Screening Patterns and Mortality Differences in Patients With Lung Cancer at an Urban Underserved Community

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Abstract

Mortality reduction via lung cancer screening is mixed in prospective trials. In a community study of 175 lung cancer screening-eligible patients with lung cancer, only 19% had a screening-driven diagnosis. Screening completion was associated with improved mortality, mediated by early cancer detection facilitating curative treatment in multivariate regression. Provider knowledge, patient race, and socioeconomic factors may have contributed to low screening rates. 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.

Original languageEnglish (US)
JournalClinical Lung Cancer
DOIs
StateAccepted/In press - Jan 1 2018

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Lung Neoplasms
Early Detection of Cancer
Mortality
Advisory Committees
Primary Health Care
Guidelines
Survival Analysis
Medical Records
Therapeutics

Keywords

  • Health disparity
  • Preventative medicine
  • Primary care
  • Survival
  • USPSTF guidelines

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

@article{00aaa8f58c07491593c208965fc7ec7a,
title = "Screening Patterns and Mortality Differences in Patients With Lung Cancer at an Urban Underserved Community",
abstract = "Mortality reduction via lung cancer screening is mixed in prospective trials. In a community study of 175 lung cancer screening-eligible patients with lung cancer, only 19{\%} had a screening-driven diagnosis. Screening completion was associated with improved mortality, mediated by early cancer detection facilitating curative treatment in multivariate regression. Provider knowledge, patient race, and socioeconomic factors may have contributed to low screening rates. 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.",
keywords = "Health disparity, Preventative medicine, Primary care, Survival, USPSTF guidelines",
author = "Su, {Christopher T.} and Amit Bhargava and Shah, {Chirag D.} and Balazs Halmos and Gucalp, {Rasim A.} and Stuart Packer and Nitin Ohri and Haramati, {Linda B.} and Roman Perez-Soler and Haiying Cheng",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.cllc.2018.05.019",
language = "English (US)",
journal = "Clinical Lung Cancer",
issn = "1525-7304",
publisher = "Elsevier",

}

TY - JOUR

T1 - Screening Patterns and Mortality Differences in Patients With Lung Cancer at an Urban Underserved Community

AU - Su, Christopher T.

AU - Bhargava, Amit

AU - Shah, Chirag D.

AU - Halmos, Balazs

AU - Gucalp, Rasim A.

AU - Packer, Stuart

AU - Ohri, Nitin

AU - Haramati, Linda B.

AU - Perez-Soler, Roman

AU - Cheng, Haiying

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Mortality reduction via lung cancer screening is mixed in prospective trials. In a community study of 175 lung cancer screening-eligible patients with lung cancer, only 19% had a screening-driven diagnosis. Screening completion was associated with improved mortality, mediated by early cancer detection facilitating curative treatment in multivariate regression. Provider knowledge, patient race, and socioeconomic factors may have contributed to low screening rates. 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.

AB - Mortality reduction via lung cancer screening is mixed in prospective trials. In a community study of 175 lung cancer screening-eligible patients with lung cancer, only 19% had a screening-driven diagnosis. Screening completion was associated with improved mortality, mediated by early cancer detection facilitating curative treatment in multivariate regression. Provider knowledge, patient race, and socioeconomic factors may have contributed to low screening rates. 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.

KW - Health disparity

KW - Preventative medicine

KW - Primary care

KW - Survival

KW - USPSTF guidelines

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U2 - 10.1016/j.cllc.2018.05.019

DO - 10.1016/j.cllc.2018.05.019

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JO - Clinical Lung Cancer

JF - Clinical Lung Cancer

SN - 1525-7304

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