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Radiology guidelines have reduced variability in lung cancer screening strategies
Most leading U.S. academic medical centers use the same radiology guidelines and nodule threshold criteria within their lung cancer screening practices since the issuance of guidelines from the American College of Radiology, according to survey results.
“We initially surveyed leading academic medical centers in 2013 and found considerable variability in their practice patterns, as well as a relatively small number of patients being screened for lung cancer at these sites,” Phillip M. Boiselle, MD, professor of radiology and associate dean for academic and clinical affairs at Harvard Medical School and a thoracic radiologist at Beth Israel Deaconess Medical Center, told HemOnc Today. “Considering landmark developments since that time — including favorable policy and payment decisions by the U.S. Preventive Services Task Force (USPSTF) and CMS, as well as the American College of Radiology (ACR) lung nodule reporting and management system (Lung-RADS) — we were curious to see whether there would be greater conformity of practice patterns and increased patient volumes in response to these developments.”
Boiselle and colleagues sent follow-up surveys in 2014 and 2015 to thoracic radiology division chiefs at the same 21 leading U.S. academic medical centers — identified through rankings published in U.S. News and World Report — as they did in 2013.
The surveys inquired as to whether the medical centers performed lung cancer screening, followed by additional questions pertaining to screening practices.
Ninety-one percent (n = 19) of centers responded to the survey in 2013, prior to the new practice guidelines. Ninety-five percent (n = 20) responded in 2014 and 86% (n = 18) responded in 2015, in the wake of guideline issuance.
Overall, a steady increase in lung cancer screening programs occurred over the course of the surveys.
Seventy-nine percent (n = 15 of 19) reported having such a program in 2013, which increased to 95% (n = 19 of 20) in 2014. In 2015, 94% (n = 17 of 18) of surveyed hospitals had a screening program.
The majority of responding hospitals (73%; n = 11) with screening programs reported using National Lung Screening Trial criteria for patient selection in 2013. However, only 35% (n = 6) sites used these criteria in 2015, due to the adoption of CMS or USPSTF criteria (n = 4 for each).
Exclusive self-pay served as the dominant payment model in 2013, according to Boiselle. However, the percentage of hospitals using this model decreased to 47% (n = 9) in 2014 and 6% (n = 1) in 2015.
When surveyed regarding how many patients were screened, most hospitals reported that only one to five patients underwent screening each week. However, the number of sites included in this category decreased from a high of 87% (n = 13) in 2013 to 53% (n = 9) in 2015.
Each year, only one site reported scanning more than 20 patients per week.
“We were surprised by the very modest level of increase in patient volumes for CT screening over time despite the favorable USPSTF and CMS decisions,” Boiselle said. “We emphasize, however, that the timing of our survey occurred too early to determine the impact of CMS coverage on patient volumes.”
According to the researchers, 75% (n = 13) of responding hospitals used the ACR Lung Imaging Reporting and Data System in 2015. In past years, a variety of other nodule management guidelines had been used.
Further, in 2015 most sites (70%; n = 12) used 6 mm as the solid nodule size threshold for a positive imaging result.
As a study limitation, the researchers acknowledged that their findings may not be representative of all academic medical centers or of community practices.
“Broad adoption of the ACR guidelines, with associated greater conformity regarding threshold nodule size criteria for a positive screen at leading academic medical centers, is a positive development that helps to ensure a uniform quality experience for patients undergoing lung cancer screening at these sites,” Boiselle said. “We plan to continue our longitudinal survey of these sites to determine the impact of CMS coverage on patient screening volumes, which we anticipate will show more substantial increases in the near future — in response not only to CMS coverage, but also to greater awareness of CT screening by referring physicians and patients at high risk for lung cancer who meet eligibility criteria.” – by Cameron Kelsall
For more information:
Phillip M. Boiselle, MD, can be reached at pboisell@bidmc.harvard.edu.
Disclosure: The researchers report no relevant financial disclosures.