Jonathan Iaccarino

M.D.

Boston University Medical Campus

Pulmonary and Critical Care Fellow

NLST (Learn more about this study)

NLST-309

May 19, 2017

Evaluating comorbidities and life expectancy in patients undergoing LDCT screening in the real world setting

After the National Lung Screening Trial demonstrated a 20% decrease in lung cancer mortality with yearly low-dose computed tomography (LDCT) screening of high-risk smokers, multiple societies issued recommendations for LDCT screening. Currently, all guidelines advise against screening patients with serious comorbidities that limit life expectancy. Screening patients with serious comorbidities subjects them to the potential harms of screening without the potential for benefit. However, uncertainty remains in what constitutes a serious comorbidity, as in preliminary data from a national survey, I found half of physicians would still offer screening to patient with severe chronic obstructive pulmonary disease. In order to optimize LDCT screening outcomes, it is critical to help clinicians discriminate patients who can benefit from screening from those likely to experience harm. As a first step, we must first understand the distribution of comorbidities among the real-world population being screened, outcomes associated with screening individuals with comorbidities, and how comorbidities factor into clinician decision-making for LDCT screening. My study will evaluate patients who have undergone LDCT screening at Boston Medical Center and the Boston VA Healthcare System to describe the comorbidities and life expectancy of patients who have undergone LDCT screening in a real world setting. I then plan to compare the comorbidity and life expectancy of patients undergoing screening at these two centers to the patients who underwent screening in the NLST. This comparison will provide valuable information regarding how we may expect the benefits and harms related to screening to differ in our real world population based upon the differences in comorbidities and chronic disease. This will be the first part of a multi-step study in which we will identify comorbidities profiles that may limit benefits of screening and increase potential risks and use this information to develop an individualized decision tool to help clinicians and patients make more informed decisions regarding screening.

Aim 1: Evaluate comorbidities and life expectancy of patients who have undergone LDCT screening in a real world setting. Using electronic medical record data from registries of over 1500 screened patients at two large and diverse medical centers (Boston Medical Center, Boston VA Healthcare System), I will assess severity of comorbidities and life expectancy using pulmonary functions tests (severity of COPD), use of supplemental oxygen, and the Charlson comorbidity index.

Aim 2: Compare the level and distribution of comorbidities in our real-world cohort to the benchmark of the NLST cohort. Data will be collected on procedural complications and mortality and these will also be compared to the NLST cohort to determine how differences in comorbidities may influence potential harms of screening.