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. 2019 Jul-Aug;40(4):520-524.
doi: 10.1016/j.amjoto.2019.04.010. Epub 2019 Apr 12.

Clinical practice patterns in laryngeal cancer and introduction of CT lung screening

Krzysztof Piersiala  1 , Lee M Akst  2 , Alexander T Hillel  2 , Simon R Best  3
Affiliations

Clinical practice patterns in laryngeal cancer and introduction of CT lung screening

Krzysztof Piersiala et al. Am J Otolaryngol. 2019 Jul-Aug.

Abstract

Objectives: After the publication of large clinical trials, in January 2014 The U.S. Preventive Services Task Force (USPSTF) recommended annual lung cancer screening with low-dose CT in a well-defined group of high-risk smokers. A significant proportion of patients with laryngeal cancer (LC) meet the introduced criteria, and we hypothesized that clinical practice would change as a result of these evidence-based guidelines.

Methods: Retrospective chart review of patients diagnosed with LC and treated at Johns Hopkins Hospital who met USPSTF criteria for annual chest screening and were followed for at least 3 consecutive years in the years surrounding the introduction of screening guidelines (January 2010 to December 2017) was performed to identify those who had recommended screening CT chest.

Results: A total of 151 patients met the inclusion criteria of the study and were followed for a total of 746 patient-years. 184/332 (55%) patient-years in the pre-guidelines period and 246/414 (59%) in the post-guidelines period included at least one recommended chest imaging (CT or PET-CT; p = 0.27). 248/332 (75%) patient-years in the pre-guidelines period and 314/414 (76%) in the post-guidelines period included any radiological chest imaging (X-ray, CT or PET-CT; p = 0.72). Screening scans were ordered by OHNS (45%), Medical Oncology (31%), Radiation Oncology (8%), and primary care (14%) with 70% of patients missing at least one year of indicated screening.

Conclusions: The implementation of new lung cancer screening guidelines did not change clinical practice in the management of patients with LC and many patients do not receive recommended screening. Further study concerning potential barriers to effective evidence-based screening and coordination of care is warranted.

Keywords: CT; Head and neck cancer; Laryngeal cancer; Lung cancer; Lung cancer screening.

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Conflict of interest statement

Conflict of Interest: None of the authors have any conflicts of interest or financial ties to disclose.

The authors whose names are listed immediately above certify that they have NO affiliations or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Figures

Figure 1:
Figure 1:
Three stage exclusion protocol to identify index patients that meet USPSTF criteria for annual chest screening. Patients were excluded in three stages: 1) age, 2) inadequate follow-up, and finally 3) smoking history or synchronous lung cancer. Of 998 initial patients, 151 fully met study criteria and were included for further analysis. * Indicates the reason for exclusion.
See this image and copyright information in PMC

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