Screening Patterns and Mortality Differences in Patients With Lung Cancer at an Urban Underserved Community

• Published in: Clinical lung cancer 2018-09, Vol.19 (5), p.e767-e773
• Main Authors: Su, Christopher T., Bhargava, Amit, Shah, Chirag D., Halmos, Balazs, Gucalp, Rasim A., Packer, Stuart H., Ohri, Nitin, Haramati, Linda B., Perez-Soler, Roman, Cheng, Haiying
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - mortality; Adenocarcinoma - therapy; Aged; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - therapy; Combined Modality Therapy; Decision Support Techniques; Early Detection of Cancer - statistics & numerical data; Female; Follow-Up Studies; Health disparity; Humans; Lung Neoplasms - diagnosis; Lung Neoplasms - mortality; Lung Neoplasms - therapy; Male; Medically Underserved Area; Middle Aged; Preventative medicine; Primary care; Prognosis; Retrospective Studies; Small Cell Lung Carcinoma - diagnosis; Small Cell Lung Carcinoma - mortality; Small Cell Lung Carcinoma - therapy; Survival; Survival Rate; Tomography, X-Ray Computed; Urban Population; USPSTF guidelines
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2018.05.019

Mortality reduction via lung cancer screening is mixed in prospective trials. In a community study of 175 lung cancer screening-eligible patients with lung cancer, only 19% had a screening-driven diagnosis. Screening completion was associated with improved mortality, mediated by early cancer detection facilitating curative treatment in multivariate regression. Provider knowledge, patient race, and socioeconomic factors may have contributed to low screening rates. The landmark National Lung Screening Trial demonstrated significant reduction in lung cancer-related mortality. However, European lung cancer screening (LCS) trials have not confirmed such benefit. We examined LCS patterns and determined the impact of LCS-led diagnosis on the mortality of newly diagnosed patients with lung cancer in an underserved community. Medical records of patients diagnosed with primary lung cancer in 2013 through 2016 (n = 855) were reviewed for primary care provider (PCP) status and LCS eligibility and completion, determined using United States Preventative Services Task Force guidelines. Univariate analyses of patient characteristics were conducted between LCS-eligible patients based on screening completion. Survival analyses were conducted using Kaplan-Meier and multivariate Cox regression. In 2013 through 2016, 175 patients with primary lung cancer had an established PCP and were eligible for LCS. Among them, 19% (33/175) completed screening prior to diagnosis. LCS completion was associated with younger age (P = .02), active smoking status (P < .01), earlier stage at time of diagnosis (P < .01), follow-up in-network cancer treatment (P = .03), and surgical management (P < .01). LCS-eligible patients who underwent screening had improved all-cause mortality compared with those not screened (P < .01). Multivariate regression showed surgery (hazard ratio, 0.31; P = .04) significantly affected mortality. To our knowledge, this is the first study to assess LCS patterns and mortality differences on patients with screen-detected lung cancer in an urban underserved setting since the inception of United States Preventative Services Task Force guidelines. Patients with a LCS-led diagnosis had improved mortality, likely owing to cancer detection at earlier stages with curative treatment, which echoes the finding of prospective trials.