Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Parkinson Pavilion, Zone C, Suite 501, 3401 N. Broad Street, Philadelphia, PA, 19140, USA.
Center for Asian Health, Lewis Katz School of Medicine at Temple University, Kresge Science Hall, Suite 320, 3440 N. Broad Street, Philadelphia, PA, 19140, USA.
Cancer Causes Control. 2021 Mar;32(3):291-298. doi: 10.1007/s10552-020-01383-0. Epub 2021 Jan 4.
Our aim was to develop a novel approach for lung cancer screening among a diverse population that integrates the Centers for Medicare and Medicaid Services (CMS) recommended components including shared decision making (SDM), low-dose CT (LDCT), reporting of results in a standardized format, smoking cessation, and arrangement of follow-up care.
Between October of 2015 and March of 2018, we enrolled patients, gathered data on demographics, delivery of SDM, reporting of LDCT results using Lung-RADS, discussion of results, and smoking cessation counseling. We measured adherence to follow-up care, cancer diagnosis, cancer treatment, and smoking cessation at 2 years after initial LDCT.
We enrolled 505 patients who were 57% African American, 30% Caucasian, 13% Hispanic, < 1% Asian, and 61% were active smokers. All participants participated in SDM, 88.1% used a decision aid, and 96.1% proceeded with LDCT. Of 496 completing LDCT, all received a discussion about results and follow-up recommendations. Overall, 12.9% had Lung-RADS 3 or 4, and 3.2% were diagnosed with lung cancer resulting in a false-positive rate of 10.7%. All 48 patients with positive screens but no cancer diagnosis adhered to follow-up care at 1 year, but only 35.4% adhered to recommended follow-up care at 2 years. The annual follow-up for patients with negative lung cancer screening results (Lung-RADS 1 and 2) was only 23.7% after one year and 2.8% after 2 years. All active smokers received smoking cessation counseling, but only 11% quit smoking.
The findings show that an integrated lung cancer screening program can be safely implemented in a diverse population, but adherence to annual screening is poor.
我们旨在为不同人群开发一种新的肺癌筛查方法，该方法整合了医疗保险和医疗补助服务中心（CMS）推荐的各项内容，包括共同决策（SDM）、低剂量 CT（LDCT）、以标准化格式报告结果、戒烟以及安排后续护理。
2015 年 10 月至 2018 年 3 月，我们招募了患者，收集了人口统计学数据、SDM 的实施情况、使用 Lung-RADS 报告 LDCT 结果、结果讨论以及戒烟咨询情况。我们在初始 LDCT 后 2 年时测量了对后续护理、癌症诊断、癌症治疗和戒烟的依从性。
我们招募了 505 名患者，其中 57%为非裔美国人，30%为白种人，13%为西班牙裔，<1%为亚洲人，61%为现吸烟者。所有参与者都参与了 SDM，88.1%使用了决策辅助工具，96.1%进行了 LDCT。在完成 LDCT 的 496 名患者中，所有人都收到了关于结果和后续建议的讨论。总体而言，12.9%的患者 Lung-RADS 为 3 或 4，3.2%被诊断为肺癌，导致假阳性率为 10.7%。所有 48 名阳性筛查但无癌症诊断的患者在 1 年内均接受了随访，但只有 35.4%在 2 年内接受了推荐的随访。在阴性肺癌筛查结果（Lung-RADS 1 和 2）的患者中，1 年后的年度随访率仅为 23.7%，2 年后的年度随访率仅为 2.8%。所有现吸烟者都接受了戒烟咨询，但只有 11%戒烟。
研究结果表明，一种综合的肺癌筛查方案可以安全地在不同人群中实施，但对年度筛查的依从性较差。
