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IIR 16-003 – HSR&D Study

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IIR 16-003
Lung Cancer Screening: Building Blocks for Effective Implementation and Partnership
Christopher G. Slatore MD MS
VA Portland Health Care System, Portland, OR
Portland, OR
Funding Period: January 2016 - December 2018

BACKGROUND/RATIONALE:
Veterans have a high risk of lung cancer and VA is currently implementing CT screening for this population, making it imperative to improve our ability to deliver high quality care to this very large group. After 3 annual screening CT scans, 39% of individuals in a recent lung cancer screening trial had a pulmonary nodule detected that required further evaluation. Our ability to provide Veteran-centric lung cancer screening and pulmonary nodule care is hindered by several gaps in our understanding of the pulmonary nodule evaluation process.

OBJECTIVE(S):
Aim 1: Develop and validate a predictive model of lung cancer risk among a cohort of Veterans with incidentally-detected pulmonary nodules. Rationale: A prognostic model would enable clinicians and patients to improve counseling and access to knowledge by providing personalized, Veteran-centric care outside of specialty settings. Aim 2: Evaluate healthcare system resource utilization amongst a cohort of Veterans with incidentally-detected pulmonary nodules. Rationale: Understanding the resources utilized by Veterans and their clinicians will enable increased safety, efficiency, and standardization which in turn will allow increased access to quality care. Aim 3: Develop and validate an algorithm based on routinely collected clinical data to identify Veterans with a pulmonary nodule diagnosis.

METHODS:
We will conduct a comprehensive review of patients in pulmonary nodule registries at the VA Portland Health Care System and VISN 23 to address these knowledge gaps. These registries are linked to other routinely-collected administrative data and are currently clinically used to track patients with nodules.

FINDINGS/RESULTS:
Using the smoking status from the electronic health record (EHR) and VHA structured administrative Health Factor data we assessed the validity of using administrative data for determining smoking status. We found that there is substantial agreement between VHA administrative data and EHR records for current, former, and never smoking categories. There also substantial agreement for ever compared with never smoking categories. These kappas are in line with previous administrative data validation studies so these data can be appropriately used for research or clinical purposes. Importantly, targeting lung cancer screening to ever smokers using administrative data would only miss 8% of ever smokers, and only 1% of those are current smokers, so these data may be useful for medical centers implementing LCS.These results were recently presented at the American Thoracic Society conference as an abstract.

IMPACT:
There are likely opportunities to improve the utility and safety of the nodule evaluation process which will become crucial when lung cancer CT screening is widely adopted. There is currently no mechanism for using administrative data to identify patients with pulmonary nodules because of a lack of a well-accepted diagnostic code. This information gap substantially hinders the ability of researchers, clinicians, and administrators to efficiently evaluate future screening interventions.

PUBLICATIONS:

Journal Articles

  1. Golden SE, Thakurta S, Slatore CG, Woo H, Sullivan DR. Military Factors Associated with Smoking in Veterans. Military medicine. 2018 Nov 1; 183(11-12):e402-e408.
  2. Heffner JL, Krebs P, Johnson H, Greene PA, Klein DE, Feemster LC, Slatore CG, Au DH, Zeliadt SB. Smokers' Inaccurate Beliefs about the Benefits of Lung Cancer Screening. Annals of the American Thoracic Society. 2018 Sep 1; 15(9):1110-1113.
  3. Rivera MP, Tanner NT, Silvestri GA, Detterbeck FC, Tammemägi MC, Young RP, Slatore CG, Caverly TJ, Boyd CM, Braithwaite D, Fathi JT, Gould MK, Iaccarino JM, Malkoski SP, Mazzone PJ, Tanoue LT, Schoenborn NL, Zulueta JJ, Wiener RS, American Thoracic Society Assembly on Thoracic Oncology. Incorporating Coexisting Chronic Illness into Decisions about Patient Selection for Lung Cancer Screening. An Official American Thoracic Society Research Statement. American journal of respiratory and critical care medicine. 2018 Jul 15; 198(2):e3-e13.
  4. Slatore CG, Falvo MJ, Nugent S, Carlson K. Afghanistan and Iraq War Veterans: Mental Health Diagnoses are Associated with Respiratory Disease Diagnoses. Military medicine. 2018 May 1; 183(5-6):e249-e257.
  5. Caverly TJ, Fagerlin A, Wiener RS, Slatore CG, Tanner NT, Yun S, Hayward R. Comparison of Observed Harms and Expected Mortality Benefit for Persons in the Veterans Health Affairs Lung Cancer Screening Demonstration Project. JAMA internal medicine. 2018 Mar 1; 178(3):426-428.
  6. Vranas KC, Jopling JK, Scott JY, Badawi O, Harhay MO, Slatore CG, Ramsey MC, Breslow MJ, Milstein AS, Kerlin MP. The Association of ICU Acuity With Outcomes of Patients at Low Risk of Dying. Critical care medicine. 2018 Mar 1; 46(3):347-353.
  7. Wiener RS, Koppelman E, Bolton R, Lasser KE, Borrelli B, Au DH, Slatore CG, Clark JA, Kathuria H. Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study. Journal of general internal medicine. 2018 Jul 1; 33(7):1035-1042.
  8. Lammers A, Mitin T, Moghanaki D, Thomas CR, Timmerman R, Golden SE, Thakurta S, Dziadziuszko R, Slatore CG. Lung cancer specialists' opinions on treatment for stage I non-small cell lung cancer: A multidisciplinary survey. Advances in radiation oncology. 2018 Apr 1; 3(2):125-129.
  9. Triplette M, Kross EK, Mann BA, Elmore JG, Slatore CG, Shahrir S, Romine PE, Frederick PD, Crothers K. An Assessment of Primary Care and Pulmonary Provider Perspectives on Lung Cancer Screening. Annals of the American Thoracic Society. 2018 Jan 1; 15(1):69-75.
  10. Golden SE, Thomas CR, Deffebach ME, Sukumar MS, Schipper PH, Tieu BH, Kee AY, Tsen AC, Slatore CG, Early Stage Lung Cancer Comparative Effectiveness Research Consortium. "It wasn't as bad as I thought it would be": a qualitative study of early stage non-small cell lung cancer patients after treatment. BMC research notes. 2017 Nov 29; 10(1):642.
  11. Kathuria H, Detterbeck FC, Fathi JT, Fennig K, Gould MK, Jolicoeur DG, Land SR, Massetti GM, Mazzone PJ, Silvestri GA, Slatore CG, Smith RA, Vachani A, Zeliadt SB, Wiener RS, ATS Assembly on Thoracic Oncology. Stakeholder Research Priorities for Smoking Cessation Interventions within Lung Cancer Screening Programs. An Official American Thoracic Society Research Statement. American journal of respiratory and critical care medicine. 2017 Nov 1; 196(9):1202-1212.
  12. Sullivan DR, Golden SE, Ganzini L, Wiener RS, Eden KB, Slatore CG. Association of Decision-making with Patients' Perceptions of Care and Knowledge during Longitudinal Pulmonary Nodule Surveillance. Annals of the American Thoracic Society. 2017 Nov 1; 14(11):1690-1696.
  13. Slatore CG, Wiener RS. Pulmonary Nodules: A Small Problem for Many, Severe Distress for Some, and How to Communicate About It. Chest. 2018 Apr 1; 153(4):1004-1015.
  14. Sullivan DR, Ganzini L, Lapidus JA, Hansen L, Carney PA, Osborne ML, Fromme EK, Izumi S, Slatore CG. Improvements in hospice utilization among patients with advanced-stage lung cancer in an integrated health care system. Cancer. 2018 Jan 15; 124(2):426-433.
  15. Miranda LS, Datta S, Melzer AC, Wiener RS, Davis JM, Tong BC, Golden SE, Slatore CG. Rationale and Design of the Lung Cancer Screening Implementation. Evaluation of Patient-Centered Care Study. Annals of the American Thoracic Society. 2017 Oct 1; 14(10):1581-1590.
  16. Zeliadt SB, Greene PA, Krebs P, Klein DE, Au DH, Slatore CG, Heffner JL. A Proactive Telephone-Delivered Risk Communication Intervention for Smokers Participating in Lung Cancer Screening: A Pilot Feasibility Trial. Journal of Smoking Cessation. 2017 Sep 7; 13(3):137-144.
Center Products

  1. Slatore CG. American Thoracic Society and American Lung Association Lung Cancer Screening Implementation Guide. American Thoracic Society and American Lung Association American Thoracic Society and American Lung Association; 2018 May 31.


DRA: Cancer
DRE: none
Keywords: Best Practices
MeSH Terms: none