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PCPs need more education on low-dose CT lung cancer screening

Although most family physicians report discussing lung cancer screening with low-dose computed tomography with high-risk patients, referrals for the procedure remain low, according to data published in Cancer.

The researchers further concluded that there are gaps in PCP knowledge regarding screening guidelines and reimbursement, indicating a need for more education. They recommended the development of “decision aids” that can help discussions with patients, and targeted interventions to close knowledge gaps.

“Screening with low-dose computed tomography is one tool that may increase the early detection of lung cancer and reduce lung cancer mortality,” Jennifer L. Ersek, MSPH, of the Arnold School of Public Health, at the University of South Carolina, and colleagues wrote. “… Although the USPSTF, CMS and multiple professional societies and organizations now publically support the use of [low-dose] CT screening for high-risk patients, some groups assert that the current evidence is still insufficient to endorse adoption of [low-dose] CT. The American Academy of Family Physicians (AAFP) is one such organization; it states that there is not enough evidence to either recommend or discourage the use of [low-dose] CT screening for lung cancer in high-risk patients.”

To assess family physicians’ knowledge of, attitudes toward and use of low-dose CT screening for lung cancer, the researchers commissioned a 32-item questionnaire, drafted by a team of family physicians, lung cancer experts and epidemiologists, and distributed it to members of the South Carolina Academy of Family Physicians. Physician knowledge was also determined through a series of clinical vignettes.

A total of 101 physicians responded. The researchers used summary statistics, calculated by Qualtrics, to analyze the resulting data.

According to the researchers, 73% of the participants reported they discuss the risks and benefits of low-dose CT screening with their high-risk patients in some capacity. However, 59% had made one or no referrals in the past year. When asked about the risks of low-dose CT screening, 88% expressed concern over unnecessary diagnostic procedures, while 52% cited psychological stress and anxiety, and 50% named unnecessary exposure to radiation. The majority of physicians (76%) agreed or strongly agreed that the benefits of low-dose CT screening outweigh the potential harms for high-risk patients.

Physicians who completed the questionnaire after CMS announced that low-dose CT screening would be covered under the Affordable Care Act were asked about Medicare and Medicaid coverage. According to the researchers, 63% were unsure if Medicaid or Medicare covered low-dose CT screening. In addition, 36% stated that screening should be continued annually, in accordance with the USPSTF recommendation. However, 31% said it should be continued biannually, and another 31% said triannually.

“In the last 5 years, many changes to lung cancer screening guidelines have been implemented,” Ersek and colleagues wrote. “Most professional organizations now support [low-dose] CT screening, and this service is now covered for select patients with the implementation of the Affordable Care Act and the CMS decision memo. Interventions targeting physician and patient education and shared decision making are needed to effectively translate recommendations for [low-dose] CT screening for lung cancer patients into practice.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.