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Nodule Size and Location Implications for Management of Patients Undergoing LDCT Positive Screening

Principal Investigator
Name
Doria Cole
Institution
Health Advances LLC
Position Title
Senior Analyst
Email
About this CDAS Project
Study
NLST (Learn more about this study)
Project ID
NLST-67
Initial CDAS Request Approval
Mar 17, 2014
Title
Nodule Size and Location Implications for Management of Patients Undergoing LDCT Positive Screening
Summary
For this project, our team is interested in investigating the precise management of patients with a positive LDCT scan based on the nodule size and type (e.g. ground glass, solid, etc.) appearing on the LDCT scans. In particular, we are interested in better understanding whether patients with larger nodules undergo more aggressive diagnostic follow-up procedures, whether there are additional patient characteristics correlated with diagnostic follow-up practices, and whether more aggressive follow-up of scans can improve long-term patient outcomes.

According to the recently updated USPSTF guidelines on lung cancer screening, individuals aged 55-80 years with a 30 pack-year smoking history who currently smoke or who have quit smoking within the past 15 years should be screened annually for lung cancer with low-dose CT. In performing this evaluation, we are looking to understand how physicians will manage patients under these new guidelines. Currently, physicians integrate a variety of factors into their decision to continue screening patients using LDCT or other imaging techniques or to send a patient directly to biopsy or surgical resection. We are interested in learning more about how size and type of nodule factor into the decision, as well as other characteristics, such as nodule location.
Aims

To do this investigation, we plan to look at the diagnostic procedures performed on patients according to nodule size and type. We will look at whether there are significant variations in the diagnostic follow-up (e.g. clinical evaluation, imaging studies, percutaneous cytologic analysis or biopsies, bronchoscopies, surgical procedures) based on nodule size and type. Using this information, we aim to better understand what factors are most important to physicians in the management of patients.

After evaluating the diagnostic follow-up of patients based on nodule size, we plan to extend our investigation to consider whether patients with differing diagnostic follow-up practices are diagnosed with different stages of lung cancer. For example, do patients who proceed more quickly to biopsy tend to receive a diagnosis of stage I or II lung cancer as opposed to later stage cancer.

Finally, we will evaluate whether the treatment paradigm or outcomes vary for patients who have received more aggressive diagnostic follow-up of LDCT. All of these analyses should help us better understand the best management of positive LDCT scans in the future based on patient outcomes.

We are interested in embarking on this research, as we feel it is critical to understand the management of lung cancer patients today to better understand how patients will be cared for in the future.

Collaborators

Doria Cole, Health Advances LLC
Gary Gustavsen, Health Advances LLC
Jay Buckingham, Health Advances LLC
David Narrow, Health Advances LLC
Tara Breton, Health Advances LLC