Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Cherie Erkmen 1 , Shelby Sferra 2 , Callan Goldman 2 , Larry Kaiser 1 , Verdi Disesa 1 ,
Grace Ma 2
1 Thoracic Surgery, Temple University Hospital, Philadelphia/PA/United States of
America, 2 Center for Health Disparities, Temple University Hospital, Philadelphia/
PA/United States of America
Background: Patients within the National Lung Screening Trial (NLST)
undergoing low-dose computed tomography (LDCT) lung cancer screening
(LCS) with abnormal results were more likely to quit smoking (Tammemagi
et al.). However, these results may not be generalizable to underserved,
ethnic minorities. Despite high incidence and mortality of smoking-related
lung cancer among African Americans (AAs), few efficacy smoking cessation
trials in the context of LDCT-LCS include a large representation of AAs. Thus,
we studied smoking patterns in a predominantly AA population undergoing
lung cancer screening. Methods: In a predominantly AA population we
studied those undergoing LDCT-LCS (n=146). These patients received shared
decision making, LDCT-LCS, results and smoking cessation in a single visit.
Patients self-reported smoking status six months following LDCT. Results:
Of 146 patients receiving lung cancer screening, 100 (68%) are AAs, 30 (21%)
Caucasians, 14 (10%) Hispanics and 2 (1%) Asians. Smoking history was a
mean of 49 pack years, median of 42 pack years with 60% current smokers.
Of the 88 active smokers, 86 received greater than 10 minutes of smoking
cessation counseling, 61 received a prescription for smoking cessation
medications, and 60 agreed to follow up smoking cessation appointments.
The overall quit rate was 11% (10 out of 88 active smokers). Quit rate for
smokers who declined medical assistance was 4% (1 out of 28). Smokers who
attended follow up visits in addition to receiving a personalized combination
of smoking cessation medications had a quit rate of 33% (5 out of 15). Quit
rate was 20% for people with normal LDCT, Lung-RADS category 1 (8 out of
40) and 5% for people with benign appearing nodules, Lung-RADS category
2 (2 out of 41). None of the 3 people with nodules requiring further follow
up, Lung-RADS category 3, or the 4 people with nodules suspicious for
cancer Lung-RADS category 4, quit smoking within 6 months of their LDCT.
Conclusion: In a predominantly AA population, 60% of screened LDCT-LCS
were active smokers, only 11% quit despite a rigorous smoking cessation
program. Different from the NLST population, our findings indicate that
patients without suspicious nodules were more likely to quit than those with
suspicious nodules. The causes of these differing results are unknown. We
theorize that the differences may be due to biological, cultural, psychological
and socioeconomic factors. We suggest that future research should aim
to examine these factors to identify barriers and facilitators to changing
smoking behaviors among those undergoing LDCT-LCS.
Keywords: delivery of health care, Disparity of health care, lung cancer
screening, Smoking Cessation
POSTER SESSION 1 - P1.03: RADIOLOGY/STAGING/SCREENING
SCREENING –
MONDAY, DECEMBER 5, 2016
P1.03-050 OUTCOMES AFTER THE DECISION TO BIOPSY: RESULTS
FROM A NURSE PRACTITIONER RUN MULTIDISCIPLINARY LUNG
CANCER SCREENING PROGRAM
Christopher Gilbert 1 , Joelle Fathi 2 , Candice Wilshire 2 , Brian Louie 3 , Ralph
Aye 3 , Alexander Farivar 3 , Eric Vallieres 4 , Jed Gorden 1
1 Interventional Pulmonolgy, Swedish Medical Center and Cancer Institute, Seattle/
WA/United States of America, 2 Interventional Pulmonolgy and Thoracic Surgery,
Swedish Medical Center and Cancer Institute, Seattle/WA/United States of
America, 3 Thoracic Surgery, Swedish Cancer Institute, Seattle/WA/United States of
America, 4 Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle/
WA/United States of America
Background: Lung cancer screening programs are increasing in popularity
after results from the National Lung Screening Trial demonstrated
improvement in mortality after screening with low dose computed
tomography. Current guidelines recommend the availability of
multidisciplinary care and evaluation; however, reported outcomes from
multidisciplinary team decision making to proceed with diagnostic sampling
in lung cancer screening remains sparse. Methods: A retrospective review
of patients enrolled in the Swedish Cancer Institute Lung Cancer Screening
Program from January 2013 to March 2016 was performed. The program is run
by an independently practicing nurse practitioner, with a multidisciplinary
team consisting of radiologists, interventional pulmonologists, and thoracic
surgeons. Positive screening results (nodules >6mm) with the potential need
to pursue diagnostic sampling were reviewed in a multidisciplinary fashion.
Basic demographics and procedural outcomes after the decision to biopsy
were obtained. Results: A total of 516 patients were enrolled within the lung
cancer screening program from 2013 – 2016. Nodule(s) >6mm were identified
in 164 (31.8%) patients. Subsequently, 25 (4.8%) patients underwent some
form of invasive testing. The mean age of this population was 66.2 (SD-6.7)
years with 56% (14/25) being female and mean pack years of 50.8 (SD-19.5).
Percutaneous needle aspiration (n=11), endoscopic sampling (n=10), and
surgical biopsy/resection (n=4) were performed as the first invasive diagnostic
procedure. The outcomes of this initial sampling were cancer (n=15), nondiagnostic
(n=7), benign (n=2), and infection (n=1). Three patients without
an initial diagnosis underwent additional non-surgical biopsy attempts.
Overall, surgical resection was performed in twelve patients (6 after previous
diagnostic procedure, 2 after previous non-diagnostic procedure, and 4
as initial procedure). Final outcomes were cancer (n=16), non-diagnostic
procedure (n=4), non-caseating granulomatous inflammation (n=2), benign
diagnosis after wedge resection (n=2), and infection (n=1). Conclusion: Within
a nurse practitioner led, multidisciplinary, lung cancer screening program, a
small proportion of patients undergo invasive diagnostic testing, despite a
rather high prevalence of potentially actionable nodules. Within the NLST
population receiving computed tomography, 6.1% underwent invasive
testing with 43% undergoing testing that ultimately did not result in a
cancer diagnosis. Within our multidisciplinary program, 4.8% underwent
invasive testing with 36% undergoing testing not ultimately resulting in a
cancer diagnosis. The utilization of multidisciplinary teams during the biopsy
decision-making process may help decrease the number of non-diagnostic
procedures. Further research is needed to help identify tools that improve
patient selection for invasive testing in lung cancer screening programs.
Keywords: lung cancer screening, Multidisciplinary team, Diagnostic
sampling, lung cancer
POSTER SESSION 1 - P1.03: RADIOLOGY/STAGING/SCREENING
SCREENING –
MONDAY, DECEMBER 5, 2016
P1.03-051 MEDICALLY UNDERSERVED AND GEOGRAPHICALLY
REMOTE INDIVIDUALS MAY BE UNDERREPRESENTED IN CURRENT
LUNG CANCER SCREENING PROGRAMS
Candice Wilshire 1 , Bretta Mccall 1 , Hannah Modin 1 , Joelle Fathi 1 , Christopher
Gilbert 2 , Brian Louie 3 , Ralph Aye 3 , Alexander Farivar 3 , Eric Vallieres 4 , Jed
Gorden 2
1 Interventional Pulmonolgy and Thoracic Surgery, Swedish Medical Center
and Cancer Institute, Seattle/WA/United States of America, 2 Interventional
Pulmonolgy, Swedish Medical Center and Cancer Institute, Seattle/WA/United
States of America, 3 Thoracic Surgery, Swedish Cancer Institute, Seattle/WA/United
States of America, 4 Thoracic Surgery, Swedish Medical Center and Cancer Institute,
Seattle/WA/United States of America
Background: The National Lung Screening Trial demonstrated a 20% reduction
in lung cancer mortality and ushered in lung cancer screening (LCS). Study
centers included 33 academic, mostly urban-based sites, which may
underrepresent low socioeconomic remote populations with minimal health
care access. United States Census Bureau 2014 data demonstrated that
smoking is concentrated among adults with low income and education, and
without private medical insurance; components of medically underserved/
shortage area designations. We sought to assess the representation of
underserved communities in our hospital-based Lung Cancer Screening
Program (LCSP). Methods: We reviewed individuals referred to our LCSP from
2012-2016, consisting of two separate screening sites located within
metropolitan King County, Washington. Each individual’s county and distance
from the LCS site was calculated. Individual’s residence designation as a
geographic medically underserved/shortage area was determined. Definitions
include: medically underserved area [MUA; healthcare resources deficient
region], medically underserved population [MUP; area with economic/
cultural/linguistic barriers to primary care services], health professional
shortage area [HPSA; primary care physician shortage]. Results: We identified
599 referred individuals, median age 64, from 13/39 counties (King County and
12 clustered, surrounding counties). Overall,