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Monica Ter-Minassian
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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
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P41.10 - Initial Low Dose CT for Lung Cancer Screening and Recalls at Kaiser Permanente Mid-Atlantic States (ID 3690)
00:00 - 00:00 | Presenting Author(s): Monica Ter-Minassian
- Abstract
Introduction
In 2013, U.S. Preventive Services Task Force (USPSTF) guidelines recommended annual LDCT screening for eligible patients in part based on the U.S. National Lung Screening trial showing reduced mortality with screening. However, there is little observational data in community health care settings on LDCT outcomes for eligible patients with prior health conditions. Our aim was to identify LDCT screening and recall rates at Kaiser Permanente Mid-Atlantic States from 2016-2018 and the associations of lung cancer related symptoms and other patient characteristics, with these rates.
Methods
We conducted a retrospective observational study of eligible patients with an initial LDCT screening and a possible subsequent recall during the period 2016-2018. We defined eligibility as 55-80 years, had no history of lung cancer or LDCT prior to the initial LDCT, were “ever” smokers (current, recent quitters, or former but not recent), no history of lung cancer prior to the initial LDCT, and had continuous enrollment 6 months prior to and during the screening year. The initial LDCT was defined using CPT4 codes as the first LDCT noted among eligible patients in 2016-2018. A recall was defined using CPT4 codes (low or standard dose) within 180 days of the initial LDCT. We calculated multivariate ORs associated with receiving an initial LDCT, and with a recall, adjusting for age, gender, race/ethnicity, insurance plan, smoking status, history of environmental smoking exposure, weight at the beginning of the screening year, COPD/Emphysema, asthma, and lung cancer symptoms noted in the prior 6 months; and LungRADs score for recalls only.
Results
Of 171,196 eligible patients. 6,215 (3.6%) had an initial LDCT. Of these, 4,809 (77.4%) had an initial LDCT with known Lung-RADS scores of 1-4; and 487 (10.1%) had a recall LDCT within 180 days. Increased likelihood of receiving an LDCT (p<0.05) was associated with ages 60-64 (aOR 1.3 (1.2-1.4)) and 65-70 (aOR 1.3 (1.2-1.5)) (versus 55-59); current smokers (aOR 9.81 (8.88-10.8)), recent quitters (aOR 5.73 (5.2-6.3)), and missing (aOR 2.4 (2.2-2.6) (versus former smokers); a history of environmental smoking exposure (aOR 1.2 (1.1-1.3)); normal weight (aOR 1.14 (1.04-1.4)) (versus underweight) and normal (aOR 1.14 (1.07-1.21)) (versus obese); having COPD/Emphysema (aOR 2.7 (2.5-2.9)); Medicare (aOR 1.22 (1.1-1.3)) (versus commercial insurance); male gender (aOR 1.2 (1.17-1.3)); non-Hispanic White (aOR 2.2 (1.9-2.6)) (versus Hispanic), non-Hispanic White (aOR 1.5 (1.4-1.6)) (versus non-Hispanic Black), non-Hispanic White (aOR 2.4 (1.9-3.0)) (versus Other); having no prior cancer (aOR 1.14 (1.2-1.05)); having no lung related symptoms (aOR 1.53 (1.1-2.2)) (versus more than 3); and not having asthma (aOR 1.1 (1.02-1.2)). Increased likelihood of a recall within 180 days (p<0.05) was associated with Lung-RADS 3 and 4 (aOR 7.9 (6.0-10.2)) (versus Lung-RADS 1); and having COPD/Emphysema (aOR 2.3 (1.9-2.9)).
Conclusion
LDCT screening is not restricted to heavy smokers, and appears to be associated with not having lung cancer related symptoms and with most expected patient characteristics. LDCT recalls within 180 days appear only to be associated with high Lung-RADS scores and with COPD/Emphysema. Further research is needed to identify associated factors at the provider level.
