#LCSM Chat Topic 9/25: Challenges in making LDCT screening chest scans standard of care for high risk patients

It has been a couple of years since the National Lung Screening Trial demonstrated a clear survival benefit for low dose CT (LDCT) screening of patients who have a high risk of lung cancer (with “high risk” defined as age 55-75 and a significant smoking history). While lung cancer screening is offered in programs at various centers around the US, it remains a controversial procedure that has not been approved by Medicare as a covered service. On Thursday, September 25th, 8PM ET/ 5PM PT, we’ll discuss the existing barriers in lung cancer screening in late 2014.

Oft-cited issues are screening cost and cost effectiveness. While it’s clear that most abnormal scans will ultimately prove to represent benign “false positive” findings that may require additional imaging, possibly a biopsy, and may contribute to patient anxiety, a recent actuarial analysis indicates that LDCT screening is cost effective.

But we also see that screening isn’t an entirely data driven decision. Breast cancer recommendations have been reversed based on social and political pressure when the evidence-based guidelines didn’t support screening in younger patients. Primary care physicians may be reluctant to accept lung cancer screening based on a fatalistic view of lung cancer and the American Academy of Family Physicians (AAFP) reluctance to recommend LDCT screening. And patients themselves may drag their feet despite being appropriate candidates, while other low risk patients may aggressively seek screening, based on a misunderstood perception of the real probability of benefit from chest CT screening.

#LCSM previously cohosted a #JACR (Journal of the American College of Radiology) tweetchat on June 26 about patient perspectives on lung cancer screening with LDCT.

With these considerations in mind, we’ll cover these three questions:

T1: With deadline for Medicare decision 11/10, how can the LC community convince decision-makers of benefit of screening?

T2: Assuming coverage, how can we maximize recommendations from PCPs to discuss & order CT screening for appropriate pts?

T3: What do people think of emerging efforts such as breath tests, blood tests, etc? How do they fit into efforts at LC screening?

To participate in the chat, remember to include #LCSM in all your tweets, or use a tweetchat tool like tchat.io and the #LCSM hashtag (more how-to info is here).

2 Comments on “#LCSM Chat Topic 9/25: Challenges in making LDCT screening chest scans standard of care for high risk patients

  1. My only concern about this is that it seems to me 95% of the lung cancer focus is now on preventative screening. it really feels to me that those of us already diagnosed have been pushed to the back burner, if we’re on the stove at all!
    This has been my disappointment with Lung Cancer Alliance. When I was first diagnosed 5 years ago, they advocated for those of us already impacted; now it feels to me.we’re not even an afterthought to them. Their mission seems to have totally changed.
    According to that recent Times article, “more women die of lung cancer each year than breast, ovarian and uterine cancers combined”. While no one wants more people diagnosed with a more advanced disease, some of us have been. And it feels to me we have now been forgotten. No one talks much about research anymore, but instead there is all this excitement about how early detection will save lives. That’s great, but doesn’t anyone want to try to save my life too?

    • I have heard other lung cancer patients make the same remark.

      However, I don’t think the focus of lung cancer advocates has shifted away from research or treatments. By my count, there have been more new treatment options offered or announced this year (and for a wider range of lung cancer types) than in any previous year: immunotherapy trials for all lung cancer types, targeted therapy trials for squamous cell, new targeted drugs for NSCLC mutations, new mutation targets … the list is long.

      I think you’re just seeing more discussion of lung cancer screening during the past year for four reasons:

      (1) The US Preventative Services Task Force finally recommended lung cancer screening with LDCT in December 2013. Lung cancer has not had a viable early detection method before. LDCT is projected to save 18,000 lives PER YEAR by catching lung cancer early, before it starts. That’s more lives than most new lung cancer treatments will save in a year.

      (2) More hospitals and clinics are beginning to offer LC screening with LDCT, and are advertising that fact.

      (3) The topic is time-sensitive. In 2014, the Centers for Medicare and Medicaid (CMS) are evaluating whether to provide insurance coverage for LC screening with LDCT. This decision will be made in November. Because many LC patients may be saved by this technology, lung cancer advocates and the medical community are discussing LDCT and urging people to ask CMS to cover it for the largest population of lung cancer patients–those over 65.

      (4) Individual advocates often can do little to bring new LC treatments to patients, other than raise awareness and fundraise for research. However, we feel our actions have a chance to make a difference when it comes to LC screening. Our voice is needed to help insure those over 65 have access to LC screening.

      #LCSM and the lung cancer community are still dedicated to increasing research that will allow more lung cancer patients to be cured or to live with lung cancer as a chronic illness. Advocating for LC screening is just one way to help more patients do this.

      Janet

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