Comorbidity and Functional Status in a Population Undergoing Lung Cancer Screening

项目总结/摘要 在美国，肺癌导致的死亡人数超过结直肠癌、乳腺癌和前列腺癌的总和。 国家肺筛查试验（NLST）显示，在目前的肺癌患者中， 和前重度吸烟者，他们接受了低剂量计算机断层扫描（LDCT）筛查， 传记虽然假阳性结果很常见，影响了四分之一的试验参与者， 专业组织对NLST结果可能无法推广到 美国2013年12月，美国预防服务工作组开始建议每年 在55至80岁的成人中进行LDCT肺癌筛查，这些成人目前或以前（在过去戒烟） 15年）吸烟者，有30包年吸烟史。关于有效性的证据有限， NLST受试者中患有共病或功能受限的患者的肺癌筛查（LCS） 被要求足够健康，接受手术切除，这导致了公平的登记， 健康的参与者虽然大量吸烟的患者患肺癌的风险较高， 他们也往往有更多的基础疾病，可能会经历更高的竞争性死亡风险， 可能不适合用于早期肺癌的标准护理治疗;因此，需要 评价LCS在既存医学合并症和功能受限患者中的有效性。 我们的长期目标是确定基于风险的LCS，包括预先存在的患者共病情况， 和虚弱程度的测量，提高了我们确定哪些患者亚组最有可能受益的能力。 同时也确定了LCS可能弊大于利的亚组。的目的 应用是评价患者合并症和功能状态对LCS结局的影响程度 in a population人口based基础setting设置.我们假设，将患者基线肺癌的信息 风险评分、共病状况和功能状态将改善某些亚组的获益-损害比， 人口的群体。我们计划通过以下三个具体目标来实现这一目标： 确定基线肺癌风险评分与LCS的相关性;（2）评估共病条件的影响， 评估功能状态对LCS的影响。这项研究利用现有的基础设施 从基于人群的登记研究中探索一个新兴的临床相关癌症筛查领域， 数据存在。这项拟议中的研究意义重大，因为它将提供有关患者LCS的真实数据 通过基线风险、共病状况和功能状态来产生肺部循证医学- 临床实践中的CER筛查。

PROJECT SUMMARY/ABSTRACT In the United States, lung cancer causes more deaths than colorectal, breast, and prostate cancers combined. The National Lung Screening Trial (NLST) showed a 20% reduction in lung cancer mortality among current and former heavy smokers who were screened with low dose computed tomography (LDCT) versus chest ra- diography. Although false positive results were common, affecting one quarter of trial participants, and some professional organizations raised concerns over the fact that NLST results may not be generalizable to the U.S. population, in December 2013 the U.S. Preventive Services Task Force began recommending annual lung cancer screening with LDCT in adults aged 55 to 80 years who are current or former (quit within the past 15 years) smokers and have a 30 pack-year smoking history. There is limited evidence on the effectiveness of lung cancer screening (LCS) in patients with comorbid conditions or functional limitations as NLST participants were required to be healthy enough to undergo surgical resection, which resulted in the enrollment of fairly healthy participants. While patients with significant smoking exposure have higher risk of developing lung can- cer, they also tend to have more underlying disease, may experience higher competing mortality risks, and may be ineligible for standard of care treatments used for early-stage lung cancer; hence, there is a need to evaluate the effectiveness of LCS in patients with preexisting medical comorbidities and functional limitations. Our long-term goal is to determine if risk-based LCS, that incorporates preexisting patient comorbid conditions and measures of frailty, improves our ability to determine which subgroups of patients are most likely to benefit from LCS while also identifying subgroups in whom LCS likely does more harm than good. The objective of this application is to evaluate the extent to which patient comorbidities and functional status impact LCS outcomes in a population-based setting. We hypothesize that incorporating information on patient’s baseline lung cancer risk score, comorbid conditions, and functional status will improve the benefit to harm ratio for certain sub- groups of the population. We plan to accomplish this objective by pursuing the following three specific aims: (1) determine the association of baseline lung cancer risk score on LCS; (2) assess the impact of comorbid condi- tions on LCS; and (3) evaluate the effect of functional status on LCS. This study utilizes existing infrastructure from a population-based registry to explore an emerging clinically relevant cancer screening area for which lim- ited data exist. The proposed research is significant because it will provide real-world data on LCS in patients by baseline risk, comorbid conditions, and functional status to generate evidence-based medicine of lung can- cer screening in clinical practice.