Applying causal inference methods to improve estimation of the real-world benefits and harms of lung cancer screening
应用因果推理方法来改进对肺癌筛查的现实益处和危害的估计
基本信息
- 批准号:10737187
- 负责人:
- 金额:$ 34.86万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-07-01 至 2028-06-30
- 项目状态:未结题
- 来源:
- 关键词:AddressAdherenceAffectBehavioralBehavioral Risk Factor Surveillance SystemBreast Cancer DetectionCharacteristicsClinical TrialsCommunicationDataData SetData SourcesDecision AidDecision MakingDevelopmentDiagnostic ProcedureEarly DiagnosisEffectivenessEligibility DeterminationEquilibriumFemaleGeneral PopulationIndividualInterventionLeftLungMalignant NeoplasmsMalignant neoplasm of lungMedicare claimMethodologyMethodsNational Cancer InstituteNational Health Interview SurveyNorth CarolinaObservational StudyOutcomeOutcome AssessmentPatientsPatternPolicy MakerPopulationPopulation CharacteristicsProceduresProviderRandomizedRandomized, Controlled TrialsRecommendationRegistriesResearchResearch PersonnelRisk FactorsSamplingScreening for cancerSelection BiasSelection for TreatmentsSmokingSubgroupSurveysTimeUnited States Preventative Services Task ForceUpdateWorkcancer therapyclinical practicecolon cancer screeningcostdesignevidence basefollow-uphuman old age (65+)improvedintervention effectlow dose computed tomographylung cancer screeningmortalitynovelpractice settingrandomized trialroutine screeningscreeningscreening guidelinesscreening programshared decision makingtooltrial enrollmentuptake
项目摘要
ABSTRACT
Randomized controlled trials have demonstrated that low-dose computed tomography can substantially reduce
lung cancer mortality, albeit at the cost of relatively high rates of false positives and complications from
downstream procedures. However, systematic differences between trial and general populations eligible for
lung cancer screening raise concerns about the relevance of trial findings for guiding the development and
dissemination of lung cancer screening programs in clinical practice. Despite clear recommendations from the
United States Preventative Services Task Force, lung cancer screening uptake and adherence remain low.
Several studies have documented dramatic and selective attrition across the screening continuum – where
about 10-20% of eligible individuals undergo lung cancer screening and of those, only about 40-60% are up-to-
date with their annual screening at 15 months. When the benefits and harms of an intervention vary across
subgroups and there is selective attrition, the balance of population-level benefits and harms is expected to
change. As such, there is an urgent need to better characterize the effectiveness of lung cancer screening with
low-dose computed tomography when applied to individuals outside of clinical trial settings. The primary
objective of this proposal is to generate real-world evidence of the benefits and harms of lung cancer screening
with low-dose computed tomography that explicitly considers the characteristics of populations at each step of
the screening continuum, from the screening-eligible, to the screened, to the adherent. To address this
objective, we will use cutting-edge causal inference methods, including trial transport and target trial emulation
using real-world data, which can avoid the potential for time-related biases. To carry-out our proposed
analyses, we will draw upon individual-level data from the randomized National Lung Screening Trial, as well
as four real-world datasets including the National Health and Interview Survey, the Behavioral Risk Factors
Surveillance Survey (Lung Cancer Screening Module), a 20% nationwide sample of Medicare claims, and the
North Carolina Lung Screening Registry. Findings from this study will generate information about the
effectiveness of lung cancer screening in real-world settings that can be used by patients, providers, and
policymakers. This work will enhance the evidence base used by policymakers to update screening
recommendations and refine decision aids to support communication with patients about screening net-
benefits during shared decision-making. Ultimately, this work will support efforts to improve the delivery of lung
cancer screening at the population level.
摘要
随机对照试验已经证明,低剂量计算机断层扫描可以显著减少
肺癌死亡率,尽管代价是相对较高的假阳性率和并发症
下游程序。然而,符合条件的试验人群和普通人群之间的系统性差异
肺癌筛查引起了人们对试验结果与指导发展和
在临床实践中推广肺癌筛查方案。尽管委员会明确提出了建议
美国预防服务工作组,肺癌筛查的接受率和依从性仍然很低。
几项研究已经记录了整个筛查过程中戏剧性和选择性的自然减员-其中
大约10%-20%的符合条件的个人接受了肺癌筛查,而在这些人中,只有大约40%-60%达到了
在15个月时与他们的年度筛查约会。当干预的好处和坏处在不同的地方不同时
亚群和有选择的自然减员,人口层面的利益和损害的平衡预计将
变化。因此,迫切需要更好地表征肺癌筛查的有效性
当应用于临床试验环境之外的个体时,低剂量计算机断层扫描。初级阶段
这项提案的目的是为肺癌筛查的益处和危害提供真实的证据
使用低剂量计算机断层扫描,明确考虑每一步人群的特征
筛选连续体,从符合筛选条件的人,到经过筛选的人,再到附着者。要解决这个问题
目标,我们将使用尖端的因果推理方法,包括试验传输和目标试验仿真
使用真实世界的数据,这可以避免潜在的与时间相关的偏差。来实施我们的建议
分析,我们还将利用来自随机国家肺部筛查试验的个人水平的数据
作为包括国民健康和访谈调查在内的四个真实世界的数据集,行为风险因素
监视调查(肺癌筛查模块),20%的全国医疗保险索赔样本,以及
北卡罗来纳州肺部筛查登记处。这项研究的发现将产生关于
患者、提供者和患者可使用的真实环境中肺癌筛查的有效性
政策制定者。这项工作将加强政策制定者用来更新筛查的证据基础
建议和改进决策辅助工具,以支持与患者就筛查网络进行沟通-
分享决策过程中的利益。最终,这项工作将支持改善肺的交付的努力
在人口层面进行癌症筛查。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Louise Henderson其他文献
Louise Henderson的其他文献
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{{ truncateString('Louise Henderson', 18)}}的其他基金
Comorbidity and Functional Status in a Population Undergoing Lung Cancer Screening
接受肺癌筛查人群的合并症和功能状态
- 批准号:
10434819 - 财政年份:2020
- 资助金额:
$ 34.86万 - 项目类别:
Comorbidity and Functional Status in a Population Undergoing Lung Cancer Screening
接受肺癌筛查人群的合并症和功能状态
- 批准号:
10210249 - 财政年份:2020
- 资助金额:
$ 34.86万 - 项目类别:
Comorbidity and Functional Status in a Population Undergoing Lung Cancer Screening
接受肺癌筛查人群的合并症和功能状态
- 批准号:
10030361 - 财政年份:2020
- 资助金额:
$ 34.86万 - 项目类别:
Comorbidity and Functional Status in a Population Undergoing Lung Cancer Screening
接受肺癌筛查人群的合并症和功能状态
- 批准号:
10650152 - 财政年份:2020
- 资助金额:
$ 34.86万 - 项目类别:
Evaluating Lung Cancer Screening Patterns and Outcomes through a North Carolina Registry
通过北卡罗来纳州登记处评估肺癌筛查模式和结果
- 批准号:
9768411 - 财政年份:2017
- 资助金额:
$ 34.86万 - 项目类别:
Evaluating Lung Cancer Screening Patterns and Outcomes in Diverse Populations and Settings
评估不同人群和环境中的肺癌筛查模式和结果
- 批准号:
10658313 - 财政年份:2017
- 资助金额:
$ 34.86万 - 项目类别:
Evaluating Lung Cancer Screening Patterns and Outcomes through a North Carolina Registry
通过北卡罗来纳州登记处评估肺癌筛查模式和结果
- 批准号:
10242671 - 财政年份:2017
- 资助金额:
$ 34.86万 - 项目类别:
Developing a Lung Cancer Screening Registry in a State with a High Smoking Rate
在吸烟率高的州建立肺癌筛查登记处
- 批准号:
8637321 - 财政年份:2014
- 资助金额:
$ 34.86万 - 项目类别:
Developing a Lung Cancer Screening Registry in a State with a High Smoking Rate
在吸烟率高的州建立肺癌筛查登记处
- 批准号:
8788924 - 财政年份:2014
- 资助金额:
$ 34.86万 - 项目类别:
Technologists Effect on the Accuracy of Mammography (TEAM)
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8435353 - 财政年份:2012
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$ 34.86万 - 项目类别:
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