Abstracts presented at CHEST 2020 explored possible reasons for low lung cancer screening rates and suggested solutions.
Lung cancer screenings are crucial for catching disease at earlier stages and lowering the risk of death from lung cancer, which is the leading cause of cancer-related deaths worldwide. But there are barriers to optimal screening rates, which potentially include inadequate assessment of patients, lax adherence to guidelines, and even physician ignorance, suggest 2 abstracts presented at the CHEST Annual Meeting.
Current US Preventive Services Task Force guidelines recommend annual screening with low-dose computed tomography (LDCT) for lung cancer in adults aged 55-80 years who have a history of heavy smoking (30 pack-years) and those who currently smoke or have quit within the past 15 years. But not all patients who could benefit from screenings are getting them, according to the abstracts.
Few Eligible Patients Receive LDCT Screenings
A study of screening rates in a clinic at an urban academic medical center examined actual screening rates against patient eligibility based on USPSTF criteria. Researchers found that while lung cancer screening rates were higher than the commonly reported 3.9%–12.7%, they were still lower than screenings for other cancers.1
Study authors reviewed patient charts from 25 random dates August 1, 2018, to July 31, 2019, using the EPIC electronic medical record system. In the study’s second phase, 25 more dates were chosen to verify results.
For each of those dates, they randomly selected 5 charts for patients aged 55–80, then documented the patients who were eligible for lung cancer screening based on USPSTF guidelines. They cross-referenced those patients with their registry to see how many had undergone lung cancer screening.
In all, 44% of eligible patients who were qualified for LDCT lung cancer screening actually received them (95% CI, 25%-66%). In phase 2, the rate was 36% (95% CI, 20%-55%). And 11% of patients completed annual screenings as the guidelines suggest (95% CI, 3%-33%).
Researchers concluded that although the rates seen in this study were better than the rates commonly reported, the rate of patients receiving yearly screenings was much lower than those who received one-time screenings. Other cancer screenings, like mammograms and colorectal cancer screenings (65.3% and 68.8%, respectively) also see higher rates, they said. They cited physician ignorance of criteria, a need for more patient education, and stigmas associated with screenings to be possible causes.
“Training providers, providing educational materials for patients, and improving documentation of patient smoking history triggering EPIC alerts for qualifying patients would improve LCS rates,” they wrote.
Increasing Screening Referrals at Primary Care Clinics
Another study aimed to evaluate adequate assessment of smoking history as a possible barrier in lung cancer screening and found that built-in reminders to physicians significantly improved the rate of screenings at Medstar Washington Hospital Center Internal Medicine (WHCIM) clinic.2
Noting that past studies have shown the rate of LDCT screening to be about 2%-3%, their goal was to implement measures to improve the rate of screenings by 50% over a 3-month period.
Researchers collected data over a 2-week period and determined a 2.88% baseline rate of LDCT screening at WHCIM. After a multidisciplinary team meeting to come up with an intervention to improve rates, researchers implemented a print-out form given to physicians by medical assistants that reminded them to collect detailed smoking histories. It also included the USPSTF guidelines for screening eligibility.
After the 3-month trial period, doctors recorded a smoking history in 26% of patients, compared with 16% before the reminder was implemented. There was also a rise in the rate of screenings, with 2.88% of patients 55 and older being referred before the intervention and 6% after the print-out reminder.
Before the reminders began, just 42% of patients eligible for screening were referred, whereas 86% of eligible patients were referred once doctors were consistently reminded. Researchers concluded that it is a cost-effective way to improve the rate of screening and that multidisciplinary team involvement can help bridge gaps in holistic patient care.
Overall, simply providing print-out reminders increased smoking history documentation by 62%, and there was a relative increase of 105% in lung cancer screening for patients who met the USPSTF criteria. Researchers look incorporate the clinical reminder into the electronic medical record and implement it across Medstar Health hospitals.
1. Neumann M, Keller S, Berman A. Lung cancer screening in a medical clinic in an urban academic medical center. Presented at: CHEST 2020; October 18-21, 2020. Abstract A1471.
2. Kohli A, Bhargava A, Veytsman I. Improving rate of lung cancer screening in primary care clinic. Presented at: CHEST 2020; October 18-21, 2020. Abstract A1460.