Simple alternative criteria identify people with the most to gain from lung cancer screening

Embargoed for release until 5:00 p.m. ET on Monday 19 August 2024      
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.      
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1. Simple alternative criteria identify people with the most to gain from lung cancer screening  

Suggested screening criteria may include groups disproportionately excluded by current guidelines 

Abstract:

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In the first study of its kind, researchers developed an alternative set of simple criteria using a prediction model to identify groups of people who would most benefit from lung cancer screening (LCS) but are disproportionately excluded by current eligibility criteria. The study found that these high-benefit groups include those who smoked for a long duration but at a lower intensity, people with heavy smoking who quit over 15 years ago, and high-benefit persons from racial and ethnic minority groups. The findings are published in Annals of Internal Medicine.  

Researchers used over 58 million smoking adults’ responses to the annual National Health Interview Survey, dated from 1997 to 2018, to study whether an alternative criteria would work to better identify high-benefit persons and whom this would include. They used Fast and Frugal Tree algorithms and the same information as is included in the U.S. Preventative Services Task Force (USPSTF) criteria to develop an alternative set of simple criteria. They compared the alternative criteria to USPSTF criteria in their sensitivity, and specificity to identify high-benefit people. Researchers also determined where the selected populations overlapped and where the alternative criteria overcame USPSTF’s limitations. Results suggest that the alternative criteria has higher sensitivity and specificity in identifying high-benefit people and is substantially more sensitive in identifying high benefit people in racial and ethnic minority populations than the USPSTF criteria. Analysis confirmed the inequity in current USPSTF criteria, which has a poor sensitivity for identifying high-benefit Black people for LCS. The alternative criteria would produce more effective screening, lead to better support of ethical risk management, and substantially reduce racial disparities in LCS eligibility. The alternative criteria is easy to remember and represents a feasible way to improve current LCS eligibility criteria. Beyond the LCS context, this approach could also be useful for other cancer screening and prevention modalities.  

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with a corresponding author, please email Lauren Kearney, MD at lekearn@bu.edu or Tanner Caverly, MD at tcaverly@med.umich.edu.   

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2. Older adults who start dialysis trade modest gains in life expectancy for less time at home    

Abstract:

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An observational cohort study of adults with chronic kidney failure examined the benefits and risks of starting dialysis versus continuing medical management on survival, home time, and time in inpatient settings. The data showed that patients who continued medical management lived fewer days but spent more days at home than patients who started dialysis. Patients who were 80 years or older and those with more advanced kidney failure had larger survival benefits over a 3-year period from starting dialysis. The study is published in Annals of Internal Medicine.   

Researchers from Veterans Affairs Palo Alto Health Care System studied over 20 thousand adults from Veterans Affairs to see whether patients who started dialysis lived longer, and how many days were spent at home instead of in a hospital or nursing facility. Participants were selected if they were 65 years or older, had chronic kidney failure, and were not on the waitlist or referred for a kidney transplant. Researchers split the population into two groups: patients who started dialysis and patients who continued medical management. They found that the group starting dialysis survived longer than the group continuing medical management yet spent more time receiving inpatient care at a medical facility. These findings shed light on the tradeoffs between survival and time spent in inpatient care that an intensive treatment like dialysis might entail. The tradeoff between survival and time at home was more favorable for adults aged 80 years or older and subgroups with more advanced kidney failure. According to the authors, results from this study have the potential to improve understanding about the benefits and risks of treatment for kidney failure, which could help patients make decisions that match their goals.   

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Manjula Kurella Tamura, MD, MPH, please email Lisa Kim at likim@stanfordhealthcare.org.  

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