Study Examines Patient and Provider Experiences with Comprehensive Lung Cancer Screening Program

BACKGROUND:
The U.S. Preventive Services Task Force recommends annual lung cancer screening with low-dose computed tomography (LDCT) for current and former heavy smokers ages 55 to 80. However, clinicians have questioned the practical aspects of implementing lung cancer screening. VA provides care for 6.7 million Veterans each year, mostly older men – many of whom are current or former smokers – thus the implementation of a lung cancer screening program for VA patients would require substantial resources. In order to understand the feasibility and implications of this for patients and clinical staff, VA implemented a three-year Lung Cancer Screening Demonstration Project (LCSDP) in eight geographically-diverse VA hospitals. This article describes the organizational- and patient-level experiences with the LCSDP, and estimates the number of VA patients who may be screening candidates. Investigators identified 93,033 primary care patients at eight sites who were assessed on screening criteria, of whom 2,106 patients were screened between July 2013 and June 2015.

FINDINGS:

• Participants in the LCSDP found implementing a comprehensive lung cancer screening program to be challenging and complex, requiring new tools (e.g., electronic tools to capture necessary clinical data in real time) and patient care processes for staff, in addition to dedicated patient coordination.
• There was wide variation in processes and patient experience among the study sites. For example, across the eight sites, 58% of patients who were offered screening agreed to be screened, ranging from 34% to 66% across the sites.
• Overall, 60% of the 2,106 Veterans screened for lung cancer had a positive result, including having nodules that needing tracking (56%), needing a workup for possible lung cancer (2%), and being diagnosed with lung cancer (2%).
• It is estimated that nearly 900,000 VA patients may be candidates for lung cancer screening.

IMPLICATIONS:

• Implementation of LCS in the VA healthcare system will likely lead to large numbers of screen-eligible patients – and will require substantial clinical effort for both patients and staff.

LIMITATIONS:

• Study analyses were based on data in clinical records rather than data collected by research staff. Missing or incorrectly recorded data about smoking, for example, were noted for nearly 40% of Veterans who met the initial screening criteria.
• Veterans may have received follow-up care for positive lung cancer screening results outside VA.
• Follow-up was less than one year; longer follow-up will be needed to determine health outcomes of lung cancer screening.

AUTHOR/FUNDING INFORMATION:
All authors are part of VHA, and this evaluation was funded through the VHA Lung Cancer Screening Demonstration Project (LCSDP). Dr. Jackson is part of HSR&D's Center for Health Services Research in Primary Care in Durham, NC. The LCSDP was led by the VHA National Center for Health Promotion and Disease Prevention under the direction of Dr. Kinsinger.

Kinsinger L, Anderson C, Kim J, et al., and Jackson G. Implementation of Lung Cancer Screening: The Experience of the Veterans Health Administration. JAMA Internal Medicine. March 1, 2017;177(3):399-406.