Partnered research with NCP to evaluate lung cancer screening in the VA

肺癌是世界范围内男性和女性癌症相关死亡的主要原因。 美国的在VA患者中，大约有7，500例肺癌被诊断出来 每年（约占美国肺癌病例的3%）;发生5，500人死亡。筛查高危患者 与每年低剂量CT（LDCT）相比， 大型随机临床试验中的年度胸部X线片。自国家发布 肺癌筛查试验（NLST）结果在2011年8月，许多专业 一些组织已经制定或认可了有利于高水平肺癌筛查的指南， 风险人群。鉴于这些发现的重要性和烟草使用的沉重负担 在退伍军人人口中，退伍军人健康管理局（VHA）已经进行了肺 癌症筛查临床示范项目，以评估 它的医疗保健系统可能来自于建立筛查。这个项目正在推出 在全国8个VHA站点。 VHA肺癌筛查项目评估小组设在VA合作社 研究流行病学中心达勒姆已由弗吉尼亚州国家卫生中心的任务 促进和疾病预防（NCP），以评估肺结核的潜在患者人群 癌症筛查，患者和提供者对筛查的接受程度，筛查结果 包括疑似癌症的结节，偶然发现（例如腹主动脉瘤， 甲状腺结节等），和肺癌的诊断。我们还将收集有关 由于筛选和时间负担，需要进行随访放射学研究和程序 供应商进行筛选。这些信息将用于估计增加的 提供者和设备资源以及肺癌筛查对预算的影响 实施.虽然筛查的好处现在已经很清楚了，但筛查的成本效益仍然很低。 这种奋进不太明确。LDCT的假阳性率高（NLST为96.4%）， 发现了大量偶然发现，需要进一步评价， 了解常规护理中这种重大变化的总体成本效益， 被评价。 我们的长期目标是制定一个服务导向的建议，以1）估计支出 接受肺癌筛查和随访治疗的患者的模式; 2）估计 在VHA医疗保健中实施的肺癌筛查计划的成本效益 系统;以及3）评估肺癌风险分层算法是否可以用于 最大限度地提高退伍军人的健康鉴于有限的筛选资源.但是在我们能够 在这项研究中，我们需要收集患者和提供者的特定数据， 成本效益模型由于示范项目不被视为研究，我们 无法联系患者进行数据收集。由于该项目是多站点的， 收集提供者任务的时间日志很困难。 基于LDCT的肺癌筛查是一项广泛而重要的任务， 退伍军人事务部它将影响数十万退伍军人，并需要大量的额外资金。 资源得到有效利用。本文的研究将有助于NCP的推广和实施 肺癌筛查在整个VA卫生系统。

Lung cancer is the leading cause of cancer-related death for men and women within the United States. Within VA patients, approximately 7,500 cases of lung cancer are diagnosed each year (~3% of US lung cancer cases; and 5,500 deaths occur. Screening high-risk patients with annual low-dose CT (LDCT) has been shown to decrease mortality by 20% as compared to annual chest radiographs in a large randomized clinical trial. Since the release of the National Lung Cancer Screening Trial (NLST) results in August 2011, numerous professional organizations have developed or endorsed guidelines in favor of lung cancer screening in high- risk populations. Given the importance of these findings and the heavy burden of tobacco use among the Veteran population, the Veteran Health Administration (VHA) has undertaken a lung cancer screening clinical demonstration project to assess the clinical and financial burdens on its healthcare system that may come from instituting screening. This project is being rolled out at 8 VHA sites nationally. The VHA lung cancer screening project evaluation team based at the VA Cooperative Studies Epidemiology Center-Durham has been tasked by the VA National Center for Health Promotion & Disease Prevention (NCP) to assess the potential patient population for lung cancer screening, level of patient and provider acceptance of screening, outcomes of screening including nodules suspicious for cancer, incidental findings (e.g. abdominal aortic aneurysms, thyroid nodules, etc.), and lung cancers diagnosed. We will also collect data on number of follow-up radiographic studies and procedures required as a result of screening and time burden on providers to implement screening. This information will be used to estimate the increased provider and equipment resources and budget impact that will result from lung cancer screening implementation. While the benefits of screening are now clearly seen, the cost-effectiveness of such an endeavor is less clear. With a high false-positive rate on LDCT (96.4% in NLST) and a significant number of incidental findings discovered that in turn require further evaluation, understanding the overall cost-effectiveness of such a significant change in routine care must be evaluated. Our long-term goal is to develop a Service Directed Proposal to 1) estimate the expenditure patterns of patients who undergo lung cancer screening and follow-up treatment; 2) estimate the cost-effectiveness of the lung cancer screening program implemented in the VHA healthcare system; and 3) evaluate whether lung cancer risk stratification algorithms can be used to maximize Veterans' health given limited screening resources. However, before we can engage in this research we need to collect patient- and provider-specific data that will be needed for the cost-effectiveness modeling. Because the demonstration project is not considered research, we cannot contact patients for data collection. Being that the project is multi-site also makes collection of time logs of provider tasks difficult. LDCT-based lung cancer screening is a wide-ranging, important task being undertaken by the VA. It will affect hundreds of thousands of veterans and require substantial additional resources to be implemented effectively. Our study will help NCP to promote and implement and lung cancer screening throughout the VA health system.