newspaper or on the internet, see a story on TV, or hear one on the radio about how screening saved someone’s life. That is encouraging and motivating for patients who are considering lung cancer screening,” Dr. Randhawa said.
In a community setting, though, the primary care physician often remains the first touch and the best source of information. “Primary care physicians help patients with informed decision making,” said Dr. Jarrar. “They know the patient best, understand the risk factors of lung cancer, and are able to recognize those who meet the criteria for screening.”
However, this study revealed that many primary care physicians do not discuss lung cancer screening with their patients. The research team reported that there is often resistance from both sides when talking about lung cancer. Patients may not be receptive to discussing lung cancer and may refuse screening even when it is paid for by Medicare and other payers; providers may refrain from consultation regarding lung cancer screening for fear of intimidating patients. In addition, physicians and patients are often frustrated and discouraged by the delays resulting from precertification required by commercial insurers, as well as the time constraints related to fulfilling CMS requirements.
“Patients’ willingness and ability to undergo lung cancer screening and possibly surgery can be challenging,” said Dr. Jarrar. “It demands effective communication and strong documentation by using various risk-assessment models and shared decision-making tools.”
Interestingly, the research group discovered through follow-up phone calls with providers that the rate of referrals increased after the researchers shared positive feedback (i.e., if a provider referred a patient and early lung cancer was found). “With this information, physicians became further convinced that lung cancer screening was beneficial, and they really became champions in their practice for lung cancer screening,” said Dr. Randhawa.
Another concern identified from this research was that some primary care physicians were not aware which patients were eligible for screening (those who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years).
In addition to the screening, Dr. Jarrar recommended that these patients be encouraged to enroll in tobacco cessation programs. “Lung cancer screening combined with tobacco cessation is cost effective for our health care system and actually saves money; more importantly, it saves lives by avoiding costly care for patients with advanced lung cancer and identifying cancer when a cure is still possible,” he said.
As learned from previous efforts in the fields of breast and colon cancers, a screening service must be widely available to eligible patients considering participation and be delivered efficiently and economically in order to optimize the public health benefit. To date, evidence-based guidance for implementing LDCT screening programs has not been determined.
“The development and disciplined implementation of lung cancer screening in communities will undoubtedly continue to evolve over time, as will the technology used for screening” said Dr. Randhawa. “In addition, we hope there will be better and increased access to screening. For patients, this means more hope and more lives saved.”
Lung cancer is the leading cause of cancer death, with more people dying of lung cancer than of colon, breast, and prostate cancers combined. The American Cancer Society estimated that more than 222,500 Americans will be diagnosed with lung cancer this year, and more than 155,000 lung cancer patients will die.
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