Decision Tool Helps Decide Who Should Get Lung Cancer Screening

by U.S. Medicine

October 28, 2018

ANN ARBOR, MI — A new online decision tool helps clinicians determine when to recommend lung cancer screening for their patients.

A report in Annals of Internal Medicine suggested that use of the instrument could help improve screening advice, based on clinical factors such as individual lung cancer risk and the potential benefits and harms of screening, as well as patient attitudes.1

The Lung Decision Precision tool, available online at https://share.lungdecisionprecision.com/, was designed by researchers from the Ann Arbor, MI, VA Healthcare System and the University of Michigan to help clinicians consult with patients on the appropriateness of lung CT scan in their specific situation.

The same team also created a website where patients and their families can weigh the positives and negatives of screening, as well as calculating their own risk of lunch cancer. It is available at www.shouldiscreen.com.

The site offers easy-to-understand information about the positives and potential negatives of lung cancer screening, while also enabling users to calculate their personal risk of lung cancer.

“Our model is built on a comprehensive view of net benefits for individual patients, which incorporates the best evidence for personalizing the pros and cons of screening and assumes that not all patients will feel the same about screening and its consequences,” explained lead researcher Tanner Caverly, MD MPH, of the VA Center for Clinical Management Research and the University of Michigan Medical School. “This allows us to identify which patients are in the preference-sensitive zone for the decision about screening, and which ones have a very clear potential benefit to them.”

The study pointed out that many health systems are looking for ways to better implement low-dose computed tomography (LDCT) screening programs that are more patient-centered. The research team pulled data from two large randomized trials, published decision analyses, and the SEER (Surveillance, Epidemiology, and End Results) cancer registry in an effort to come up with some solutions.

“Moderate differences in preferences about the downsides of LDCT screening influenced whether screening was appropriate for eligible persons with annual lung cancer risk less than 0.3% or life expectancy less than 10.5 years,” according to the results. “For higher-risk eligible persons with longer life expectancy (roughly 50% of the study population), the benefits of LDCT screening overcame even highly negative views about screening and its downsides.”

Essentially, the study determined that anyone with an annual chance of lung cancer between 0.3% and 1.3%, and a life expectancy of more than 10 years, fell into the high-benefit category. That represents about 50% of Americans who qualify for screening under the current guidelines.

For the rest, however, personal preferences should play a large role in determining who gets tested.

“If a physician is not clear about the potential benefit for a patient who’s in the high-benefit zone, they could miss an opportunity to do something really good for them, to say, ‘I don’t recommend this for everyone but I recommend it for you’,” Caverly explained. “But coming across strong for screening with a patient who has a fine balance of pros and cons could miss an opportunity to give them a choice, to tell them that their decision depends on the kind of person they are.”

1. Caverly TJ, Cao P, Hayward RA, Meza R. Identifying Patients for Whom Lung Cancer Screening Is Preference-Sensitive: A Microsimulation Study. Ann Intern Med. 2018 Jul 3;169(1):1-9. doi: 10.7326/M17-2561. Epub 2018 May 29. PubMed PMID: 29809244; PubMed Central PMCID: PMC6033668.

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