Lung Cancer Diagnosed Through Screening, Lung Nodule, and Neither Program: A Prospective Observational Study of the Detecting Early Lung Cancer (DELUGE) in the Mississippi Delta Cohort

Author(s): Raymond U. Osarogiagbon , MBBS1;Wei Liao, PhD1;Nicholas R. Faris, MDiv1;Meghan Meadows-Taylor, PhD1;Carrie Fehnel, BBA1;Jordan Lane, MA1;Sara C. Williams, MFA1;Anita A. Patel, MBBS1;Olawale A. Akinbobola, MPH1;Alicia Pacheco, MHA1;Amanda Epperson, RN1;Joy Luttrell, RN1;Denise McCoy, BS1;Laura McHugh, RN1;Raymond Signore, RN1;Anna M. Bishop, MSN1;Keith Tonkin, MD1,2;Robert Optican, MD, MSHA1,2;Jeffrey Wright , MD, PhD1,3;Todd Robbins, MD1;Meredith A. Ray , PhD4;and Matthew P. Smeltzer , PhD4
Source: DOI: 10.1200/JCO.21.02496 Journal of Clinical Oncology 40, no. 19 (July 01, 2022) 2094-2105.

Interesting study which the demonstrates the importance of prescriptive approach to detect NSCLC. Hopefully, in the future ctDNA may enhance or replace LDCT ability to detect patients with stage I/II disease.

PURPOSE

Lung cancer screening saves lives, but implementation is challenging. We evaluated two approaches to early lung cancer detection—low-dose computed tomography screening (LDCT) and program-based management of incidentally detected lung nodules.

METHODS

A prospective observational study enrolled patients in the early detection programs. For context, we compared them with patients managed in a Multidisciplinary Care Program. We compared clinical stage distribution, surgical resection rates, 3- and 5-year survival rates, and eligibility for LDCT screening of patients diagnosed with lung cancer.

RESULTS

From 2015 to May 2021, 22,886 patients were enrolled: 5,659 in LDCT, 15,461 in Lung Nodule, and 1,766 in Multidisciplinary Care. Of 150, 698, and 1,010 patients diagnosed with lung cancer in the respective programs, 61%, 60%, and 44% were diagnosed at clinical stage I or II, whereas 19%, 20%, and 29% were stage IV (P = .0005); 47%, 42%, and 32% had curative-intent surgery (P < .0001); aggregate 3-year overall survival rates were 80% (95% CI, 73 to 88) versus 64% (60 to 68) versus 49% (46 to 53); 5-year overall survival rates were 76% (67 to 87) versus 60% (56 to 65) versus 44% (40 to 48), respectively. Only 46% of 1,858 patients with lung cancer would have been deemed eligible for LDCT by US Preventive Services Task Force (USPSTF) 2013 criteria, and 54% by 2021 criteria. Even if all eligible patients by USPSTF 2021 criteria had been enrolled into LDCT, the Nodule Program would have detected 20% of the stage I-II lung cancer in the entire cohort.

CONCLUSION

LDCT and Lung Nodule Programs are complementary, expanding access to early lung cancer detection and curative treatment to different-risk populations. Implementing Lung Nodule Programs may alleviate emerging disparities in access to early lung cancer detection.

Author Affiliations

1Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN 2Mid-South Imaging and Therapeutics, Memphis, TN 3Memphis Lung Physicians, Memphis, TN 4Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN

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