Lung Cancer Screening Program via Primary Care Clinics

Lung Cancer Screening (LCS) reduces lung cancer mortality by 20 to 24% however in the US only 5.7% of eligiblepatients participate. Increasing screening of individuals at risk for lung cancer is an unmet need. We started a LCSprogram using primary care physicians (PCP) visits where the intake nurse asked age appropriate patients abouttheir smoking status. If patients met criteria, the physician was alerted to perform shared decision making, offersmoking cessation and order a low dose screening CT scan (LDCT). The results were managed by a physician'sassistant dedicated to the LCS program. This quality improvement study analyzed all patients enrolled from June2019 to July 2021. The LCS program rolled out slowly beginning with 6 PCPs in June to November 2019, 26 PCPsfrom November 2019 to February 2020 and all 56 PCPs from February 2020 to July 2021. COVID-19 stopped LDCTsfrom March 2020 to August 2020. Use of a LCS program run through PCP clinics screened 1,247 (21.3%) eligibleveterans, a 3.7 fold increase over the national average. Of the 2,069 (35.3%) eligible patients initially identified by thecomputer based reminder, 1,824 (88.2%) accepted LCS, 1,383 (66.8%) completed the initial LDCT and 136 (9.8%)were ultimately found to be ineligible after completion of the LDCT. The 136 ineligible patients received 173 LDCTs ofwhich 91% were Lung-RADS 1 or 2 and 0.6% were Lung-RADS 4A. Within the appropriately screened patients, 12(1%) lung cancers and 1 papillary thyroid cancer were found and 26.5% of scans showed evidence of Chronic Obstructive Pulmonary Disease and 11.9% showed coronary artery disease. Use of PCP clinics increased enrollment 3.7 fold over national averages.

PP01.22 First Lung Cancer Screening Program in Greece - Initial Experience, Preliminary Data and Pitfalls

Background: Poor prognosis of lung cancer is linked to its late diagnosis, typically in the advanced stage 4 in 50-70% of incidental cases. Lung Cancer Screening Programs provide low-dose lung CT screening to current and former smokers who are at high risk for developing this disease. Greece is an EU country, returning strong from a long period of economic recession, ranked 2nd place in overall age-standardized tobacco smoking prevalence in the EU. In December 2020, at the Metropolitan Hospital of Athens, we started the 1st Screening Program in the country. We present our initial results and pitfalls met. Method(s): A weekly outpatient clinic offers consultation to possible candidates. LDCT (<=3.0mGy), Siemens VIA, Artificial Intelligence multi-computer-aided diagnosis (multi-CAD) system and LungRADS (v.1.1) are used for the validation of any abnormal findings with semi-auto measurement of volume and volume doubling time. Patients get connected when necessary with the smoking cessation and Pulmonology clinic. USPSTF guidelines are used, (plus updated version). Abnormal CT findings are discussed by an MDT board with radiologists, pulmonologists/interventional pulmonologists, oncologists and thoracic surgeons. A collaboration with Fairlife Lung Cancer Care the first non-profit organization in Greece is done, in order to offer the program to population with low income too. An advertisement campaign was organized to inform family doctors and the people about screening programs, together with an anti-tobacco campaign. Result(s): 106 people were screened, 74 males & 32 females (mean age 62yo), 27/106 had an abnormal finding (25%). 2 were diagnosed with a resectable lung cancer tumor (primary adenocarcinoma) of early-stage (1.8%). 2 with extended SCLC (lung lesion & mediastinal adenopathy). 1 with multiple nodules (pancreatic cancer not known until then). 3 patients with mediastinal and hilar lymphadenopathy (2 diagnosed with lymphoma, 1 with sarcoidosis). 19 patients were diagnosed with pulmonary nodules (RADS 2-3, 17%) - CT follow up algorithm. Conclusion(s): We are presenting our initial results, from the first lung cancer screening program in Greece. Greece represents a country many smokers, who also started smoking at a young age, with a both public and private health sector, returning from a long period of economic recession. COVID-19 pandemia has cause practical difficulties along the way. LDCT with AI software, with an MDT board and availability of modern diagnostic and therapeutic alternatives should be considered as essential. A collaboration spirit with other hospitals around the country is being built, in order to share current experience and expertise. Copyright © 2022

A Programmatic Approach to Improve Efficiency in Lung Cancer Screening

Introduction: Largely as a result of the COVID pandemic, our lung cancer screening (LCS) program was underperforming entering 2021. The program serves a majority minority, socio-economically disadvantaged community. Loss of personnel and reallocated resources, allied to pandemic focus, led to decreased referrals and excessive time from referral to low dose computed tomography (LDCT) appointments. Here we describe our programmatic approach to improve LCS metrics. Methods: LCS transitioned from a Department of Radiology program into a Cancer Center-administered collaborative effort under surgical oncology and radiology leadership. Outreach efforts were reinitiated. To facilitate referrals from our primary care network, the cancer service line created a practical guide, “6 Steps to Lung Cancer Screening”, directly linked to an e-referral mechanism in our EMR. Monthly review and quality assurance meetings were held with a multidisciplinary team, specifically focused on program volume and on addressing delays to LDCT appointments. An additional Nurse Practitioner was brought in to enhance the existing LCS Nurse Navigator and Cancer Center staff were utilized to contact and schedule patients and to perform data compilation and analysis. Results: In 2020, LCS referrals had decreased 13% from 2019. In Q1/2021, the median monthly number of LCS referrals was 132 which increased steadily by quarter to 218 in Q4/2021 (p=0.16, Figure 1A). In January 2021, the average time from LCS referral to LDCT appointment was 101 days. Despite the increasing number of referrals through 2021, we were able to decrease the time to appointment from a median of 86 days in Q1/2021 to a median of 29 days in Q4/2021 (p=0.02, Figure 1B). By December 2021, the average time from LCS referral to LDCT appointment was just 18 days. Our LCS referral population was predominantly non-white (76%). Among them, 7.4% of patients with LDCT scans were found to have Lung RADS 3 or 4 nodules. All of these patients were referred to a newly created high-risk lung nodule clinic for management and follow up. Conclusions: We employed a multidisciplinary team approach to improve inefficiencies in our LCS program. The resources, support, and leadership of the health care system’s Cancer Center were crucial to this multi-pronged initiative. The decreased time from LCS referral to LDCT facilitates our ability to handle the anticipated growth in referral volume. This has been shown to enhance engagement with LCS and to improved annual screening compliance, translating to earlier detection of lung cancer and to improved patient outcomes. [Formula presented] Keywords: Lung cancer screening, Adherence, Disparity

Current status of High-risk Smokers Participating in Population-based National Lung Cancer Screening Program in Korea

Introduction: Following assessment of the effectiveness and feasibility based on the results from a two-year population-based nationwide prospective multi-center trial, the Korean government implemented a national lung cancer screening program using low-dose computed tomography (LDCT) for high-risk smokers in 2019. Methods: National Health Insurance Corporation selected high risk targets who are current smokers aged 54 to 74 years with 30 packs per year or more smoking history on the basis of national health-screening database. (Figure 1). Those eligible were offered lung cancer screening by invitation letters in every two years. Screening units provide LDCT using radiation less than 3mGy by at least 16-row multi-detector CT scanners. Screening results were reported by Lung Imaging Reporting and Data System (Lung-RADS). The examinee received results by mail or e-mail;after then, counseling on results and mandatory smoking cessation counselling were provided by certified doctors. National Cancer Center monitored participation rates, post-counseling rates and statistics of screening result for quality control. Screening positive rate is defined as proportion of Lung-RADS category 3 and 4 nodules. Results: The participation rate gradually increased from 24.8% among 332,244 eligible targets in 2019, 25.9% in 2020, to 38.7% among 310,260 targets in 2021, however, the proportion of examinees who participated in post-counseling decreased from 46.3% in 2019 to 32.7% in 2021 due to the COVID-19 pandemic (Figure 2). The positive rates slightly decreased from 9.2% in 2019 to 8.7% in 2021. The variation in positive rates of screening units showed a tendency to decrease (in 2019, the 1st quartile was 4.3%, and the 3rd quartile was 12.9%;and in 2021, 5.2% and 12.5% respectively). Conclusions: National lung cancer screening program has been implemented successfully in Korea with controlling screening positive rates not so high. Controlling false negatives and strengthening post-screening management including smoking cessation counselling needs to improve. [Formula presented] [Formula presented] Keywords: National Lung Cancer Screening, Quality control

The short-term impact of COVID-19 on lung cancer screening participation and adherence

Objective: Screening with low-dose CT (LDCT) effectively reduces mortality from lung cancer. Elective imaging procedures, including lung cancer screening (LCS) LDCT exams, were paused during the height of the COVID-19 pandemic at our institution to conserve healthcare resources and minimize risk as we learned how to mitigate the spread of COVID-19. We aimed to investigate the short-term impact of this COVID-related screening pause on patient participation and adherence to LCS. Methods: We analyzed data of 5133 LDCT screening exams performed at our institution from 2961 patients who were aged 50-80 at each screen between July 31, 2013 and Dec 30, 2020. Independent t-test, Pearson's chi-square and Fisher's exact tests were used to compare monthly average number of LDCTs, on-time adherence rates (i.e., completion of recommended or more invasive follow-up within 15, 9, 5, and 3 months for Lung-RADS 1/2, 3, 4A, and 4B/4X, respectively), percentages of positive screens (Lung-RADS 3 and 4), and lung cancer diagnoses across pre- (July 31, 2013 ∼ Mar 18, 2020), during (Mar 19, 2020 ∼ May 19, 2020), and post-COVID screening pause (May 20, 2020 and after) periods. Results: As expected, compared with the pre-COVID screening pause, there was a significant decrease in monthly average number of LDCTs during the COVID screening pause period (total monthly mean ± sd: pre 55±28 vs during 17±1, p<0.05;new patient monthly mean ± sd: pre 34±16 vs during 6±2, p<0.05). However, a surge in LCS activities was observed after the COVID screening pause period (total: during 17±1 vs post 89±10, p<0.05;new: during 6±2 vs post 42±8, p<0.05), surpassing monthly means in the pre-COVID period (total: pre 55±28 vs post 89±10, p<0.05;new: pre 34±16 vs post 42±8, p<0.05). Overall on-time adherence decreased in the post-COVID period as opposed to the pre-COVID period (p<0.05). There were no significant changes in the percent of positive screens across the three periods (p>0.05). Among the 88 patients diagnosed with lung cancers, 76 diagnoses were made before COVID, 12 diagnoses were made after the COVID pause, and no lung cancer diagnoses were made during the COVID screening pause period. There were no significant differences in terms of the rate of lung cancer (pre 2.9% vs post 1.9%, p>0.05) and the percent of advanced lung cancers (pre 20% vs post 0%, p>0.05) during the two periods. Conclusion: The rate of LCS exams performed at our institution declined during the early days of the COVID-19 pandemic, as elective exams were paused. Once screening resumed, we experienced a surge in the rate of LCS that surpassed pre-COVID rates. Although there were no significant changes in the percentages of positive screens and lung cancer diagnoses shortly after the COVID screening pause period, long-term follow-up is needed to monitor these trends. Additionally, interventions may be needed to improve rates of patients' timely adherence to LCS follow-up recommendations, which decreased in the post-COVID period.