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Title:Presenters:
Date:
Proportion of Newly Diagnosed Non-Small Cell Lung Cancer Patients That Would Have
Been Eligible for Lung Cancer Screening
Division of Thoracic SurgeryCity of Hope National Medical Center
Duarte, CA
Geena X. Wu, MD; Leanne Goldstein, DrPH; Jae Y. Kim, MD; Dan J. Raz, MD
Introduction
• Lung cancer screening (LCS) guidelines among major health organizations.
LCS criterion
Other(NLST
derived) USPSTF CMS
NCCN AATS
Primary Secondary Primary Secondary
Age (years) 55-74 55-80 55-77 55-74 50-79 55-79 50-79
Smoking History (pack-years)
≥30 ≥30 ≥30 ≥30 ≥20 ≥30 ≥20
Quit time (years) 15 15 15 15 none none none
Other criteria - - - -Additional risk factor
-
Additional risk factor ↑ lung cancer risk
≥5% in 5 yearsAmerican Lung Association. http://www.lung.org/lung-disease/lung-cancer/lung-cancer-screening-guidelines/ Detterbeck FC. Chest 2013;143(5 Suppl):e78S-92S.Jaklitsch MT1. JTCVS 2012;144(1):33-38.Jensen T. Memo: CMS 2015. Report No.: CAG-00439N.Smith RA. CA Cancer J Clin 2014;64(1):30-51Wood DE. J NCCN 2012;10(2)240-265.Moyer VA. Ann Intern Med 2013.
Methods
2,244 adults with NSCLC
2,030 NSCLC patients with
complete smoking history
Current smokers630 (31%)
Former smokers873 (43%)
Never smokers 527 (26%)
214 patients with unknown or incomplete
smoking status or history
Retrospective institutional cohort (1994-2014)
Text-mining and manual review of EMR
Final cohort
Excluded from analysis
Patients with history of malignancy 442 (22%)
Identified in cancer registry
Secondary LCS criteria
Primary LCS criteria
Results: Applying USPSTF LCS Criteria
Current smokers
n=873
Former smokers
N=630
Mean age (years) 63 69
Median pack-years smoked 46 30
Median quit-time (years) - 15
LCS criteria met, n (%)
All
Age
Pack-year
Quit time
425 (67.5)
480 (76.2)
524 (83.2)
-
273 (31.3)
685 (78.5)
497 (56.9)
440 (50.4)
All All All All
31.8%26.9%
16.4%
40.7%
Results: Applying USPSTF LCS Criteria
Current smokers
n=873
Former smokers
N=630
Mean age (years) 63 69
Median pack-years smoked 46 30
Median quit-time (years) - 15
LCS criteria met, n (%)
All
Age
Pack-year
Quit time
425 (67.5)
480 (76.2)
524 (83.2)
-
273 (31.3)
685 (78.5)
497 (56.9)
440 (50.4)
M F M F M F M F
13.1%5.8%
Results: Applying USPSTF LCS Criteria
All criteria metn=698 (34.4%)
+6.6% +9.3%+23.0%
Exclude quit timen=832 (41.0%)
Exclude quit timeand age
n=887 (43.7%)
Exclude quit time and pack-year
n=1,165 (57.4%)
Discussion
• Summary– A third of NSCLC patients met all LCS criteria– Only half of former smokers met quit time criterion
• Limitations– Generalizability of data– Retrospective application of LCS to NSCLC patients– Inability to determine timing or benefit of LCS
• Future Directions– Prospective assessment of utility of current LCS criteria,
especially the quit time maximum– Consensus on a uniform, validated set of criteria to
promote LCS
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