Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire; The Dartmouth Institute of Health Policy and Clinical Practice, Lebanon, New Hampshire.
Dartmouth-Hitchcock Medical Center, Department of Surgery, Section of Thoracic Surgery, Lebanon, New Hampshire; Geisel School of Medicine, Hanover, New Hampshire.
J Surg Res. 2021 Jun;262:14-20. doi: 10.1016/j.jss.2020.11.050. Epub 2021 Jan 30.
Rural populations face many health disadvantages including higher rates of tobacco use and lung cancer than more populated areas. Given this, we specifically sought to understand the current screening landscape in a cohort of patients with resected lung cancer to help direct improvements in the screening process.
We retrospectively reviewed our prospective database at a rural, quaternary, academic institution from January 2015 to June 2018. All patients who underwent resection for primary lung cancer were studied to assess the frequency of preoperative low-dose chest computed tomography per accepted guidelines. The intent was to evaluate participant demographics, clinical stage, frequency, and distribution of Lung-RADS reporting.
About 446 patients underwent primary resection, of which 252 were deemed screening-eligible. About 57 (22.6%) underwent low-dose chest computed tomography screening and 195 (77.4%) did not. No significant demographic differences were identified between groups. However, 82.5% (47/57) of the screened patients presented with clinical stage IA disease, compared with 67.1% (131/195) of the nonscreened patients (P = 0.03). Among those screened, 36.8% (21/57) did not have a Lung-RADS score documented despite 52.3% (11/21) of those coming from accredited programs.
Our screening completion rate was only 22.6% of eligible patients and 36.8% of those patients did not have a documented Lung-RADS score. These findings, in combination with the increased rate of diagnosis of stage IA disease, provide compelling reasons to further investigate factors designed to improve access and screening practices at rural institutions.
农村人口面临许多健康劣势，包括吸烟率和肺癌发病率均高于人口密集地区。鉴于此，我们专门研究了一组接受过肺癌切除术的患者的当前筛查情况，以帮助改善筛查流程。
我们回顾性地分析了一家农村四级学术机构从 2015 年 1 月至 2018 年 6 月的前瞻性数据库。所有接受原发性肺癌切除术的患者都接受了术前低剂量胸部计算机断层扫描检查，以评估是否符合现行指南。其目的是评估患者的人口统计学特征、临床分期、肺癌筛查报告的频率和分布。
约有 446 名患者接受了原发性切除术，其中 252 名被认为符合筛查标准。约 57 名（22.6%）接受了低剂量胸部计算机断层扫描筛查，195 名（77.4%）未接受。两组之间没有明显的人口统计学差异。然而，筛查组中 82.5%（47/57）的患者为 IA 期临床疾病，而未筛查组中这一比例为 67.1%（131/195）（P=0.03）。在接受筛查的患者中，尽管有 52.3%（11/21）来自认证项目，但有 36.8%（21/57）的患者未记录肺癌筛查报告评分。
我们的筛查完成率仅为符合条件的患者的 22.6%，而其中 36.8%的患者没有记录肺癌筛查报告评分。这些发现，结合 IA 期疾病诊断率的增加，有力地证明了需要进一步研究旨在改善农村机构获得和筛查实践的因素。
