A Community-based Pulmonary Nodule Clinic: Improving Lung Cancer Stage at Diagnosis

Objective Pulmonary nodules (PNs) are a common incidental finding and are often how lung cancer is discovered. Our goal was to determine if establishing a pulmonary nodule clinic (PNC) in a community healthcare setting would lead to an earlier stage at diagnosis. Methods A single healthcare system retrospective review was conducted of all PNC patients from 2010-2015 diagnosed with lung cancer. The stage at diagnosis was analyzed and compared to lung cancer patients in our healthcare system outside the PNC and to national data. Five-year survival rates for PNC patients from 2010-2012 were also analyzed. Results A total of 119 patients and 127 lung cancers were diagnosed through the PNC from 2010-2015. There were 990 lung cancers, with a known stage, diagnosed outside the PNC in our healthcare system from 2010 to 2015. Two hundred and eighty one (28.4%) cancers were Stage I, compared to 69 (54.3%) (p <0.0001) through the PNC; 110 (11.1%) cancers were diagnosed at Stage II compared to 17 (13.4%) through the PNC (0.4471); 277 (25.7%) cancers were diagnosed at Stage III, compared to 21 (16.5%) through the PNC (p 0.0060); 598 (60.4%) cancers were diagnosed at Stage IV, compared to 20 (15.7%) through the PNC (p <0.0001). Five-year survival rates for patients diagnosed in 2010 were 80% (four of five patients), 79.2% (19/24) in 2011, and 62.2% (23/37) in 2012. Conclusions Lung cancer survival is directly related to the stage at diagnosis. Establishment of our PNC has led to an earlier stage at diagnosis compared to the general lung cancer population in our community.

[1]  C. Gatsonis,et al.  Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening , 2012 .

[2]  Harry J de Koning,et al.  Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening. , 2014, The Lancet. Oncology.

[3]  P. V. van Ooijen,et al.  Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT: analysis of data from the randomised, controlled NELSON trial. , 2016, The Lancet. Oncology.

[4]  Caroline Dive,et al.  Progress and prospects of early detection in lung cancer , 2017, Open Biology.

[5]  M. Gould,et al.  Recent Trends in the Identification of Incidental Pulmonary Nodules. , 2015, American journal of respiratory and critical care medicine.

[6]  M. Gould,et al.  Systems-Level Resources for Pulmonary Nodule Evaluation in the United States: A National Survey. , 2016, American journal of respiratory and critical care medicine.

[7]  G. Diette,et al.  Management of Pulmonary Nodules by Community Pulmonologists , 2015, Chest.

[8]  Lisa M. Schwartz,et al.  Resource use and guideline concordance in evaluation of pulmonary nodules for cancer: too much and too little care. , 2014, JAMA internal medicine.

[9]  Aaron D. Cann,et al.  Community-Based Multidisciplinary Computed Tomography Screening Program Improves Lung Cancer Survival. , 2016, The Annals of thoracic surgery.

[10]  R. Wiener,et al.  Primary Care Providers and a System Problem: A Qualitative Study of Clinicians Caring for Patients With Incidental Pulmonary Nodules. , 2015, Chest.

[11]  C. la Vecchia,et al.  Stopping Smoking Reduces Mortality in Low‐Dose Computed Tomography Screening Participants , 2016, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.