Doctors continue to forgo CT lung screening discussions

2019 02 08 21 02 2467 Patient Consulting Doctor 400

The low rate of patient-physician discussions about CT lung cancer screening appears to be sinking lower still. New data show that less than 9% of doctors talked about screening with their patients who currently smoke, according to an article published online April 25 in Cancer Epidemiology, Biomarkers & Prevention.

Participation in CT lung screening has been on the decline over the past several years, dwindling to as low as 1.9% for eligible smokers in 2016. One possible hurdle restricting uptake of CT lung screening may be the minimal effort physicians make to discuss the potential harms and benefits of screening with their patients.

However, such discussions, also called shared decision-making, are believed to offer an important chance for physicians to persuade individuals to stop smoking. As such, shared decision-making sessions are required for providers to receive Medicare reimbursement for CT lung screening provided to patients.

Seeking to determine how often physicians were discussing CT lung screening with patients, the researchers led by Dr. Jinhai Huo, PhD, from the University of Florida, analyzed data from 9,443 participants of the U.S. National Cancer Institute's Health Information National Trends Survey (HINTS) in 2012, 2014, and 2017. The surveys examined the participants' smoking status and the prevalence of patient-physician discussions about CT lung cancer screening each year, among other topics.

The researchers discovered that the overall rate of CT lung screening discussions between physicians and all participants was very low and decreased by more than 35% from 2012 to 2017. The rate was higher for current smokers, compared with the general population, but still decreased considerably from 2012 to 2017.

Rate of patient-physician discussions about CT lung screening
  2012 2014 2017
General population 6.7% 4.2% 4.3%
Current smokers 12% 8.4% 8.7%
The differences were statistically significant.

The group additionally categorized the data based on age, race, and smoking status and found that the highest rates of discussion about CT lung screening were between physicians and current smokers older than 74 years (22.1%), followed by current smokers 55 years to 74 years (17.9%) and former smokers older than 74 years (16.3%).

Additional analyses showed that non-Hispanic African Americans, Hispanics, individuals with health insurance, and patients diagnosed with heart or lung disease were more likely to have discussed CT lung screening with a physician. Multivariable analysis further revealed a lack of statistically significant association between CT lung screening discussions and a smoker's recent attempts to quit or plan to quit within six months.

"The low prevalence of discussions about lung cancer screening and lack of association with smokers' intents and attempts to quit are surprising," Huo said in a statement to the American Association for Cancer Research. "Our results suggest that lung cancer screening is substantially underutilized and not reaching high-risk smokers who would benefit the most."

The HINTS data did not include pack-year smoking history, limiting the researchers' capacity to classify the cohort based on specific eligibility criteria for CT lung screening, such as the U.S. Preventive Services Task Force (USPSTF) guidelines.

Nonetheless, providers should still be making a more concerted effort to prioritize lung screening and smoking cessation discussions, especially for eligible high-risk smokers, Huo noted.

"More physicians need to initiate a shared decision-making process with their patients who want to have or are eligible for lung cancer screening to reduce the risk of mortality associated with lung cancer," he said.

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