Incorporating Coexisting Chronic Illness into Decisions about Patient Selection for Lung Cancer Screening An Official American Thoracic Society Research Statement
Incorporating Coexisting Chronic Illness into Decisions about Patient Selection for Lung Cancer Screening An Official American Thoracic Society Research Statement
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DOI：
10.1164/rccm.201805-0986st
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发表时间：
2018-07-15
影响因子：
24.7
通讯作者：
Wiener, Renda Soylemez
中科院分区：
文献类型：
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作者：
Rivera, M. Patricia;Tanner, Nichole T.;Wiener, Renda Soylemez
背景资料：肺癌筛查（LCS）有可能降低健康个体的肺癌死亡风险，但共存的慢性疾病对LCS结果的影响尚未得到很好的定义。考虑肺癌基线风险、治疗相关危害和竞争原因死亡风险之间的复杂关系，对于确定LCS的获益和危害平衡至关重要。目的：总结证据，确定知识和研究差距，优先考虑主题，并为未来研究提出方法，以最好地将合并症纳入LCS决策。方法：一个由国际临床医生和研究人员组成的多学科小组审查了关于合并症对LCS结局影响的现有数据，重点关注肺癌风险和死亡竞争风险的并列，考虑慢性阻塞性肺疾病患者的获益和风险，风险沟通和筛查检测肺癌的治疗。本声明确定了关于合并症和竞争性死亡原因如何影响LCS结局的知识差距，我们制定了问题，以帮助指导未来的研究工作，以更好地为患者选择，教育和LCS的实施提供信息。结论：迫切需要进一步的研究来帮助指导临床决策-与那些由于共存的慢性疾病而可能无法从LCS中受益的患者进行沟通。本声明建立了一个研究框架，以解决有关如何将合并症风险纳入并传达到患者选择和LCS决策中的基本问题。
Background: Lung cancer screening (LCS) has the potential to reduce the risk of lung cancer death in healthy individuals, but the impact of coexisting chronic illnesses on LCS outcomes has not been well defined. Consideration of the complex relationship between baseline risk of lung cancer, treatment-related harms, and risk of death from competing causes is crucial in determining the balance of benefits and harms of LCS.Objectives: To summarize evidence, identify knowledge and research gaps, prioritize topics, and propose methods for future research on how best to incorporate comorbidities in making decisions regarding LCS.Methods: A multidisciplinary group of international clinicians and researchers reviewed available data on the effects of comorbidities on LCS outcomes, focusing on the juxtaposition of lung cancer risk and competing risks of death, consideration of benefits and risks in patients with chronic obstructive pulmonary disease, communication of risk, and treatment of screen-detected lung cancer.Results: This statement identifies gaps in knowledge regarding how comorbidities and competing causes of death impact outcomes in LCS, and we have developed questions to help guide future research efforts to better inform patient selection, education, and implementation of LCS.Conclusions: There is an urgent need for further research that can help guide clinical decision-making with patients who may not benefit from LCS owing to coexisting chronic illness. This statement establishes a research framework to address essential questions regarding how to incorporate and communicate risks of comorbidities into patient selection and decisions regarding LCS.