Lung Cancer Screening Metrics at the Baltimore Veterans Affairs Medical Center

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Abstract Objective: We aim to reduce lung cancer mortality by evidence-based lung cancer screening (LCS) processes as part of the Veterans Affairs National Center for Lung Cancer Screening (NCLCS). We hope that recognizing the difference in adherence in screened populations will identify areas for improvement in LCS. Methods:Within the NCLCS database, cigarette pack year (CPY) information was collected in the 50-80 year old population. Patients were considered LCS eligible if they had smoked >20 years and were a current smoker or quit <15 years prior. Patients were considered LCS assessed if they agreed to screening, were referred to a screening coordinator, and did not meet exclusion criteria that would make them unsuitable for LCS. Patient demographics were collected from charts, and low dose computed tomography (LDCT) scan results were noted. Results: Of the 14,042 charts reviewed, 2,738 patients had CPY information. Of these, 2,534 were eligible for LCS and 2,516 were assessed for LCS. LCS was offered to 2,508 patients, and of these, 2,503 accepted. LDCT scans were completed within one year for 1,586 patients (63.4%). LDCTs were completed within one year in 62.8% of men and 54.8% of women. When considering race, LDCTs were completed within one year for 58.3% of Asian patients, 60.6% of African American patients, 67.9% of Latino patients, 63.3% of Caucasian patients, and 66.7% of patients with more than one race. LDCTs were completed within one year for 58.5% of homeless patients, 60.4% of those in independent housing, 57.7% of those in unstable housing, and 64.2% of those who identify as “not homeless.” LDCTs were completed within one year for 59.5% of those who live rurally, compared to 62.5% of those who live in an urban environment. Of the completed LDCTs, 1.64% were LUNGRADS 0, 35.8% were LUNGRADS 1, 52.6% were LUNGRADS 2, 4.6% were LUNGRADS 3, 3.2% were LUNGRADS 4A, 1.54% were LUNGRADS 4B, and 0.54% were LUNGRADS 4X. Conclusions: A barrier to entrance to LCS is at the outset, as a minority of patients had CPY information available. Once the patients are reviewed, a majority of them accept LCS, with 93.4% of patients appropriately screened. Adherence to completing 1 year LDCTs remains a challenge, especially among those in rural environments or with unstable housing.

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