Identifying older adults who benefit from lung cancer screening

确定受益于肺癌筛查的老年人

• 批准号: 10726195
• 负责人: Alison Silvis Rustagi
• 金额: $ 15.33万
• 依托单位: NORTHERN CALIFORNIA INSTITUTE/RES/EDU
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10726195
• 关键词: Address; Adult; Adverse event; Age; Aging; Algorithms; American; Arrhythmia; Cancer Etiology; Caring; Categories; Cessation of life; Chest; Chronic Obstructive Pulmonary Disease; Complication; Data; Decision Making; Diagnostic Imaging; Diagnostic Procedure; Disease; Elderly; Electronic Health Record; Eligibility Determination; Ensure; Equilibrium; Ethnic Origin; Exclusion; Frail Elderly; Future; Goals; Guidelines; Health; Health Status; Health system; Individual; Intervention; Intuition; Joints; Knowledge; Life; Life Expectancy; Logistic Regressions; Lung; Malignant neoplasm of lung; Measures; Mentorship; Methodology; Methods; Modeling; Names; National Institute on Aging; Nature; Outcome; Pattern; Physicians; Positioning Attribute; Prevalence; Preventive; Preventive Health Services; Procedures; Race; Recommendation; Research Personnel; Risk; Scanning; Screening for cancer; Smoking History; Smoking and Health Research; Standardization; Techniques; Testing; United States; Veterans Health Administration; Woman; Work; adverse outcome; career; clinically relevant; cohort; college; comorbidity; computed tomography screening; experience; falls; health application; health data; high risk; improved; innovation; lung cancer screening; lung imaging; multiple chronic conditions; novel; personalized decision; prevent; screening; sex; tool

PROJECT SUMMARY/ABSTRACT Lung cancer is primarily a disease of aging. Lung cancer is the number one cause of cancer death in the United States, with 127,000 deaths annually. Lung cancer screening (LCS) can prevent lung cancer death among older adults ages 50-80 without advanced comorbidities. Screening must balance the risk of immediate harms against the potential to prevent death years in the future. There is a fundamental knowledge gap in how to identify older adults who are “healthy enough” for LCS, among the 14.5 million who are currently eligible. My long-term goal is to maximize the benefit of LCS for older adults by providing them individualized estimates of net benefit from LCS based on health status, and become an expert on preventive health interventions for older adults. The objective of the proposed project is to examine the association between health and use of LCS and then measure risks of immediate harms after LCS by health status. I will define health in various ways and identify a metric of health that best predicts harms of LCS. The central hypothesis of this proposal is that LCS is common among those in the poor health, which undermines its benefit and increases the risk of harm (e.g., complications of invasive procedures after abnormal lung scans). I will leverage national data from Veterans Health Affairs (VHA), which has pioneered a tool to systematically assess LCS eligibility via detailed smoking history. I will test my central hypothesis in the following specific aims. Aim 1: Determine the associations between use of LCS and pre-screening health as measured by three health metrics – (1) life expectancy, (2) life years gained by screening, and (3) advanced chronic obstructive pulmonary disease. Aim 2: Determine the rates of complications from diagnostic procedures prompted by LCS across pre-screening health status measured with the same three health metrics, using advanced quantitative methods (i.e., joint modeling) to account for the interrelated nature of procedure choice and complication risk. This project is methodologically innovative because I will (1) apply a novel, validated algorithm to exclude diagnostic imaging to provide unbiased estimates of LCS use and harms, (2) apply joint modeling to identify older adults at higher risk of adverse screening outcomes, and (3) utilize detailed smoking and health data in the VHA which is not available elsewhere and has been a persistent barrier to prior work. This project is conceptually innovative because I will use health metrics uniquely relevant to LCS. The proposed project is significant in that it will provide a rich understanding of how LCS is currently used across categories defined by health and advance our knowledge by identifying those most likely to benefit from LCS. This knowledge could guide older adults and their clinicians towards informed, individualized screening decisions that prioritize LCS among competing health needs. This project directly responds to the National Institute on Aging’s priorities to meet the needs of older adults with multiple comorbidities and to optimize their health by personalizing decision-making based on their unique health status.

项目概要/摘要 肺癌主要是一种衰老疾病。肺癌是癌症死亡的第一大原因 美国，每年有 127,000 人死亡。 Lung cancer screening (LCS) can prevent lung cancer death among older adults ages 50-80 without advanced comorbidities.筛查必须平衡立即发生的风险 harms against the potential to prevent death years in the future.在如何进行方面存在基本知识差距 to identify older adults who are “healthy enough” for LCS, among the 14.5 million who are currently eligible. My long-term goal is to maximize the benefit of LCS for older adults by providing them individualized estimates of net benefit from LCS based on health status, and become an expert on preventive health interventions for 老年人。 The objective of the proposed project is to examine the association between health and use of LCS，然后根据健康状况衡量 LCS 后直接伤害的风险。我会用多种方式来定义健康 and identify a metric of health that best predicts harms of LCS.该提案的中心假设是 LCS 在健康状况不佳的人群中很常见，这会削弱其益处并增加伤害风险 （例如，肺部扫描异常后侵入性操作的并发症）。 我将利用退伍军人健康事务部 (VHA) 的国家数据，该机构首创了一种工具，可以系统地 通过详细的吸烟史评估 LCS 资格。我将在以下具体内容中检验我的中心假设 目标。目标 1：确定 LCS 的使用与预筛查健康之间的关联（通过三个指标来衡量） 健康指标 – (1) 预期寿命，(2) 通过筛查获得的生命年，以及 (3) 晚期慢性阻塞性肺疾病 肺病。 Aim 2: Determine the rates of complications from diagnostic procedures prompted by LCS 使用相同的三个健康指标，使用先进的定量方法测量预筛查的健康状况 methods (i.e., joint modeling) to account for the interrelated nature of procedure choice and complication risk. 这个项目在方法上是创新的，因为我将（1）应用一种新颖的、经过验证的算法来排除 diagnostic imaging to provide unbiased estimates of LCS use and harms, (2) apply joint modeling to identify 老年人出现不良筛查结果的风险较高，并且 (3) 利用详细的吸烟和健康数据 the VHA which is not available elsewhere and has been a persistent barrier to prior work.这个项目是 概念上具有创新性，因为我将使用与 LCS 独特相关的健康指标。 拟议的项目意义重大，因为它将提供对濒海战斗舰当前如何使用的丰富理解 跨越健康定义的类别，并通过确定最有可能受益的人群来增进我们的知识 濒海战斗舰。这些知识可以指导老年人及其临床医生进行知情、个性化的筛查 在相互竞争的健康需求中优先考虑 LCS 的决策。该项目直接响应国家 老龄化研究所的优先事项是满足患有多种合并症的老年人的需求并优化他们的生活 根据他们独特的健康状况做出个性化决策，以确保他们的健康。