Christopher T Su1, Amit Bhargava2, Chirag D Shah1, Balazs Halmos3, Rasim A Gucalp3, Stuart H Packer3, Nitin Ohri4, Linda B Haramati5, Roman Perez-Soler3, Haiying Cheng6. 1. Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. 2. Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. 3. Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. 4. Department of Radiation Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. 5. Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY; Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. 6. Department of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Electronic address: hcheng@montefiore.org.
Abstract
BACKGROUND: The landmark National Lung Screening Trial demonstrated significant reduction in lung cancer-related mortality. However, European lung cancer screening (LCS) trials have not confirmed such benefit. We examined LCS patterns and determined the impact of LCS-led diagnosis on the mortality of newly diagnosed patients with lung cancer in an underserved community. PATIENTS AND METHODS: Medical records of patients diagnosed with primary lung cancer in 2013 through 2016 (n = 855) were reviewed for primary care provider (PCP) status and LCS eligibility and completion, determined using United States Preventative Services Task Force guidelines. Univariate analyses of patient characteristics were conducted between LCS-eligible patients based on screening completion. Survival analyses were conducted using Kaplan-Meier and multivariate Cox regression. RESULTS: In 2013 through 2016, 175 patients with primary lung cancer had an established PCP and were eligible for LCS. Among them, 19% (33/175) completed screening prior to diagnosis. LCS completion was associated with younger age (P = .02), active smoking status (P < .01), earlier stage at time of diagnosis (P < .01), follow-up in-network cancer treatment (P = .03), and surgical management (P < .01). LCS-eligible patients who underwent screening had improved all-cause mortality compared with those not screened (P < .01). Multivariate regression showed surgery (hazard ratio, 0.31; P = .04) significantly affected mortality. CONCLUSION: To our knowledge, this is the first study to assess LCS patterns and mortality differences on patients with screen-detected lung cancer in an urban underserved setting since the inception of United States Preventative Services Task Force guidelines. Patients with a LCS-led diagnosis had improved mortality, likely owing to cancer detection at earlier stages with curative treatment, which echoes the finding of prospective trials.
BACKGROUND: The landmark National Lung Screening Trial demonstrated significant reduction in lung cancer-related mortality. However, European lung cancer screening (LCS) trials have not confirmed such benefit. We examined LCS patterns and determined the impact of LCS-led diagnosis on the mortality of newly diagnosed patients with lung cancer in an underserved community. PATIENTS AND METHODS: Medical records of patients diagnosed with primary lung cancer in 2013 through 2016 (n = 855) were reviewed for primary care provider (PCP) status and LCS eligibility and completion, determined using United States Preventative Services Task Force guidelines. Univariate analyses of patient characteristics were conducted between LCS-eligible patients based on screening completion. Survival analyses were conducted using Kaplan-Meier and multivariate Cox regression. RESULTS: In 2013 through 2016, 175 patients with primary lung cancer had an established PCP and were eligible for LCS. Among them, 19% (33/175) completed screening prior to diagnosis. LCS completion was associated with younger age (P = .02), active smoking status (P < .01), earlier stage at time of diagnosis (P < .01), follow-up in-network cancer treatment (P = .03), and surgical management (P < .01). LCS-eligible patients who underwent screening had improved all-cause mortality compared with those not screened (P < .01). Multivariate regression showed surgery (hazard ratio, 0.31; P = .04) significantly affected mortality. CONCLUSION: To our knowledge, this is the first study to assess LCS patterns and mortality differences on patients with screen-detected lung cancer in an urban underserved setting since the inception of United States Preventative Services Task Force guidelines. Patients with a LCS-led diagnosis had improved mortality, likely owing to cancer detection at earlier stages with curative treatment, which echoes the finding of prospective trials.
Authors: Haiying Cheng; H Dean Hosgood; Lei Deng; Kenny Ye; Christopher Su; Janaki Sharma; Yuanquan Yang; Balazs Halmos; Roman Perez-Soler Journal: Clin Lung Cancer Date: 2019-07-17 Impact factor: 4.785
Authors: Mary S Rodríguez-Rabassa; Vani N Simmons; Agueda Vega; Daniela Moreno; Jessica Irizarry-Ramos; Gwendolyn P Quinn Journal: J Health Care Poor Underserved Date: 2020