The Benefits and Harms of Lung Cancer Screening in Individuals With Comorbidities

Minal S. Kale MD, MPH , Keith Sigel MD, PhD , Arushi Arora MPH , Bart S. Ferket MD, PhD , Juan Wisnivesky MD, DrPh , Chung Yin Kong PhD
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Abstract

Introduction

Individuals with a history of smoking and a high risk of lung cancer often have a high prevalence of smoking-related comorbidities. The presence of these comorbidities might alter the benefit-to-harm ratio of lung cancer screening by influencing the risk of complications, quality of life, and competing risks of death. Nevertheless, individuals with chronic diseases are underrepresented in screening clinical trials. In this study, we use microsimulation modeling to determine the impact of chronic diseases on lung cancer benefits and harms.

Methods

We extended a validated lung cancer screening microsimulation model that comprehensively recapitulates an individual’s lung cancer development, progression, detection, follow-up, treatment, and survival. We parameterized the model to reflect the impact of chronic diseases on complications from invasive testing, quality of life, and mortality in individuals in five-year age categories between the ages of 50 and 80 years. Outcomes included life-years (LY) gained per 100,000 in patients with chronic obstructive pulmonary disease, diabetes mellitus, heart disease, and history of stroke compared with screening-eligible individuals without comorbidities.

Results

Among individuals between the ages of 50 and 54 years, we found that the presence of a comorbidity altered the LY gained from screening per 100,000 individuals depending on the comorbidity: 4296 LY with no comorbidities; 3462 LY, 3260 LY, 3031 LY, and 3257 LY with chronic obstructive pulmonary disease, heart disease, diabetes mellitus, and stroke, respectively. We observed greater reductions in LY gained in individuals with two comorbidities; we observed similar patterns for individuals between the ages of 55 and 59 years, 60 and 64 years, 65 and 69 years, 70 and 74 years, and 75 and 80 years.

Conclusions

Comorbidities reduce LY gained from screening per 100,000 compared with no comorbidities, and our results can be used by clinicians when discussing the benefits and harms of screening in their patients with comorbidities.

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合并症患者进行肺癌筛查的益处和害处
导言有吸烟史和肺癌高风险的人往往有较高的吸烟相关合并症。这些合并症的存在可能会影响并发症风险、生活质量和死亡风险,从而改变肺癌筛查的利弊比。然而,在筛查临床试验中,慢性病患者的比例偏低。在本研究中,我们使用微观模拟模型来确定慢性病对肺癌益处和危害的影响。方法我们扩展了一个经过验证的肺癌筛查微观模拟模型,该模型全面再现了个体的肺癌发生、发展、检测、随访、治疗和生存过程。我们对模型进行了参数设置,以反映慢性疾病对侵入性检查并发症、生活质量和死亡率的影响。结果包括慢性阻塞性肺病、糖尿病、心脏病和中风病患者与无并发症的符合筛查条件者相比,每十万人获得的生命年数(LY)。结果我们发现,在 50 至 54 岁的人群中,合并症的存在会根据合并症的不同而改变每 10 万人从筛查中获得的收益:无合并症者为 4296 LY;患有慢性阻塞性肺病、心脏病、糖尿病和中风者分别为 3462 LY、3260 LY、3031 LY 和 3257 LY。结论与无合并症相比,合并症会降低每 10 万人从筛查中获得的 LY,临床医生在讨论对合并症患者进行筛查的益处和害处时可以参考我们的结果。
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来源期刊
CiteScore
4.20
自引率
0.00%
发文量
145
审稿时长
19 weeks
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