Dr Kumar’s team analyzed data from study participants in the NLST. All the participants in this cohort were aged 55 to 74 years, had a smoking history of at least 30 pack years, and former smokers were abstinent for no more than 15 years. Using this data, the research team developed a multistate regression model that predicted health state transitions as a function of each participant’s baseline characteristics.
WHAT WAS LEARNED
The researchers stratified 53,086 NLST participants according to their baseline risk for lung cancer mortality. They found that highest quintile participants were 8 years older on average and more likely to be white. They tended to be male and have a positive family history of lung cancer.
The lung cancer mortality benefit from LDCT screening increased with increasing baseline risk for death from lung cancer compared with chest radiography. The study showed that those at greater risk for lung cancer mortality had more comorbid conditions and higher screening-related costs. The incremental lung cancer mortality benefits ranged from 1.2 lung cancer deaths prevented per 10,000 person-years for the lowest risk deciles to 9.5 lung cancer deaths prevented per 10,000 person-years for the highest risk deciles during the first 7 years.
The study demonstrated that a greater number of early lung cancer deaths can be averted per patient screened by applying the risk-targeting approach. At the same time, the analysis showed that higher-risk patients are more costly to screen and have a lower life expectancy. The researchers concluded that using a risk-targeting model is unlikely to lead to substantial improvements in the cost-effectiveness of LDCT screening.
“Our work compared the 2 approaches and found that screening the highest-risk patients can help prevent more lung cancer deaths for every scan done in the short-term (7 years). However, the highest risk patients are older, have preexisting medical conditions, and generate more expense following screening. Hence, the highest and lowest risk patients appear very similar in terms of long-term cost-effectiveness,” said Dr Kumar.
IMPLICATIONS FOR NURSES
Only 5% of people who should be screened for lung cancer are actually undergoing screening. Subsequently, there is a greater need for more screening. This current investigation failed to show that a more complicated approach to patient selection was superior. Follow-up studies are planned, and some experts believe that a more refined risk stratification might improve the risk-benefit ratio for lung cancer screening.
“What many people are doing is trying to see if there is a better way,” Dr Kumar told Oncology Nurse Advisor. “Although the precise nature of this work is aimed at policymakers, oncology nurses should be aware of the current guidelines for lung cancer screening and help improve the uptake of lung cancer screening nationally.”
Kumar V, Cohen JT, van Klaveren D, et al, Risk-targeted lung cancer screening: a cost-effectiveness analysis [published online January 2, 2018]. Ann Intern Med. doi:10.7326/M17-1401