The GHRI research team studying perspectives on lung cancer screening includes Josh Roth, Susan Brandzel, Karen Wernli, Lisa Carter-Harris, and Diana Buist.

Susan Brandzel, GHRI project manager, tells about two studies that are exploring personal experiences with a new cancer screening program.

It seems like information about cancer screening appears in the media on an almost daily basis. And now a new type of cancer screening is on the scene: low-dose computed tomography (LDCT) for lung cancer for people with a long-term history of heavy smoking. In 2015, Group Health started offering LDCT for patients at high risk of lung cancer. Group Health Director of Medical Specialties, Jennifer Nazarko, FACHE, has described the program and its roll out. Now, GHRI researchers, working with junior faculty from the University of Washington and Fred Hutchinson Cancer Research Center (FHCRC) and the University of Indiana, are learning about patients’ and providers’ perspectives on the service as a potential way to improve care.

The idea behind cancer screening is to try to find cancers as early as possible. Newer or smaller cancers are usually easier to treat. LDCT lung cancer screening is simple (only about a five-minute process once a patient is settled in the CT machine) and involves less radiation than a regular CT scan. However, LDCT has a relatively high rate of showing things that look like problems in the lungs but actually are not. And when a doctor sees something that looks like a problem, she or he has to follow up to make sure it is not cancer.

For some people, this means more scans, lung biopsies, or, once in a while, lung surgery for something that isn’t cancer. These procedures can be scary, painful, and costly. That’s why some people might hesitate about having LDCT screening.

Asking doctors and patients about screening decisions

Group Health patients who are considered at high risk for lung cancer decide whether to have screening with LDCT after a conversation with their doctor about the possible risks and benefits. As GHRI researchers Diana Buist, PhD, and Karen Wernli, PhD, looked back at 2015, they saw that some patients were choosing to have the screening and others were not. And they wanted to know why. Both of these epidemiologists mentor junior scientists who are building their research careers.

So they engaged two early career researchers, Lisa Carter-Harris, PhD, from the University of Indiana and Josh Roth, PhD, a GHRI postdoctoral fellow now at the University of Washington and FHCRC, to collaborate on two pilot studies that interviewed patients about their decision to have or not have LDCT lung cancer screening.

The SAILS study, headed by Dr. Carter-Harris in collaboration with Dr. Buist, interviewed Group Health patients who were offered LDCT but chose not to have it. Additionally, SAILS is interviewing Group Health doctors about what it has been like to start the lung cancer screening services at Group Health. Dr. Roth, in partnership with Dr. Wernli, led the PELICANS study, which interviewed Group Health patients who chose to have LDCT for lung cancer screening.

What we could learn

Both the SAILS and PELICANS teams are hard at work analyzing why patients made their choices about lung cancer screening. The results of these studies could lead to a number of helpful outcomes, including:

• Feedback to Group Health and other health care providers about what patients understand about the pluses and minuses of lung cancer screening;
• How patients want to hear about LDCT for lung cancer screening;
• What kind of experience patients who choose lung cancer screening have;
• And learning whether the option of lung cancer screening affects a patient’s health behavior, including if it makes current smokers want to quit or continue smoking.

As soon as we have results, we’ll publish them in clinical journals. The SAILS and PELICANS researchers also hope to apply for larger grants that will help them study LDCT for lung cancer screening in more detail. They want to explore even further the upsides and downsides of this new cancer screening process. The bottom-line goal is to work toward improving the health care experience and the health of patients who may be at high risk for lung cancer.

by Susan Brandzel, MPH, GHRI project manager