National guidelines advise physicians to discuss the benefits and risks of lung cancer screening with high-risk patients, but these discussions were found to be uncommon and occurring less frequently than just a few years ago, according to new research.
Data from the National Cancer Institute’s Health Information National Trends Survey (HINTS) revealed that 8.7% of current smokers said they discussed lung screening with their doctor in 2017 compared to 12% in 2012, Jinhai Huo, MD, PhD, of the University of Florida in Gainesville, and colleagues reported.
Among the general population, these rates were 4.3% and 6.7%, respectively, they wrote in Cancer, Epidemiology, Biomarkers & Prevention.
Furthermore, when these screening discussions did occur, they had no effect on patients’ attempts or resolve to quit smoking.
Lung cancer screening is recommended in 55- to 80-year-olds who are current heavy smokers (30 pack-year smoking history) or former heavy smokers who quit in the past 15 years.
In an interview with MedPage Today, Huo said the decline in physician-patient lung cancer screening discussions was a surprise, as was the failure of such discussions to impact patient motivation to quit smoking.
Huo noted that the low rate of patient-reported physician-patient discussions about lung cancer screening shown in the study may reflect physician concerns about the downsides of screening, such as the high rate of false positives, the need for invasive procedures following a positive test, the potential for complications from these procedures, and the downstream healthcare costs.
Huo said physicians may carry negative views (ineffective, time consuming) of smoking cessation counseling. One recent study found that when lung screening talks did occur, they averaged less than a minute.
At the time the analysis was conducted, just one clinical trial — the National Lung Screening Trial — had demonstrated the effectiveness of lung cancer screening using low-dose CT.
Since then, the European NELSON trial confirmed a mortality benefit for lung cancer screening. The study showed a 26% decrease in lung cancer deaths among high-risk men and a decrease of up to 61% among high-risk women who had screening low-dose CT chest scans.
“With promising findings from two large clinical trials from two continents, the number of physician-patient discussions about lung cancer screening may increase in the near future,” Huo said.
The newly published analysis included HINTS data from the 2012, 2014, and 2017 surveys, which were combined to create a multi-year analytic dataset.
The researchers calculated the association between participant characteristics and the presence of discussion about lung cancer screening, and using logistic regression they estimated the probability of smokers’ attempt to quit and intent to quit. The analysis, which included 9,443 survey participants, revealed that physician-patient lung screening discussions occurred among 6.7% of respondents in 2012, 4.2% in 2014, and 4.3% in 2017.
Current smokers from the ages of 55 through 74 were most likely to have the discussions with their physicians in 2012 (26.8%). Patients over age 74 were counseled most often about lung cancer screening in 2014 and 2017.
Lung cancer screening discussions did not appear to influence patient intent to quit (OR 1.22, 95% CI 0.62-2.40, P=0.560) or quit attempts (OR 1.61, 95% CI 0.75-3.46, P=0.219), according to a multivariable analysis.
“It is difficult to pinpoint the cause of this unexpected finding in our study,” Huo noted. “Further qualitative studies are warranted.”
The researchers noted that “significant variation in the quality of smoking cessation counseling services exists among different facilities that offered lung cancer screening.”
“The finding in this large national sample, together with those of other clinical studies with similar findings, suggest that a simple physician-patient discussion about lung cancer screening alone may not be sufficient to build lasting motivation for current smokers to modify their smoking behavior successfully,” they wrote.
Huo reported no relevant relationships with industry related to this study.