality-adjusted life years (QALYs) gained from screening. The ILungSS models health progression and smoking behavior of US ever-smokers as a dynamic and stochastic process using a partially observable Markov decision process (POMDP). A POMDP is typically used to model sequential decision making under uncertainty and provides a well-suited framework to optimize screening decisions. Screening decisions are based on the personal lung cancer risk of individuals, which is updated leveraging on information obtained from past screening exams and changes in smoking behaviors.

    Result
    

    The ILungSS offers personalized optimal screening policies for ever smoked individuals that include the optimal screening starting and stopping ages, and screening frequency. The ILungSS offers fully dynamic screening policies and age-specific risk thresholds that define screening eligibility. The ILungSS yields higher QALYs and lung cancer-specific mortality reduction, recommends extending screening coverage to current light smokers but increases the number of screening exams as compared to the US Preventive Services Task Force (USPSTF) strategy. Upon smoking cessation, the ILungSS adjusts future screening decisions recommending less screens as compared to the USPSTF guidelines. The clear presentation of the health benefits associated with smoking cessation, in terms of personal lung cancer risk and number of recommended future screening exams, could support a smoking cessation program supplementing screening.

    

    Conclusion
    

    Personalized, dynamic risk-based lung cancer screening could improve the effectiveness of lung cancer screening. The ILungSS integrates screening with a smoking cessation program that could further improve the effectiveness of screening.

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