Rates of Lung Cancer Screening Discussions Are Low, and Falling Further

By Marilynn Larkin

May 06, 2019

NEW YORK (Reuters Health) - Too few physician-patient discussions are taking place to address lung cancer screening and smoking cessation for at-risk individuals, researchers say.

"It is difficult to pinpoint what causes this unexpected finding," Dr. Jinai (Stephen) Huo of the University of Florida in Gainesville told Reuters Health by email. "The low rates of patient-reported physician-patient discussions about lung cancer screening shown in our study may reflect physicians' concerns about the high false-positive rates for screening, invasive diagnostic procedures after a positive test, potential complications after these invasive diagnostic procedures, and the downstream health care costs."

Even when they do take place, he said, such discussions "may not have integrated effective smoking cessation counseling, which requires both patient and physician commitment, and well-trained healthcare professionals with experience in communicating with patients about smoking cessation."

Further, there needs to be sufficient time to discuss both smoking cessation and lung cancer screening. "Studies have reported that physicians may have a negative attitude toward smoking cessation, which they may feel is ineffective and time-consuming," he noted.

Dr. Huo and colleagues analyzed data from the National Cancer Institute's Health Information National Trends Survey (HINTS) in 2012, 2014, and 2017, following three events in support of lung cancer screening: in 2011, the National Lung Screening Trial (NLST) demonstrated that low-dose computed tomography (LDCT) scanning reduced lung cancer mortality by 20%; in 2013, the United States Preventive Services Task Force issued a recommendation for lung cancer screening; and, in 2015, the Centers for Medicare and Medicaid Services released a lung cancer screening policy.

The HINTS survey included questions on smoking status and whether respondents had talked with their physicians about having a test to check for lung cancer.

As reported online April 25 in Cancer Epidemiology, Biomarkers and Prevention, the study sample consisted of 9,443 individuals: 54% were 55 and older, 57% were women and 58% were non-Hispanic white.

Rates of lung cancer screening discussions were low and decreased significantly (crude estimates) from 6.7% in 2012, to 4.2% in 2014 and 4.3% in 2017.

Those more likely to have such discussions were patients older than 55 (OR, 3.25); patients older than 77 (OR, 4.77); current smokers (OR, 3.93); and former smokers (OR, 1.90).

Other factors associated with increased likelihood of the discussion were being non-Hispanic black or Hispanics; living in the Northeast U.S.; having a cancer diagnosis other than lung; and having diabetes; high blood pressure; or lung diseases.

Across age and smoking status groups, the highest rates of physician-patient discussions were among current smokers ages 55 to 74 in 2012 (26.8%), and current smokers older than 74 in 2014 (23.5%) and 2017 (22.1%).

In multivariate analysis, whether or not a physician-patient discussion about lung cancer screening took place was not significantly associated with patients' intent to quit or attempt to quit.

"At the time of the study, the NLST was the only clinical trial that demonstrated the effectiveness of lung cancer screening using LDCT scanning," Dr. Huo noted. "Now, the NELSON study, a large clinical trial in lung cancer screening in Europe, confirmed the benefits of LDCT in reducing the risk of lung cancer mortality. With promising findings from two large clinical trials from two continents, the number of physician-patient discussions about lung cancer screening may increase in the near future."

Dr. Huo and colleagues are planning studies to assess the real-world rate of false positives and associated healthcare costs. The team is also "designing shared decision-making tools that will facilitate physician-patients discussions on lung cancer screening and can maximize the benefits and minimize the harms of screening," he said.

Dr. Vani Simmons, associate member of the Health Outcomes and Behavior Department at Moffitt Cancer Center in Tampa, Florida, commented by email, "With respect to conversations regarding smoking cessation, most patients are asked by their providers about their smoking status and are advised to quit; however, much fewer are provided assistance in quitting smoking."

"Some of the barriers that have been identified in prior studies include beliefs about patient resistance to smoking cessation treatment and feeling ill-prepared to assist patients in quitting," she told Reuters Health.

"With respect to lung cancer screening, our prior research suggests that conversations are not occurring with primary care providers because lung cancer screening has not yet become part of conversations unlike other cancer screenings - e.g., mammography, prostate cancer screening," she said. "In addition, providers noted concerns related to insurance/cost barriers and the potential risk of false positives. Providers also noted that conversations may not occur given the comorbidities and acute health concerns smokers may have."

"There is a need to increase awareness of lung cancer screening and to increase the occurrence of shared decision-making regarding the choice to get screened," Dr. Simmons stressed. "With respect to smoking cessation, we need to move beyond asking about smoking to connecting patients to evidence-based smoking cessation interventions."

SOURCE: http://bit.ly/2VHowuK

Cancer Epidemiol Biomarkers Prev 2019.