FROM A THORACIC ONCOLOGY SYMPOSIUM
CHICAGO (FRONTLINE MEDICAL NEWS) – Nearly one-fourth of primary care providers were unaware of current lung cancer screening guidelines in a survey of 212 PC providers in North Carolina, a state with one of the nation’s highest lung cancer death rates .
Only 12% of respondents ordered low-dose computed tomography (LDCT) in the past year to screen their patients at high risk for lung cancer, while 21% ordered a chest x-ray, a nonrecommended screening test, said Dr. Jennifer Lewis of Wake Forest University, Winston-Salem, N.C.
The use of LDCT screening for high-risk patients has been recommended by multiple health care organizations including the American College of Chest Physicians, American Lung Association, and U.S. Preventative Services Task Force. The 2013 USPSTF recommendations call for annual LDCT screening for adults aged 55-80 years who have a 30–pack-year smoking history and currently smoke or have quit within the past 15 years.
The survey found that 67% of providers knew screening was recommended for current and former smokers, but less than half knew the eligible age to initiate screening in any guideline is 50-55 years (35%), the eligible age to stop screening is 75-80 years (29%), and that a 1-year screening interval is recommended (25%).
Only 47% of respondents knew three or more of the guideline components and 24% knew no components.
Providers who knew three or more guideline components, however, were significantly more likely to use LDCT screening (P = .0002), Dr. Lewis said during a briefing at the 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology .
The online survey was sent to 488 primary care providers, including physicians, physician assistants, and nurse practitioners, affiliated with Wake Forest Baptist Health . Of the 293 respondents (60%), 212 providers cared for patients older than age 40 years in the past year and were eligible for the study.
Less than half of respondents (42%) perceived of LDCT as “very” or even moderately effective in reducing cancer-specific mortality.
“In actuality, if you look at the number needed to screen to prevent one lung cancer death, low-dose CT is more effective than mammography or even flexible sigmoidoscopy,” she observed.
The major perceived barrier to LDCT screening was financial cost to patients. Other barriers were false positives, patient awareness of screening, incidental finding, and insurance coverage.
To put the study in perspective, 12,000 lives could be saved each year if low-dose CT screening were fully implemented, Dr. Lewis said. Before this can happen, providers need education. The good news is that 80% of respondents said they want more education.
“This education should focus on the effectiveness of low-dose CT screening in saving lives from cancer, the guideline recommendations (meaning who to screen, when to screen, and how often), as well as the correct lung cancer screening test,” she said. “This is all needed before providers can have those shared decision-making conversations with their patients.”
Although the survey was conducted at Wake Forest, the “results and conclusions can likely be extrapolated to much of the primary care population in the United States,” session moderator Dr. Laurie E. Gaspar , professor and chair of radiation oncology at the University of Colorado at Denver, Aurora, said.
