SAN FRANCISCO—With increased imaging now detecting lung cancer nodules in sicker patients, a new report suggested that guidelines should be more directive in how to maximize benefit and minimize harm, while taking into account comorbidities and life expectancy.

The study in PLoS One pointed out that current pulmonary nodule guidelines don’t provide enough information on how to individualize follow-up for complex patients.

University of California San Francisco-led researchers sought to characterize comorbidity and life expectancy in older veterans with incidental, symptom-detected or screen-detected nodules in 2008-09 vs. 2013-14. The retrospective cohort study compared the effect of those patient factors on four-year nodule follow-up among the 2008-09 subgroup.

The study, conducted at an urban VAMC, focused on 243 veterans 65 and older with newly diagnosed pulmonary nodules in 2008-09—followed for four years through 2012 or 2013—and 446 older veterans diagnosed in 2013-14.

Defined as the primary outcome was receipt of any follow-up nodule imaging and/or biopsy within four years after nodule diagnosis. Primary predictor variables included age, Charlson-Deyo Comorbidity Index (CCI) and life expectancy, with favorable life expectancy defined as age 65–74 with CCI 0, while limited life expectancy was defined as age 85 or older with CCI ≥1 or age 65 or older with CCI ≥4. Researchers also examined Interaction by nodule size.

The study noted that, from 2008-09 to 2013-14, the number of older veterans diagnosed with new pulmonary nodules almost doubled, including among those with severe comorbidity and limited life expectancy.

Results indicated that, overall among the 2008-09 subgroup, receipt of nodule follow-up decreased with increasing comorbidity (CCI ≥4 vs. 0: adjusted RR 0.61, 95% CI 0.39-0.95) with a trend toward decreased follow-up among those with limited life expectancy (adjusted RR 0.69, 95% CI 0.48-1.01).

“However, we detected an interaction effect with nodule size such that comorbidity and life expectancy were associated with decreased follow-up only among those with nodules ≤6 mm,” the researchers wrote.

They added, “We found some individualization of pulmonary nodule follow-up according to comorbidity and life expectancy in older veterans with smaller nodules only.”