The benefits and harms of lung cancer screening in Florida

佛罗里达州肺癌筛查的好处和危害

基本信息

批准号：
10314047
负责人：
Jiang Bian
金额：
$ 33.51万
依托单位：
UNIVERSITY OF FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-01-01 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10314047
关键词：
Adoption Age American Awareness Cancer Control Cancer Etiology Cancer Patient Cessation of life Clinical Colon Carcinoma Complication Costs and Benefits County Data Data Set Decision Making Diagnosis Diagnostic Procedure Electronic Health Record Eligibility Determination Event Florida Future General Population Goals Gold Guidelines Harm Reduction Health Care Costs Health Policy Health Services Research Healthcare Incidence Incidental Findings Individual Information Retrieval Intervention Knowledge Link Lung Machine Learning Malignant neoplasm of lung Malignant neoplasm of pancreas Malignant neoplasm of prostate Manuals Mathematics Medical Medicare Methods Modality Modeling Natural Language Processing Outcome Patients Pattern Performance Physicians Policies Policy Maker Population Professional Organizations Provider Publishing Radiology Specialty Randomized Clinical Trials Recording of previous events Reporting Research Research Personnel Resource Allocation Resources Risk Smoke Smoking Smoking History Specific qualifier value Sputum Cytology Screening Structure Sum Survival Rate System Techniques Test Result Thoracic Radiography Time United States United States Centers for Medicare and Medicaid Services Use Effectiveness Woman Work aged base beneficiary cancer care care costs care outcomes computable phenotypes computed tomography screening cost cost effectiveness curative treatments data registry deep learning model economic evaluation economic outcome high risk high risk population innovation low dose computed tomography lung cancer screening lung imaging malignant breast neoplasm men mortality neoplasm registry patient oriented phenotyping algorithm prevent prospective repository screening screening guidelines screening program shared decision making trend

项目摘要

PROJECT SUMMARY/ABSTRACT Lung cancer is the leading cause of cancer related death in both men and women in the United States. Currently, approximately 70% of lung cancer patients are diagnosed at advanced stages, and the 5-year survival rate of advanced stage lung cancer is very low, at only 16%. Investigators have been searching for effective screening modalities for the early detection of lung cancer so that patients can receive curative treatments at an early stage. When the National Lung Screening Trial (NLST) demonstrated the effectiveness of using low-dose computed tomography (LDCT) scan for lung cancer screening (LCS), researchers and physicians hope to save lives from lung cancer by screening high-risk population who aged 55 to 77 years and have a 30 pack years making history or former smokes who have quitted within the past 15 years. Since the release of the landmark NLST results, many medical associations published guidelines to recommend LDCT-based screening for individuals at high risk for lung cancer and the Centers for Medicare and Medicaid Services (CMS) also decided to cover the LCS for Medicare beneficiaries who are at high risk for lung cancer. While many efforts have been made to accelerate the dissemination the beneficial LCS, the concerns over the high false positive rates (96.4% of the positive results), invasive diagnostic procedures, postprocedural complications and health care costs may hinder the utilization of lung cancer screening. This concern was magnified as researchers and policy makers started questioning whether the complication rate and false positives in real-world settings would be even higher than the rates reported in the NLST, which was conducted in a setting with well-established facilities and proficiency in cancer care. Therefore, we propose to understand the contemporary use of lung cancer screening and associated health care outcomes and costs using data from a real-world setting. Our study has three goals: 1) to develop an innovative computable phenotype algorithm to identify high-risk and low-risk individuals for LCS from both structured and unstructured (i.e., clinical notes) electronic health record (EHR) data and to develop advanced natural language processing (NLP) methods to extract LCS related clinical information from clinical notes such as radiology reports; 2) to determine the appropriate and inappropriate use of LDCT among high-risk and low-risk individuals in Florida and to examine the test results of LDCT, the rates of invasive diagnostic procedures, postprocedural complications, and incidental findings in real-world settings; and 3) to develop and validate a microsimulation model of the clinical courses of LCS incorporating the real-world data in LCS to estimate the long-term benefits and the cost-effectiveness of LCS. Our proposed study has the potential to reduce lung cancer incidence and mortality by informing policymakers and practitioners on the appropriateness of contemporary use of LCS. This knowledge will help both patients and physicians better understand the harm- benefit tradeoff of lung cancer screening and transform such knowledge into practice to prevent avoidable postprocedural complications.

项目概要/摘要肺癌是美国男性和女性癌症相关死亡的主要原因。现在，大约70%的肺癌患者确诊时已是晚期，5年生存率晚期肺癌发生率非常低，仅为16%。研究人员一直在寻找有效的筛查方法肺癌的早期发现方法，以便患者能够及早接受治疗阶段。当国家肺部筛查试验 (NLST) 证明使用低剂量计算机断层扫描 (LDCT) 扫描用于肺癌筛查 (LCS)，研究人员和医生希望节省通过筛查年龄在 55 岁至 77 岁且寿命为 30 岁的高危人群来预防肺癌创造历史或在过去 15 年内戒烟的前吸烟者。自地标发布以来 NLST 结果显示，许多医学协会发布了指南，推荐基于 LDCT 的筛查肺癌高危人群以及医疗保险和医疗补助服务中心 (CMS) 还决定为肺癌高风险的医疗保险受益人承保 LCS。虽然已经做了很多努力为了加速传播有益的 LCS，人们担心高误报率（96.4％）的阳性结果）、侵入性诊断程序、术后并发症和医疗保健费用可能阻碍了肺癌筛查的利用。随着研究人员和政策制定者的关注，这种担忧被放大开始质疑现实环境中的并发症发生率和误报率是否会更高高于 NLST 中报告的比率，NLST 是在设施完善的环境中进行的，并且熟练掌握癌症护理。因此，我们建议了解肺癌筛查的当代用途使用现实世界环境中的数据来计算相关的医疗保健结果和成本。我们的研究有三个目标： 1）开发创新的可计算表型算法来识别LCS的高风险和低风险个体来自结构化和非结构化（即临床记录）电子健康记录 (EHR) 数据并开发先进的自然语言处理（NLP）方法从临床中提取 LCS 相关临床信息放射学报告等注释； 2) 确定高危人群中适当和不适当的LDCT使用佛罗里达州的低风险人群，并检查 LDCT 的测试结果、侵入性诊断的比率手术过程、术后并发症以及现实环境中的偶然发现； 3) 开发和验证 LCS 临床过程的微观模拟模型，结合 LCS 中的真实世界数据评估濒海战斗舰的长期效益和成本效益。我们提出的研究有潜力通过向政策制定者和从业者通报适当性来降低肺癌发病率和死亡率 LCS 的当代使用。这些知识将帮助患者和医生更好地了解危害肺癌筛查的利益权衡，并将这些知识转化为实践，以预防可避免的情况术后并发症。