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  P41 - Screening and Early Detection - Lung Cancer Screening Programmes (ID 176)

  • Event: WCLC 2020
  • Type: Posters
  • Track: Screening and Early Detection
  • Presentations: 1
  • Moderators:
  • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall

  • 35616

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    P41.09 - Comorbidity Profile and Diagnostic Complication Risk: A Study of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial (ID 1257)

    00:00 - 00:00  |  Presenting Author(s): Eric M Robinson
    • Abstract
    • Slides

    Introduction
    

    Many individuals who are eligible for lung cancer screening also have major comorbid conditions (such as chronic obstructive pulmonary disease [COPD], cardiovascular disease [CVD], and stroke) due to the shared risk factor with lung cancer (i.e., tobacco exposure). Others have diabetes mellitus (DM); another condition that is prevalent among middle aged and older individuals eligible for screening. These chronic conditions may substantially alter the benefits from lung cancer screening among screening recipients by increasing the risk of complications from diagnostic work-up. We investigated the association of invasive biopsy complication rate and comorbidity status among patients undergoing positive lung cancer screening evaluation lung cancer workup in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening trial.

    Methods
    

    The PLCO is a randomized controlled trial in which 77,464 participants aged 55 to 74 years were randomly assigned to the intervention arm and received a baseline chest radiograph (CXR) followed by three annual CXRs. The control arm (n=77,470) was treated with usual care. We examined all patients with complete comorbidity information who underwent diagnostic workup for lung cancer. Procedure categories included surgical biopsy (thoracotomy/thoracoscopy), bronchoscopy, cytology, needle biopsy, mediastinoscopy, and biopsy-unspecified. Complications were assigned to the most invasive procedure in the antecedent 60-days. The hierarchy of procedure invasiveness was thoracotomy, thoracoscopy, mediastinoscopy, needle biopsy, bronchoscopy with biopsy, thoracentesis, cytology, bronchoscopy w/o biopsy, and finally biopsy-unspecified. Available comorbidity information included self-reported COPD, CVD, stroke, DM, arthritis, diverticulitis, gallstones, osteoporosis, and polyps. We used multiple logistic regression to model the association of comorbidities and biopsy complication, while adjusting for age, sex, BMI, and pack years.

    Results
    

    14,957 patients underwent at least one diagnostic procedure secondary to suspected lung cancer; 11,873 patients were screening related. A further, 3779 patients underwent at least one invasive biopsy procedure. Among individuals who underwent an invasive biopsy procedure, 60% were male and the mean age was 64. 70% had a > 30 pack year smoking history. Approximately 23% (n=864) patients had a diagnostic related complication during workup. The individual procedure complication rate was 12.1% (1447/11938). The most common complication was pneumothorax (442/1447; 30.55%). Diabetes was significantly associated with risk of complication (OR 1.73; CI 1.25 - 2.40; p=0.0024).

    Conclusion
    

    Chronic conditions may alter the benefits from lung cancer screening. Shared decision making concerning the benefits of lung cancer screening should be personalized with discussions of patient's individual risk factors for adverse events.

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