Risk-Prediction Tool Helps Tailor Lung Cancer Screening to Patient Preference and Clinical Benefit

Key Points

  • Moderate differences in preferences about the downside of low-dose CT screening influenced whether screening was appropriate for eligible persons with an annual lung cancer risk of less than 0.3% or life expectancy of less than 10.5 years.
  • For higher-risk eligible persons with longer life expectancy, the benefits of screening overcame even highly negative views and screening.
  • Identifying circumstances in which low-dose CT screening is more vs less preference-sensitive may help clinicians personalize screening discussions, tailoring them to both patient preference and clinical benefit.

A microsimulation model study found that the benefits of low-dose computed tomography (CT) screening for lung cancer varied substantially across the eligible population, with 3 factors being particularly influential: lung cancer risk, competing risks or life expectancy, and patient preferences. The study by Caverly et al was published in <em>Annals of Internal Medicine</em>. The study’s findings may help guide clinicians to tailor lung cancer screening recommendations for eligible patients based on clinical benefit and personal preferences. 

In 2011, the National Lung Screening Trial found that annual screening with low-dose CT substantially reduced mortality from lung cancer, the leading cause of cancer death in the United States, according to the National Cancer Institute. However, several factors complicate the implementation of low-dose CT screening, including variability of absolute risk reduction among eligible patients; the potential harms and costs; and how patients value the tradeoffs and risks of screening. 

Study Details

The researchers created a Markov microsimulation model based on the National Lung Screening Trial to examine clinical outcomes and health states that patients would experience under two scenarios: 3 years of annual low-dose CT screening for lung cancer or no screening. To estimate the outcomes of lung cancer screening that are representative of the contemporary U.S. population, the researchers used the National Health Interview Survey to simulate a nationally representative sample of 1 million persons aged 55 to 80 who met the U.S. Preventive Services Task Force criteria for heavy smoking: ≥ 30 pack-years and ≤ 15 years since smoking cessation.

The study showed that moderate differences in preferences related to the downside of low-dose CT screening influenced whether screening was appropriate for eligible persons with an annual lung cancer risk of less than 0.3% or life expectancy of less than 10.5 years. For higher-risk eligible persons with longer life expectancy (roughly 50% of the study population), the benefits of screening overcame even highly negative views about screening. Those with higher risk and longer life expectancy also had a robust net benefit even in scenarios where false-positive rates were very high (ie, a 60% rate of false-positive findings).

Implications

“Our results support the importance of personalizing the harm-benefit assessment of [low-dose] CT lung cancer screening for informing screening decisions rather that uniformly recommending or withholding a recommendation for eligible patients. Because the harm-benefit considerations can be complex, we have created and made available a web-based decision tool that incorporated the rules of thumb derived from our findings to facilitate personalized discussions about [low-dose] CT screening,” concluded the study authors. 

Tanner J. Caverly, MD, MPH, a general internist and Health Services Research Fellow at the Ann Arbor VA Medical Center and a clinical lecturer at the University of Michigan Medical School, is the corresponding author of this study.

Funding for this study was provided by the Veterans Affairs Quality Enhancement Research Institute and the National Cancer Institute. Conflict of interest disclosures can be found at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2561

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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