Comorbidity and Functional Status in a Population Undergoing Lung Cancer Screening

项目摘要/摘要 在美国，肺癌导致的死亡人数超过了结直肠癌、乳腺癌和前列腺癌的总和。 国家肺部筛查试验(NLST)显示，在当前人群中，肺癌死亡率降低了20% 以及曾经的重度吸烟者，他们接受了低剂量计算机断层扫描(LDCT)的筛查，并与胸片进行了对比。 航海摄影。尽管假阳性结果很常见，影响到四分之一的试验参与者，还有一些 专业组织对NLST结果可能不能推广到 美国人口，2013年12月，美国预防服务工作组开始建议每年 现役或既往55-80岁成年人的LDCT肺癌筛查(既往戒烟 15年)吸烟者，有30包年的吸烟史。关于这一方法的有效性的证据有限。 作为NLST参与者的合并疾病或功能受限患者的肺癌筛查 被要求足够健康才能接受手术切除，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部疾病的风险更高，但- CER，他们也往往有更多的潜在疾病，可能会经历更高的竞争性死亡风险，以及 可能不符合用于早期肺癌的标准护理治疗；因此，有必要 评估LCS对既有内科合并症和功能受限患者的疗效。 我们的长期目标是确定基于风险的LCS是否包含了先前存在的患者的共病情况 和脆弱性的测量，提高了我们确定哪些亚组的患者最有可能受益的能力 来自LCS，同时识别LCS可能弊大于利的子组。这样做的目的是 应用是评估患者的合并症和功能状态对LCS预后的影响程度 在以人口为基础的环境中。我们假设，结合患者基线肺癌的信息 风险评分、并存状态和功能状态将改善某些亚型的受益/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：(1) 确定基线肺癌风险评分与LCS的关系；(2)评估合并疾病的影响。 (3)评价功能状态对LCS的影响。这项研究利用现有的基础设施 从基于人群的登记中探索一种新兴的临床相关癌症筛查领域，LIM- 已存储的数据存在。这项拟议的研究具有重要意义，因为它将提供患者LCS的真实数据 通过基线风险、合并症和功能状态来产生肺的循证医学可以- 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.