The authors wrote, “Lung cancer is the leading cause of malignancy-related death in the United States. USPSTF [U.S. Preventive Services Task Force] guidelines recommend screening for cancer be offered to those between 50-80 years old with a 20-pack year history and currently smoke or have quit smoking in the past 15 years unless they have comorbidity that limits life expectancy. However, the contribution of specific comorbid diagnoses to limited life expectancy in those eligible for screening remains undefined.”
The researchers gathered data from 180 patients using Michigan Medicine’s electronic medical records. Data were extracted to include patients recorded in monthly Michigan Medicine CT Lung Cancer Screening documentation who underwent USPSTF-guided screening in Spring 2017.
Variables evaluated included age at the time of screening, ethnicity, gender, current tobacco use status, presence of malignancy, diagnosis of comorbidities including chronic obstructive pulmonary disease (COPD), cirrhosis, heart failure (HF), chronic kidney disease (CKD), dialysis use, hyperlipidemia, type 2 diabetes mellitus (T2DM), and insulin usage.
The primary outcome was mortality within 5 years of screening (dead/alive). Researchers employed the Statistical Package for the Social Sciences for statistical analysis and to ascertain statistically significant variances between groups; Chi-square analysis and the independent samples t-test were utilized.
With regard to results, the authors wrote, “The following pre-specified clinical features or demographic characteristics were significantly higher in patients that died when compared to those alive within five years of initial lung cancer screening; older age (68.91 ± 7.964 vs. 63.18 ± 5.67; P <0.005), COPD (45.5% vs. 23.4%; P = 0.027), heart failure diagnosis (18.2% vs. 1.9%; P <0.001), CKD (27.3% vs. 3.2%; P <0.001), diabetes (36.4% vs 17.1%; P = 0.032). Furthermore, rates of insulin use were significantly higher in those who were deceased (18.2%) compared to those still alive (3.9%; P <0.006).”
Based on their findings, the authors concluded that among patients who died of nonlung cancer–related illness within 5 years of being screened compared to those who were still alive, factors such as older age; diagnoses of COPD, HF, CKD, and T2DM; and insulin use were all meaningfully more predominant.
“Studies of comorbid conditions that predict a high probability of non-lung cancer related mortality should be used to create models that help identify those with limited potential to benefit from lung cancer screening, and focus clinical tools aimed at increasing uptake among those most likely to benefit from lung cancer screening,” the authors concluded.
The authors noted that continual study of screened populations may assist in recognizing specific clinical predictors for screening efficiency.
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