1061 — Adoption of Lung Cancer Screening Among VHA Medical Centers

Lead/Presenter: Paul Krebs, COIN - Seattle/Denver
All Authors: Zeliadt SB (COIN Seattle/Denver) Pham E (COIN Seattle/Denver) Takasugi JE (VA Puget Sound Health Care System) Heffner JL (Fred Hutchinson Cancer Research Center) Krebs P (NY Harbor Health Care System) Feemster LC (COIN Seattle/Denver) Backhus LM (VA Palo Alto Health Care System) Au DH (COIN Seattle/Denver)

Objectives:
Annual lung cancer screening for long term smokers is now recommended. VHA conducted the 8-site Lung Cancer Screening Demonstration Project between 2013-2015 to explore clinical requirements for offering screening, which screened 2106 Veterans. Since the end of the Demonstration Project in 2015, delivery of screening has been implemented at the discretion of each Medical Center. The objective of this study is to monitor early adoption and diffusion of screening nationally across VHA.

Methods:
LCS procedures were identified through VA's CDW using a combination of chest CT code CPT 71250 combined with a screening indication, or new LCS specific codes S8032 and G0297. We identified the initial LCS procedure for each unique Veteran and subsequent LCS procedures between 1/2013 and 3/2017. Cancer diagnosis outcomes are currently being identified.

Results:
Since 2013, a total of 47,696 Veterans have been screened, which increased from 1,983 Veterans screened in 2013, 25,037 in 2016, and 9,788 receiving an initial screen in Q1 2017. A total of 39 VA Medical Centers have screened at least 100 Veterans. By Q1 2017, a total of 15,732 screened Veterans had at least 15 months of follow-up time. A total of 2,367 (15%) had received short-term follow-up screening CT within 6 months. Accounting for deaths and short-term follow-up, only 6,053 (47%) of Veterans had returned for annual screening. The cancer outcome analysis has not yet been completed. The cancer detection rate was 3.6% after 3 rounds of screening in the National Lung Screening Trial which may have a minor influence on adherence.

Implications:
Many, but not all, VA Medical Centers are beginning to offer lung cancer screening. Adherence to receipt of annual screening is under 50%, which is considerably lower than the 95% adherence rate observed in the National Lung Screening Trial.

Impacts:
Over 900,000 Veterans are estimated to be eligible for lung cancer screening. Understanding whether the mortality reduction of lung cancer screening observed in the National Lung Screening Trial will be translated to the real-world setting is critical. Carefully monitoring diffusion of screening and outcomes among screened Veterans will help inform care delivery.