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
• 负责人: Louise Henderson
• 金额: $ 54.61万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10658313
• 关键词: Academy; Adherence; Adult; Affect; Age; American College of Radiology; Attitude; Behavior; Black Populations; Black race; Cancer Control; Cancer Detection; Cancer Etiology; Caring; Cessation of life; Characteristics; Cigarette; Communities; Continuity of Patient Care; Data; Development; Disparity; Effectiveness; Eligibility Determination; Ethnic Origin; Funding; Future; Goals; Guidelines; Heterogeneity; Individual; Knowledge; Life; Lung; Lung nodule; Malignant neoplasm of lung; Medicine; Methods; Modeling; National Cancer Institute; North Carolina; Not Hispanic or Latino; Outcome; Participant; Patients; Pattern; Patterns of Care; Performance; Policies; Population; Population Heterogeneity; Predictive Value; Procedures; Race; Randomized, Controlled Trials; Recommendation; Recording of previous events; Registries; Research; Research Priority; Research Support; Risk; Screening Result; Smoke; Smoking; Smoking History; Specificity; Surveys; Testing; Training; United States; United States National Institutes of Health; United States Preventative Services Task Force; Update; Vulnerable Populations; Woman; aged; black men; black patient; black women; cancer risk; clinically significant; evidence base; experience; follow-up; high risk population; imaging facilities; improved; innovation; low dose computed tomography; lung cancer screening; men; mortality; patient screening; pilot test; population based; practice setting; primary care provider; radiologist; randomized trial; screening; screening guidelines; sex; shared decision making; smoking exposure

ABSTRACT Lung cancer is the leading cause of cancer deaths in the United States, with higher rates of lung cancer among Black versus White men, despite Black populations having lower smoking rates, smoking fewer cigarettes per day, and being less likely to smoke heavily. Randomized trials demonstrated early detection of lung cancer with annual low dose computed tomography reduces lung cancer mortality by 20-33% in high-risk populations. In 2013 the US Preventive Services Task Force (USPSTF) recommended annual lung cancer screening (LCS) in individuals ages 55-80 years who currently or former (quit within 15 years) smoked at least 30 pack-years. Some studies suggested the 2013 USPSTF LCS eligibility criteria under selected women and Black individuals who tend to smoke less intensely yet have increased risk of developing lung cancer. In 2021, the USPSTF expanded their LCS recommendations to include individuals ages 50-80 years with at least a 20 pack-year history, increasing the number eligible by more than 80% to 14.5 million U.S. adults. These expanded criteria will result in higher relative increases in screening eligibility for women versus men and non-Hispanic Black versus non-Hispanic White populations. Yet, the impact of the expanded 2021 USPSTF eligibility criteria on screening practice and outcomes is unknown. The objective of this application is to understand how the updated 2021 USPSTF LCS recommendations are implemented in practice and quantify the impact of the new recommendations on the LCS care continuum from adherence to performance. Our central hypothesis is that there will be race and sex-based differences in the benefits and harms of LCS among newly eligible individuals (e.g., ages 50-54 years or smoking 20-29 P-Y) because of heterogeneity in the baseline risk of developing lung cancer. Guided by strong preliminary data, the hypothesis will be tested by pursuing the following specific aims: 1) Evaluate patients’ and clinicians' attitudes, knowledge, and experiences with the expanded 2021 USPSTF LCS recommendations; 2) Determine the impact of the 2013 vs. 2021 USPSTF LCS eligibility criteria across the screening care continuum in terms of (a) baseline lung cancer risk in the population screened, (b) adherence to annual LCS, and (c) receipt of recommended care following an abnormal LCS result; and 3) Compare the performance of LDCT LCS in individuals screened per the USPSTF 2013 criteria versus the 2021 newly eligible criteria. The study is innovative in combining survey and quantitative methods in a large, diverse, community-based population to evaluate the impact of the 2021 USPSTF LCS recommendations on LCS care patterns and outcomes. The proposed research is significant because it will quantify the experiences of LCS in the 14.5 million individuals now eligible for screening. The findings are expected to advance and expand our understanding of LCS in diverse populations and settings which will enable clinicians to deliver more evidence based, high-quality LCS care.

抽象的 肺癌是美国癌症死亡的主要原因，其中肺癌发病率较高 黑人与白人男性相比，尽管黑人人口的吸烟率较低，但每人吸烟较少 日，并且不太可能大量吸烟。随机试验证明肺癌的早期检测 每年进行低剂量计算机断层扫描可将高危人群的肺癌死亡率降低 20-33%。 2013 年，美国预防服务工作组 (USPSTF) 建议每年进行肺癌筛查 (LCS) 年龄在 55-80 岁之间，目前或曾经（15 年内戒烟）吸烟至少 30 包年的个人。 一些研究表明 2013 年 USPSTF LCS 资格标准针对选定的女性和黑人个体 吸烟量较少但患肺癌的风险较高的人。 2021 年，USPSTF 扩大了他们的 LCS 建议范围，将年龄在 50-80 岁且每年至少有 20 包的个人纳入其中 历史上，符合资格的美国成年人人数增加了 80% 以上，达到 1,450 万。这些扩展的标准 将导致女性与男性和非西班牙裔黑人的筛查资格相对增加 与非西班牙裔白人人口相比。然而，扩大的 2021 年 USPSTF 资格标准对 筛查实践和结果尚不清楚。该应用程序的目的是了解如何 更新的 2021 年 USPSTF LCS 建议已在实践中实施，并量化了新建议的影响 关于 LCS 护理从依从性到表现的连续性的建议。我们的中心假设是 对于新符合资格的个人来说，LCS 的益处和危害将存在基于种族和性别的差异 （例如，年龄 50-54 岁或吸烟 20-29 年），因为患肺癌的基线风险存在异质性 癌症。在强有力的初步数据的指导下，将通过追求以下具体内容来检验该假设 目标：1) 在 2021 年扩展的范围内评估患者和临床医生的态度、知识和经验 USPSTF 濒海战斗舰建议； 2) 确定 2013 年与 2021 年 USPSTF LCS 资格标准的影响 在整个筛查护理连续过程中，(a) 筛查人群的基线肺癌风险，(b) 遵守年度 LCS，以及 (c) 在 LCS 结果异常后接受建议的护理；和 3) 比较根据 USPSTF 2013 年标准与 2021 年标准筛选的个体中 LDCT LCS 的表现 新的合格标准。这项研究的创新之处在于将调查和定量方法结合起来，进行了大规模、多样化的研究。 以社区为基础的人群评估 2021 年 USPSTF LCS 建议对 LCS 护理的影响 模式和结果。拟议的研究意义重大，因为它将量化濒海战斗舰的经验 目前有 1,450 万人有资格接受筛查。研究结果预计将推进和扩大我们的 了解不同人群和环境中的 LCS，这将使临床医生能够提供更多证据 基于 LCS 的高质量护理。

项目成果

Randomized control trial of unconditional versus conditional incentives to increase study enrollment rates in participants at increased risk of lung cancer.

• DOI: 10.1016/j.jclinepi.2021.08.027
• 发表时间: 2022-01
• 期刊: Journal of clinical epidemiology
• 影响因子: 7.2
• 作者: Kumar AD;Durham DD;Lane L;Perera P;Rivera MP;Henderson LM
• 通讯作者: Henderson LM

Complementary Approaches to Lung Cancer Detection in High-Risk Populations.

高危人群肺癌检测的补充方法。

• DOI: 10.1200/jco.22.00494
• 发表时间: 2022
• 期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology
• 作者: Rivera,MPatricia;Cupertino,Paula;Henderson,LouiseM
• 通讯作者: Henderson,LouiseM

Lung cancer screening and shared decision making in cancer survivors: the long and winding road.

肺癌筛查和癌症幸存者的共同决策：漫长而曲折的道路。

• DOI: 10.21037/tlcr.2018.12.14
• 发表时间: 2019
• 期刊: Translational lung cancer research
• 影响因子: 4
• 作者: Rivera,MPatricia;Henderson,LouiseM
• 通讯作者: Henderson,LouiseM

Changes in Physician Knowledge, Attitudes, Beliefs, and Practices regarding Lung Cancer Screening.

医生关于肺癌筛查的知识、态度、信念和实践的变化。

• DOI: 10.1513/annalsats.201812-867rl
• 发表时间: 2019
• 期刊: Annals of the American Thoracic Society
• 影响因子: 8.3
• 作者: Henderson,LouiseM;Benefield,ThadS;Bearden,SCaitlin;Reuland,DanielS;Brenner,AlisonT;Goldstein,AdamO;Throneburg,Allison;Rivera,MPatricia
• 通讯作者: Rivera,MPatricia