Effectiveness of Lung Cancer Screening Implementation in the Community Setting in the United States
| Autor: | J. King, Amy Copeland, Angela Criswell, Andrew Ciupek |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Oncology
medicine.medical_specialty Lung Neoplasms MEDLINE Computed tomography Medicare ORIGINAL CONTRIBUTIONS Workflow 03 medical and health sciences 0302 clinical medicine Lung cancer screen Surveys and Questionnaires Internal medicine medicine Humans Mass Screening 030212 general & internal medicine Lung cancer Care Delivery Early Detection of Cancer Mass screening medicine.diagnostic_test Oncology (nursing) business.industry Health Policy Community Health Centers medicine.disease United States 030220 oncology & carcinogenesis Community setting National Lung Screening Trial business Lung cancer screening Program Evaluation |
| Zdroj: | Journal of Oncology Practice |
| ISSN: | 1935-469X 1554-7477 |
| Popis: | PURPOSE: The National Lung Screening Trial demonstrated a 20% relative reduction in lung cancer mortality with low-dose computed tomography screening, leading to implementation of lung cancer screening across the United States. The Centers for Medicare and Medicaid Services approved coverage, but questions remained about effectiveness of community-based screening. To assess screening implementation during the first full year of CMS coverage, we surveyed a nationwide network of lung cancer screening centers, comparing results from academic and nonacademic centers. METHODS: One hundred sixty-five lung cancer screening centers that have been designated Screening Centers of Excellence responded to a survey about their 2016 program data and practices. The survey included 21 pretested, closed- and open-ended quantitative and qualitative questions covering implementation, workflow, numbers of screening tests completed, and cancers diagnosed. RESULTS: Centers were predominantly community based (62%), with broad geographic distribution. In both community and academic centers, more than half of lung cancers were diagnosed at stage I or limited stage, demonstrating a clear stage shift compared with historical data. Lung-RADS results were also comparable. There are wide variations in the ways centers address Centers for Medicare and Medicaid Services requirements. The most significant barriers to screening implementation were insurance and billing issues, lack of provider referral, lack of patient awareness, and internal workflow challenges. CONCLUSION: These data validate that responsible screening can take place in a community setting and that lung cancers detected by low-dose computed tomography screening are often diagnosed at an early, more treatable stage. Lung cancer screening programs have developed different ways to address requirements, but many implementation challenges remain. |
| Databáze: | OpenAIRE |
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