Title:Presenters:

Date:

Proportion of Newly Diagnosed Non-Small Cell Lung Cancer Patients That Would Have

Been Eligible for Lung Cancer Screening

Division of Thoracic SurgeryCity of Hope National Medical Center

Duarte, CA

Geena X. Wu, MD; Leanne Goldstein, DrPH; Jae Y. Kim, MD; Dan J. Raz, MD

Disclosures

• Leanne Goldstein: Rockwell Medical, Inc• Dan Raz: Cireca, LLC

Introduction

• Lung cancer screening (LCS) guidelines among major health organizations.

LCS criterion

Other(NLST

derived) USPSTF CMS

NCCN AATS

Primary Secondary Primary Secondary

Age (years) 55-74 55-80 55-77 55-74 50-79 55-79 50-79

Smoking History (pack-years)

≥30 ≥30 ≥30 ≥30 ≥20 ≥30 ≥20

Quit time (years) 15 15 15 15 none none none

Other criteria - - - -Additional risk factor

-

Additional risk factor ↑ lung cancer risk

≥5% in 5 yearsAmerican Lung Association. http://www.lung.org/lung-disease/lung-cancer/lung-cancer-screening-guidelines/ Detterbeck FC. Chest 2013;143(5 Suppl):e78S-92S.Jaklitsch MT1. JTCVS 2012;144(1):33-38.Jensen T. Memo: CMS 2015. Report No.: CAG-00439N.Smith RA. CA Cancer J Clin 2014;64(1):30-51Wood DE. J NCCN 2012;10(2)240-265.Moyer VA. Ann Intern Med 2013.

Methods

2,244 adults with NSCLC

2,030 NSCLC patients with

complete smoking history

Current smokers630 (31%)

Former smokers873 (43%)

Never smokers 527 (26%)

214 patients with unknown or incomplete

smoking status or history

Retrospective institutional cohort (1994-2014)

Text-mining and manual review of EMR

Final cohort

Excluded from analysis

Patients with history of malignancy 442 (22%)

Identified in cancer registry

Secondary LCS criteria

Primary LCS criteria

Results: Applying USPSTF LCS Criteria

Current smokers

n=873

Former smokers

N=630

Mean age (years) 63 69

Median pack-years smoked 46 30

Median quit-time (years) - 15

LCS criteria met, n (%)

All

Age

Pack-year

Quit time

425 (67.5)

480 (76.2)

524 (83.2)

-

273 (31.3)

685 (78.5)

497 (56.9)

440 (50.4)

All All All All

31.8%26.9%

16.4%

40.7%

Results: Applying USPSTF LCS Criteria

Current smokers

n=873

Former smokers

N=630

Mean age (years) 63 69

Median pack-years smoked 46 30

Median quit-time (years) - 15

LCS criteria met, n (%)

All

Age

Pack-year

Quit time

425 (67.5)

480 (76.2)

524 (83.2)

-

273 (31.3)

685 (78.5)

497 (56.9)

440 (50.4)

M F M F M F M F

13.1%5.8%

Results: Applying USPSTF LCS Criteria

All criteria metn=698 (34.4%)

+6.6% +9.3%+23.0%

Exclude quit timen=832 (41.0%)

Exclude quit timeand age

n=887 (43.7%)

Exclude quit time and pack-year

n=1,165 (57.4%)

Results: Comparing LCS Criteria

Discussion

• Summary– A third of NSCLC patients met all LCS criteria– Only half of former smokers met quit time criterion

• Limitations– Generalizability of data– Retrospective application of LCS to NSCLC patients– Inability to determine timing or benefit of LCS

• Future Directions– Prospective assessment of utility of current LCS criteria,

especially the quit time maximum– Consensus on a uniform, validated set of criteria to

promote LCS

Title:Presenters:

Date:

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