Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
Medicum, Nicoalus Copernicus University in Torun, Bydgoszcz/Poland
Background: Screening using computerized tomography of the chest for an
early detection of lung cancer has been performed worldwide since decades,
but only two years ago, after proving in a prospective randomized study that
it prolongs survival of the study population, it received the recommendation
of scientific societies. However, the issue of cost-effectiveness of this
screening remains open. Methods: A review of several cost-effectiveness
analyses of lung cancer screening with low-dose CT available in the literature
was performed. We also conducted our own cost-effectiveness analysis on
the basis of epidemiological data and data from the National Health Fund
concerning the type, number and cost of medical procedures reimbursed
for lung cancer patients. Results: The results of cost-effectiveness analyses
carried out in different countries are equivocal and depend mainly on the
inclusion and exclusion criteria, methods of analysis and prices of medical
procedures. More recent analyses, performed in different countries, indicate
high profitability of this screening. In our study, the cost of early detection of
one lung cancer using CT scan is comparable to the cost of a detection of one
breast cancer using mammography and is about 3,400 Euro. The incremental
cost-effectiveness ratio (ICER) in our analysis is about 1180 Euro / life year
gained. Conclusion: As the widely accepted limit of cost-effectiveness is
three times the gross national product per capita / life year gained, lung
cancer screening with low-dose CT in Poland should be considered highly
cost-effective. In future screening programs, high cost-effectiveness can be
achieved by strict adherence to inclusion and exclusion criteria. To ensure
this, screening should be performed either as prospective observatory nonrandomized
clinical trials or in dedicated screening centers. To ensure low
level of false positive and false negative results, radiologists in screening
centers should be equipped with software for measuring and monitoring the
volume of pulmonary nodules.
Keywords: cost-effectiveness analysis, lung cancer screening, ICER, cancer
screening
POSTER SESSION 1 - P1.03: RADIOLOGY/STAGING/SCREENING
SCREENING –
MONDAY, DECEMBER 5, 2016
P1.03-059 ORGANIZED HIGH RISK LUNG CANCER SCREENING IN
ONTARIO, CANADA: A MULTI-CENTRE PROSPECTIVE EVALUATION
Martin Tammemägi 1 , Joanne Hader 2 , Monica Yu 2 , Kiran Govind 2 , Erin Svara 2 ,
Marta Yurcan 2 , Beth Miller 2 , Gail Darling 2
1 Health Sciences, Brock University, St. Catharines/Canada, 2 Cancer Care Ontario,
Toronto/ON/Canada
Background: Guidelines published in Ontario Canada in 2013, recommend
screening individuals at high risk of lung cancer with low-dose computed
tomography through an organized program. Cancer Care Ontario, Ontario’s
provincial cancer agency, is implementing a prospective evaluation of
organized high risk lung cancer screening (HRLCS) in a 2-year, multi-centre
pilot. The pilot evaluation aims to inform: · Recommendations to Ontario’s
Ministry of Health and Long Term Care regarding the potential for a
provincial program · Optimal program design and requirements for effective
implementation. Methods: The process to establish a robust evaluation plan
for the HRLCS pilot included the development of a logic model, evaluation
objectives and evaluation questions. Input from a multidisciplinary panel of
experts, including clinicians, epidemiologists, and administrators guided the
development of the evaluation plan. A modified Delphi technique facilitated
panel input on the proposed evaluation questions, which were drafted based
on the logic model and evaluation objectives, and aligned to the steps in the
screening pathway. Panel members rated the importance of each evaluation
question through an online survey using a 5-point Likert scale, and proposed
changes or additional questions. A question was retained if >75% of panel
members rated it as important or very important. A facilitated discussion post
survey enabled a review of survey results to confirm consensus on the final
set of evaluation questions. Results: The survey was completed by all panel
members. Of 32 evaluation questions proposed, 31 were rated as important
or very important by more than 75% of respondents. Endorsed questions
addressed both screening processes and key outcomes, and included, for
example: · Did recruitment strategies engage individuals representative of
the eligible population? · Did the follow-up processes occur as intended? · Did
screening identify early stage lung cancers? Panel discussion led to retention
of the single question that did not meet the threshold, and the addition of
one new question to the evaluation plan. Given consensus was achieved, a
second round modified Delphi survey was not required. Conclusion: Using
an expert panel and modified Delphi technique was an effective method to
obtain consensus on the pilot evaluation questions. Endorsed evaluation
questions will frame the development of measures and indicators to be
assessed throughout the pilot. This comprehensive evaluation strategy will
inform the design and implementation of a high quality organized HRLCS
screening program.
Keywords: Evaluation, high risk lung cancer screening
POSTER SESSION 1 - P1.03: RADIOLOGY/STAGING/SCREENING
SCREENING –
MONDAY, DECEMBER 5, 2016
P1.03-060 LUNG CANCER SCREENING: A QUALITATIVE STUDY
EXPLORING THE DECISION TO OPT OUT OF SCREENING
Lisa Carter-Harris 1 , Susan Brandzel 2 , Joshua Roth 3 , Karen Wernli 2 , Diana
Buist 2
1 School of Nursing, Indiana University, Indianapolis/IN/United States of America,
2 Group Health Research Institute, Group Health, Seattle/WA/United States of
America, 3 Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Research Center, Seattle/United States of America
Background: Lung cancer screening (LCS) with annual low-dose computed
tomography is relatively new for long-term smokers in the US supported by a
US Preventive Services Task Force Grade B recommendation. As LCS programs
are more widely implemented and providers engage patients about LCS, it is
critical to understand what influences the decision to screen, or not, for lung
cancer. Understanding LCS behavior among high-risk smokers who opt out
provides insight, from the patient perspective, about the shared decisionmaking
(SDM) process. This study explored LCS-eligible patients’ decision to
opt out of LCS after receiving a provider recommendation. New knowledge
will inform intervention development to enhance SDM processes between
high-risk smokers and their provider, and decrease decisional conflict about
LCS. Methods: Semi-structured qualitative interviews were performed
with 18 LCS-eligible men and women who were members of an integrated
healthcare system in Seattle about their decision to opt out of screening.
Participants met LCS criteria for age, smoking and pack-year history. Audiorecorded
interviews were transcribed verbatim. Two researchers with cancer
screening and qualitative expertise conducted data analysis using thematic
content analytic procedures. Results: Participant mean age was 66 years (SD
6.5). Majority were female (61%), Caucasian (83%), current smokers (61%).
Five themes emerged: 1) Knowledge Avoidance; 2) Perceived Low Value;
3) False Positive Worry; 4) Practical Barriers; and 5) Misunderstanding.
Representative thematic example quotes are presented in the Table below.
Knowledge Avoidance
“It’s fear of the unknown…if I know, you have to follow through and do more
and more.”
Perceived Low Value
“It could show me if I had lung cancer…what are they going to do?...screening
doesn’t really make any difference...”
False Positive Worry
“I did schedule one…then after I read the print out, I canceled it…the false
positives were so high. I thought why… that would be so stressful…”
Practical Barriers
“I really didn’t have time to get over there.”
Misunderstanding
“I wasn’t hurting or having any problems breathing…wasn’t a top priority for
me” [reflecting misunderstanding of the concept of screening]
Conclusion: Many screening-eligible smokers opt out of LCS. Participants in
our study provided new insights into why some patients make this choice.
LCS is effective in early lung cancer detection among high-risk patients.
However, LCS has associated risks and harms making the SDM process critical.
Understanding why people decide not to screen will enhance future efforts
to improve knowledge transfer from providers to patients about the risks and
benefits of LCS and ultimately enhance SDM about screening.
Keywords: health behavior, qualitative, decision making, lung cancer
screening
POSTER SESSION 1 - P1.03: RADIOLOGY/STAGING/SCREENING
SCREENING –
MONDAY, DECEMBER 5, 2016
P1.03-061 PATIENT MOTIVATIONS FOR PURSUING LOW-DOSE
CT LUNG CANCER SCREENING IN AN INTEGRATED HEALTHCARE
SYSTEM: A QUALITATIVE EVALUATION
Joshua Roth 1 , Susan Brandzel 2 , Lisa Carter-Harris 3 , Diana Buist 2 , Karen
Wernli 2
S298 Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017