Lung Cancer Screening: Practical Aspects for Primary Care

✍ Scribed by Janelle V. Baptiste (editor), Richard M. Schwartzstein (editor), Carey C. Thomson (editor)

• Publisher: Springer
• Year: 2022
• Tongue: English
• Leaves: 131
• Category: Library

✦ Synopsis

Lung cancer is the second most diagnosed cancer and remains the leading cause of cancer-related deaths in the United States. The high mortality is largely the consequence of late diagnosis; lung cancer is typically asymptomatic in early stages when a surgical cure is most likely. As a result, there has been great interest in and research on early detection of lung cancer through screening. 

There is evidence for reduced disease-specific mortality through screening for lung cancer.  However, creating an integrated, systematic approach to lung cancer screening remains a challenge for providers. A successful lung cancer screening program weighs the benefits and harms of screening, clearly defines the target population and the screening process, and does not exclude eligible patient populations based on race, ethnicity, or socioeconomic status, In addition it should promote shared decision-making and address risk reduction.

Lung Cancer Screening: Essentials for Primary Care provides a comprehensive and pragmatic guide to screening for lung cancer in real world clinical practice. The first two chapters summarize the epidemiology, risk factors and disparities in lung cancer, and provide the evidence base for screening for lung cancer. The disparities in lung cancer among different groups within the US population are well known. This text highlights how health disparities in lung cancer affect screening and have led to modification of lung cancer screening guidelines. Subsequent chapters provide a guide to implementing a successful lung cancer screening program and address the barriers that arise during implementation. The book concludes with real-world solutions to overcoming barriers in lung cancer screening. 

This pocket guide is an essential read and bookshelf reference for providers who do not have the specialized knowledge of screening for lung cancer. It also appeals to pulmonologists, fellows in Pulmonary Medicine, chest radiologists, and advanced practice providers with an interest in setting up lung cancer screening in any clinical practice. 

✦ Table of Contents

Introduction
Contents
Chapter 1: Epidemiology of Lung Cancer and Risk Factors
1.1 Epidemiology of Lung Cancer
1.1.1 Incidence
1.1.2 Mortality
1.1.3 Stage at Presentation
1.1.4 Histological Subtypes
1.2 Lung Cancer Risk Factors
1.2.1 Demographic Factors
1.2.2 Smoking
1.2.3 Passive Smoking
1.2.4 E-Cigarettes
1.2.5 Air Pollution
1.2.6 Radon
1.2.7 Asbestos
1.2.8 Infection
1.2.9 Genetics and Family History
1.3 Conclusion
References
Chapter 2: Health Disparities in Lung Cancer Screening
2.1 Overview of Health Disparities in Lung Cancer
2.2 The Landscape of Health Disparities in Lung Cancer Screening
2.2.1 Disparities Associated with Patient Demographics Including Race and Gender
2.2.2 The Role of Social Determinants of Health (SDOH)
2.3 Barriers to Lung Cancer Screening
2.3.1 Barriers to Lung Cancer Screening That Act at the Health Policy Level
2.3.2 Barriers to Lung Cancer Screening That Act at the Health System Level
2.3.3 Barriers to Lung Cancer Screening That Act at the Patient Level
2.3.4 Barriers to Lung Cancer Screening That Act at the Health Care Provider Level
2.4 Overcoming Disparities in Lung Cancer Screening
References
Chapter 3: Best Practices in Lung Cancer Screening
3.1 Evidence Base for Lung Cancer Screening
3.1.1 Introduction
3.1.2 Measuring Benefits and Harms of Screening
3.1.3 Screening Modalities
3.1.3.1 Chest Radiography and Sputum Cytology
3.1.3.2 Low-Dose CT Scan
Observational Studies
3.1.3.3 Randomized Clinical Trials
National Lung Screening Trial
European Randomized Lung Cancer Screening Trials
NELSON Trial
3.1.4 Patient Selection
3.1.5 Evidence of Potential Harms
3.1.6 Shared Decision-Making Evidence in Lung Cancer Screening
3.1.7 Cost-Effectiveness of Lung Cancer Screening
3.1.8 Smoking and Lung Cancer Screening
3.1.9 Non-lung nodule Findings
3.1.10 Evidence Needs
3.1.11 Conclusion
3.2 Quality Indicators in Lung Cancer Screening Programs
3.2.1 Challenges in Developing Quality Metrics in Lung Cancer Screening
3.2.2 Expert Consensus in Measuring Program Quality in Lung Cancer Screening
3.2.3 National Trends in Screening Rates, Disparities, and Targets
3.3 Structure and Governance
3.3.1 Steering Committee Governance of CT Lung Screening Programs
3.3.2 Program Design
3.3.3 Provider Continuing Education
3.3.4 Community Outreach
3.3.5 Measuring Outcomes
3.3.6 Research Oversight
3.4 Navigation
3.4.1 Introduction
3.4.2 Office/Department-Based Navigation
3.4.3 Lung Cancer Screening Program Navigation
3.4.4 The Benefit of Nursing Navigation in Cancer Screening
3.4.5 Navigating Lung Cancer Screening in the Electronic Medical Record
3.4.6 Navigation Summary
References
Chapter 4: Implementing Lung Cancer Screening in Clinical Practice
4.1 Lung Cancer Screening Eligibility Criteria and Confirmation of Eligibility
4.1.1 Current Eligibility Criteria for Lung Cancer Screening
4.1.2 Determining and Ensuring Eligibility for Lung Cancer Screening (LCS)
4.1.3 Suggested Areas of Research
4.2 Barriers to Implementing Lung Cancer Screening (LCS) in Clinical Practice
4.2.1 Discussing Barriers to Implementation of LCS in Primary Care
4.2.2 Lung Cancer Screening Is Complex and Costly
4.2.3 External Influences Is a Barrier to Lung Cancer Screening Implementation
4.2.4 Future Direction
4.3 Integration of Lung Cancer Screening into the Electronic Health Record
4.3.1 Areas of Focus for Leveraging the EHR
4.3.1.1 Documentation of Lung Cancer Risk Factors
4.3.2 EHR Support for Identifying LCS-Eligible Individuals
4.3.3 Tracking LDCT Findings for Follow-Up
4.3.4 Research Gaps
4.3.5 Future Directions
4.4 Insurance Coverage and Prior Authorization of Lung Cancer Screening
4.4.1 Private Insurance Coverage
4.4.2 Medicare Coverage
4.4.3 Medicaid Coverage
4.4.4 Prior Authorization
References
Chapter 5: Innovations in Integrating Smoking Cessation and the Shared Decision-Making Discussion into Lung Cancer Screening
5.1 Components of a Shared Decision-Making Discussion
5.2 Challenges in Shared Decision-Making Decisions: Embracing Uncertainty
5.2.1 Biology of the Tumor
5.2.2 Concept of False Positives
5.2.3 Relative Versus Absolute Risk Reduction
5.2.4 Addressing Uncertainty in Lung Cancer Screening
5.3 Smoking Cessation
5.3.1 Evidence-Based Tobacco Treatment
5.3.2 Tobacco Therapy and the Shared Decision
5.3.3 Personalized Risk Assessment to Support Quitting
5.3.4 Barriers to Quitting
5.4 Innovation in Lung Screening and Decision Support Tools
5.4.1 What Is Innovation?
5.4.2 Current Educational Tools Are Lacking
5.4.3 Experiential Learning and Understanding Pulmonary Nodules
5.4.4 Measuring the Effectiveness of a Tactile Lung Nodule Tool
5.4.5 Innovations for Rural Engagement and Supporting Quitting
5.4.6 Virtual Reality: Next Generational Teaching Tool
References
Chapter 6: Lung Cancer Screening Results and Tracking
6.1 Ordering a LCS CT
6.2 Standardized Reporting Protocols and National Registry Requirements
6.3 Managing Screening Findings on Lung Cancer Screening CTs
6.4 Managing Incidental Findings on Lung Cancer Screening CT
6.5 Updates in Lung Cancer Screening Technology
6.6 Women and Lung Cancer Screening
References
Index