Challenges to effective implementation of lung cancer screening

有效实施肺癌筛查的挑战

• 批准号: 8951087
• 负责人: Samir Suresh Soneji
• 金额: $ 21.14万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-16 至 2017-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8951087
• 关键词: Academic Medical Centers; Accounting; Address; Adopted; Affect; Age; Cancer Control; Caring; Cessation of life; Cigarette Smoker; Clinical; Clinical Treatment; Colorectal Cancer; Communities; Community Practice; Complication; Data; Diagnosis; Diagnostic Procedure; Disease; Effectiveness; Future; General Population; Grant; Guidelines; Health Personnel; Health Surveys; Knowledge; Lung; Malignant Neoplasms; Malignant neoplasm of lung; Malignant neoplasm of prostate; Medical; Medicare; National Health Interview Survey; National Health and Nutrition Examination Survey; Not Hispanic or Latino; Operative Surgical Procedures; Participant; Patients; Pattern; Physicians; Population; Population Heterogeneity; Postoperative Period; Preparation; Prevalence; Procedures; Race; Randomized; Relative (related person); Research; Respondent; Risk; Sampling; Smoker; Smoking Status; Source; Stage at Diagnosis; Staging; Statistical Models; Thoracic Radiography; Time; Translating; Translations; Weight; X-Ray Computed Tomography; aged; base; cancer surgery; clinical practice; cohort; experience; improved; lung cancer screening; malignant breast neoplasm; models and simulation; mortality; public health relevance; racial disparity; randomized trial; screening; sex; shared decision making; treatment effect

 DESCRIPTION (provided by applicant): Since 1974, lung cancer has caused more deaths each year in the US than breast, colorectal, and prostate cancer combined. The burden of lung cancer mortality is especially high for Blacks who are even more likely than Whites to be diagnosed at the most advanced stages of the disease. For the first time, screening for lung cancer through computed tomography (CT) has been shown to reduce lung cancer mortality. The recently completed National Lung Screening Trial (NLST) concluded CT screening reduced lung cancer mortality by 20%, compared to screening with chest X-ray. CT screening in NLST reduced lung cancer mortality as much-and possibly more-for Blacks than for Whites (38% versus 14% reduction). While promising, we do not yet know if the efficacy of CT screening demonstrated in NLST will translate to effective reductions in lung cancer mortality as CT screening has now begun to occur in community practice. We also do not yet know if the benefits of CT screening will be shared equally between Black and White patients. Often the benefits demonstrated in randomized trials far exceed the benefits realized in the community. CT screening may provide less benefit to patients in the community than it did for NLST participants because of barriers to screening (e.g., low knowledge about screening and its risks) and treatment-related complications (e.g., high rates of post-operative mortality for lung cancer surgery). Moreover, if these screening barriers and treatment- related complications are higher among Blacks than Whites-as they are for other leading cancers-racial disparities in lung cancer mortality may actually widen over time. In this study, we will use data from NLST, nationally representative health survey data, and Medicare administrative claims data to address the following specific aims. First, we will generalize the findings of NLST to the US population of cigarette smokers. Second, we will assess the structural and clinical barriers facing cigarette smokers to receiving and benefiting from CT screening for lung cancer. Third, we will estimate the number of lung cancer deaths in the US that could be averted by CT screening assuming race-specific rates of CT screening and varying the effectiveness of CT screening to reduce lung cancer mortality. This project will help to improve clinical practice and narrow future racial disparities in lung cancer mortality by revealing the structural and clinical barriers that impede equally effective translation of CT screening. This project will also improve shared decision making between patients and their healthcare providers as they discuss lung cancer screening by providing the most up-to-date estimates of screening benefits and harms in everyday practice. Thus, this project will directly address key research objectives of PA-13-288. Finally, this project will inform preparation of an NCI R01 grant to assess contemporary CT screening rates in pre-Medicare and Medicare aged populations and determine if and how actual screening patterns affect disparities in stage at diagnosis, survival and lung cancer mortality at the population level.

 描述（由申请人提供）：自1974年以来，肺癌在美国每年造成的死亡人数超过乳腺癌、结直肠癌和前列腺癌的总和。肺癌死亡率的负担对于黑人来说尤其高，他们甚至比白人更有可能在疾病的最晚期被诊断出来。通过计算机断层扫描（CT）进行肺癌筛查首次被证明可以降低肺癌死亡率。最近完成的国家肺筛查试验（NLST）得出结论，与胸部X光筛查相比，CT筛查可将肺癌死亡率降低20%。NLST中的CT筛查降低了黑人肺癌死亡率（38%比14%），而且可能更多。虽然前景看好，但我们还不知道NLST中证明的CT筛查的疗效是否会转化为有效降低肺癌死亡率，因为CT筛查现已开始在社区实践中进行。我们还不知道CT筛查的好处是否会在黑人和白色患者之间平等分享。通常，随机试验中证明的益处远远超过社区中实现的益处。CT筛查可能为社区患者提供的益处少于NLST参与者，因为筛查存在障碍（例如，关于筛查及其风险的知识不足）和治疗相关的并发症（例如，肺癌手术的术后死亡率较高）。此外，如果这些筛查障碍和治疗相关并发症在黑人中比白人高--就像其他主要癌症一样--肺癌死亡率的种族差异实际上可能会随着时间的推移而扩大。在这项研究中，我们将使用NLST的数据，全国代表性的健康调查数据和医疗保险行政索赔数据，以解决以下具体目标。首先，我们将把NLST的发现推广到美国的吸烟人群。其次，我们将评估吸烟者接受肺癌CT筛查并从中受益所面临的结构和临床障碍。第三，我们将估计美国通过CT筛查可以避免的肺癌死亡人数，假设种族特异性的CT筛查率，并改变CT筛查降低肺癌死亡率的有效性。该项目将有助于改善临床实践，并通过揭示阻碍CT筛查同等有效转化的结构和临床障碍来缩小未来肺癌死亡率的种族差异。该项目还将通过提供日常实践中筛查益处和危害的最新估计，改善患者及其医疗保健提供者在讨论肺癌筛查时的共同决策。因此，该项目将直接解决PA-13-288的关键研究目标。最后，该项目将为NCI R 01拨款的准备提供信息，以评估医疗保险前和医疗保险老年人群的当代CT筛查率，并确定实际筛查模式是否以及如何影响人群水平上诊断阶段，生存率和肺癌死亡率的差异。