IMPLEMENTATION OF
Lung Cancer Screening
Proceedings of a Workshop
Erin Balogh, Margie Patlak, and Sharyl J. Nass, Rapporteurs
National Cancer Policy Forum
Board on Health Care Services
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This project was supported by Contract No. 200-2011-38807 (Task Order No. 0051) and Contract No. HHSN263201200074I (Task Order No. HHSN26300052) with the Centers for Disease Control and Prevention and the National Cancer Institute/ National Institutes of Health, respectively, and by the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Helsinn Healthcare SA, LIVESTRONG Foundation, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-45132-1
International Standard Book Number-10: 0-309-45132-9
Digital Object Identifier https://doi.org/10.172216/23680
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Implementation of lung cancer screening: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.172216/23680.
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WORKSHOP PLANNING COMMITTEE1
GRETA MASSETTI (Chair), Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor and Program Manager, Prevention Policy, Department of Veterans Affairs
SAMIR N. KHLEIF, Professor of Medicine, Biochemistry, Molecular Biology, and Graduate Studies, Augusta University
BARNETT KRAMER, Director, Division of Cancer Prevention, National Cancer Institute
LEE M. KRUG, Disease Area Head, Lung and Head & Neck Cancer, Immuno-Oncology, Bristol-Myers Squibb
CHRISTOPHER S. LATHAN, Assistant Professor of Medicine, Harvard Medical School; Director, Cancer Care Equity, Dana-Farber Cancer Institute
JENNIFER A. PIETENPOL, Director, Vanderbilt-Ingraham Cancer Center; Executive Vice President for Research, Vanderbilt University Medical Center; and Benjamin F. Byrd, Jr. Professor of Oncology, Vanderbilt University
YA-CHEN TINA SHIH, Professor of Health Economics, Chief, Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center
ROBERT SMITH, Vice President, Cancer Screening, American Cancer Society
JAMIE L. STUDTS, Associate Professor, Department of Behavioral Science, University of Kentucky College of Medicine; Director, Behavioral & Community-Based Research Shared Resource Facility, Markey Cancer Center
DANIEL SULLIVAN, Professor Emeritus, Department of Radiology, Duke University School of Medicine
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
ROBERT J. VOLK, Professor, Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center
Project Staff
SHARYL J. NASS, Director, National Cancer Policy Forum
ERIN BALOGH, Senior Program Officer
CYNDI TRANG, Research Assistant
PATRICK ROSS, Research Assistant (until July 2016)
NATIONAL CANCER POLICY FORUM1
MICHAEL CALIGIURI (Chair), Chief Executive Officer, James Cancer Hospital and Solove Research Institute; Director, The Ohio State University Comprehensive Cancer Center
PATRICIA A. GANZ (Vice Chair), Distinguished Professor, University of California, Los Angeles, Fielding School of Public Health; Director, Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center
AMY P. ABERNETHY, Chief Medical Officer and Senior Vice President for Oncology, Flatiron Health
LUCILE ADAMS-CAMPBELL, Professor of Oncology, Associate Director for Minority Health and Health Disparities Research, Georgetown University Lombardi Cancer Center
KENNETH ANDERSON, Kraft Family Professor of Medicine, American Cancer Society Clinical Research Director, Jerome Lipper Multiple Myeloma Center, Harvard Medical School, Dana-Farber Cancer Institute
MONICA M. BERTAGNOLLI, Richard E. Wilson Professor of Surgery, Harvard Medical School; Chief, Division of Surgical Oncology, Dana-Farber/Brigham and Women’s Cancer Center; Group Chair, Alliance for Clinical Trials in Oncology
OTIS W. BRAWLEY, Chief Medical Officer, American Cancer Society
ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network
GREGORY CURT, Executive Director, External Scientific and Clinical Relations, U.S. Medical Affairs, AstraZeneca
WENDY DEMARK-WAHNEFRIED, Professor and Webb Endowed Chair of Nutrition Sciences, Associate Director for Cancer Prevention and Control, University of Alabama at Birmingham Comprehensive Cancer Center
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
GEORGE D. DEMETRI, Professor of Medicine, Harvard Medical School; Director, Ludwig Center; Senior Vice President for Experimental Therapeutics, Dana-Farber Cancer Institute; Associate Director for Clinical Sciences, Dana-Farber/Harvard Cancer Center
JAMES H. DOROSHOW, Deputy Director for Clinical and Translational Research, National Cancer Institute
JOHN FRIEND II, Senior Vice President, Helsinn Therapeutics
LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor and Program Manager, Prevention Policy, Department of Veterans Affairs
LINDA HOUSE, President, Cancer Support Community
HEDVIG HRICAK, Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center
LISA KENNEDY SHELDON, Chief Clinical Officer, Oncology Nursing Society; Editor, Clinical Journal of Oncology Nursing
SAMIR N. KHLEIF, Professor of Medicine, Biochemistry, Molecular Biology, and Graduate Studies, Augusta University
RONALD M. KLINE, Medical Officer, Patient Care Models Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services
LEE M. KRUG, Disease Area Head, Lung and Head & Neck Cancer, Immuno-Oncology, Bristol-Myers Squibb
RICHARD A. LARSON, Professor of Medicine and Director, Hematologic Malignancies Clinical Research Program, The University of Chicago Comprehensive Cancer Center
MICHELLE M. LE BEAU, Arthur and Marian Edelstein Professor of Medicine and Director, The University of Chicago Comprehensive Cancer Center
GRETA MASSETTI, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention
DANIEL R. MASYS, Affiliate Professor, Biomedical and Health Informatics, University of Washington School of Medicine
MARTIN J. MURPHY, Chief Executive Officer, CEO Roundtable on Cancer
LOYCE PACE, Executive Director, Global Health Council (LIVESTRONG Representative)
RICHARD PAZDUR, Director, Oncology Center of Excellence; Acting Director, Office of Hematology and Oncology Products, Food and Drug Administration
STEVEN PIANTADOSI, Phase One Foundation Endowed Chair and Director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center
JENNIFER A. PIETENPOL, Director, Vanderbilt-Ingraham Cancer Center; Executive Vice President for Research, Vanderbilt University Medical Center; and Benjamin F. Byrd, Jr. Professor of Oncology, Vanderbilt University
MACE L. ROTHENBERG, Chief Development Officer, Oncology, Pfizer Global Product Development, Pfizer Inc.
RICHARD L. SCHILSKY, Senior Vice President and Chief Medical Officer, American Society of Clinical Oncology
DEBORAH SCHRAG, Chief, Division of Population Sciences, Professor of Medicine, Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute
YA-CHEN TINA SHIH, Professor of Health Economics, Chief, Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center
ELLEN V. SIGAL, Chair and Founder, Friends of Cancer Research
RALPH WEICHSELBAUM, Daniel K. Ludwig Professor and Chair, Department of Radiation; Oncology and Cellular Director, Ludwig Center for Metastasis Research, The University of Chicago Medical Center
GEORGE J. WEINER, President, Association of American Cancer Institutes; C.E. Block Chair of Cancer Research, Professor of Internal Medicine, and Director, Holden Comprehensive Cancer Center, University of Iowa
RICHARD WOODMAN, Senior Vice President and Head, North America Oncology Clinical Development & Medical Affairs, Novartis Pharmaceuticals Corporation
WENDY WOODWARD, Associate Professor and Section Chief of Clinical Breast Radiation, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center
National Cancer Policy Forum Staff
SHARYL J. NASS, Forum Director and Director, Board on Health Care Services
ERIN BALOGH, Senior Program Officer
SYLARA MARIE CRUZ, Senior Program Assistant
MATINA KAKALIS, Summer Intern (May-July 2016)
KIMBERLY MAXFIELD, Mirzayan Science and Technology Policy Fellow (January-May 2016)
PATRICK ROSS, Research Assistant (until July 2016)
CYNDI TRANG, Research Assistant
PATRICK BURKE, Financial Officer
Reviewers
This Proceedings of a Workshop has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published Proceedings of a Workshop as sound as possible and to ensure that the Proceedings of a Workshop meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this Proceedings of a Workshop:
MICHAEL K. GOULD, Kaiser Permanente
ELLA KAZEROONI, University of Michigan
MICHAEL L. LEFEVRE, University of Missouri
PETER MAZZONE, Cleveland Clinic
IDE MILLS, Patient Advocate
Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the Proceedings of a Workshop before its release. The review of this Proceedings of a Workshop was overseen by SUSAN J. CURRY, University of Iowa. She
was responsible for making certain that an independent examination of this Proceedings of a Workshop was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this Proceedings of a Workshop rests entirely with the rapporteurs and the institution.
IN MEMORIAM
This Proceedings of a Workshop is dedicated to Dr. Gregory Curt, an accomplished physician and scientist, a valued member of the National Cancer Policy Forum, and an irreplaceable colleague and friend.
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Acknowledgments
Support from the many annual sponsors of the National Academies of Sciences, Engineering, and Medicine’s National Cancer Policy Forum is crucial to the work of the Forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Non-federal sponsors include the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Helsinn Healthcare SA, LIVESTRONG Foundation, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc.
The Forum wishes to express its gratitude to the expert speakers whose presentations helped examine the policy and implementation issues in lung cancer screening. The Forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.
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Contents
EVIDENCE BASE FOR LUNG CANCER SCREENING
ELIGIBILITY, CLINICAL PRACTICE GUIDELINES, AND MODELING
Representativeness of the NLST Population
Adherence to Clinical Practice Guidelines
INSURANCE COVERAGE OF LUNG CANCER SCREENING
CMS National Coverage Decision on Lung Cancer Screening
CHALLENGES TO IMPLEMENTATION OF LUNG CANCER SCREENING PROGRAMS
Clinician Awareness and Concerns About Lung Cancer Screening
Incorporation of Lung Cancer Screening in Clinical Practice
Patient Access to Screening and Health Disparities
Patient Outreach and Information Needs
Patient Access to Lung Cancer Screening
STRUCTURING LUNG CANCER SCREENING PROGRAMS
ENSURING THE QUALITY OF LUNG CANCER SCREENING
Confirming Eligibility for Lung Cancer Screening
Maintenance of Annual Lung Cancer Screening
Ensuring Access to Smoking Cessation Services
High-Quality Image Interpretation and Management of Findings
SMOKING CESSATION AND LUNG CANCER SCREENING
Results of Cessation Efforts Linked to Screening Programs
Impact of Screen Results on Willingness to Quit
Intensity of Smoking Cessation Programs and Quitting Success
Boxes, Figures, and Tables
BOXES
2 Risk Modeling for Assessing Lung Cancer Risk and Selecting Screening Participants
3 Resources and Tools to Facilitate Implementation of Lung Cancer Screening
4 Department of Veterans Affairs Lung Cancer Screening Pilot
5 Cleveland Clinic’s Lung Cancer Screening Program
FIGURES
2 Variability in lung cancer screening among different institutions
3 Aetna LDCT screening utilization
4 Percent change in LDCT scans performed by health service area
5 CT scanner capacity and geographic disparities in the United States by health service area
Acronyms and Abbreviations
AAFP |
American Academy of Family Physicians |
AATS |
American Association for Thoracic Surgery |
ACA |
Patient Protection and Affordable Care Act |
ACCP |
American College of Chest Physicians |
ACR |
American College of Radiology |
ACS |
American Cancer Society |
AHRQ |
Agency for Healthcare Research and Quality |
ALA |
American Lung Association |
ASCO |
American Society of Clinical Oncology |
ATS |
American Thoracic Society |
BI-RADS | Breast Imaging Reporting and Data System |
CDC | Centers for Disease Control and Prevention |
CMS |
Centers for Medicare & Medicaid Services |
COPD |
chronic obstructive pulmonary disorder |
CT |
computed tomography |
DANTE |
Detection and Screening of Early Lung Cancer by Novel Imaging Technology and Molecular Essays |
DLCST |
Danish Lung Cancer Screening Trial |
EMR |
electronic medical record |
FDA | Food and Drug Administration |
GOLF |
Groupe d’Oncologie de Langue Française |
HEDIS |
Healthcare Effectiveness Data and Information Set |
IASLC |
International Association for the Study of Lung Cancer |
I-ELCAP |
International-Early Lung Cancer Action Program |
IFCT |
French Cooperative Thoracic Intergroup |
IPDAS |
International Patient Decision Aids Standards Collaboration |
LDCT | low-dose computed tomography |
Lung-RADS |
ACR Lung Imaging Reporting and Data System |
MEDCAC |
Medicare Evidence Development and Coverage Advisory Committee |
NCCN | National Comprehensive Cancer Network |
NCD |
national coverage determination |
NCI |
National Cancer Institute |
NELSON |
Nederlands-Leuvens Longkanker Screenings Onderzoek |
NLST |
National Lung Screening Trial |
PET | positron emission tomography |
PLCO |
Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial |
PROSPR |
Population-based Research Optimizing Screening through Personalized Regimens |
QALY | quality-adjusted life year |
USPSTF | U.S. Preventive Services Task Force |
VA | Department of Veterans Affairs |