The downstream costs associated with invasive diagnostic procedures for lung cancer screening may be higher than previously thought, according to a new study published today in JAMA Internal Medicine. Complication rates for lung abnormalities were also twice as high compared to numbers seen in lung cancer screening trials.
The results drive home the need to incorporate these risk factors during the shared-decision making process between patients and physicians when evaluating lung cancer screening options for high-risk groups, wrote corresponding author Ya Chen Tina Shih, PhD, professor of Health Services Research, in a prepared statement.
“When looking at the results of the (National Lung Screening Trial) NLST trial, many have concerns about false positives, which put patients at risk with invasive diagnostic procedures,” Shih said. “We felt that downstream complication rates reported in this trial might be underestimated because it was conducted in a well-controlled environment. For screenings conducted in real-world practices, where patients are not subject to clinical trial protocols, we might see even higher complication rates from invasive procedures.”
After comparing data from nearly 175,000 patients who had received an invasive diagnostic procedure to a matched-control group of nearly 170,000 individuals who did not have a procedure, the team found a 22.2 percent post-procedural complication rate in younger patients (55 to 64) compared to the 9.8 percent noted in the NLST. For those 65 to 77, that rate was 23.8 percent compared to 8.5 percent in the NLST.
One limitation of the data, taken from a MarketScan database, was that it did not show if a patient had low-dose CT screening because the corresponding billing code was established after the study period. The data used in their study included claims for similar procedures for lung abnormalities.
Shih and colleagues found management of the downstream costs associated with post-procedural complications ranged from more than $6,000 for minor complications to nearly $57,000 for major ones.
“It’s very important for physicians to include information about possible adverse risks when communicating with their patients considering lung cancer screening,” Shih said in the same statement. “Our findings suggest these complications may be higher than anticipated when implementing lung cancer screening programs outside a clinical-trial setting, and the health care system needs to be ready for that potential issue."
Likely less than five percent of people have invasive procedures for abnormal findings, the authors wrote—a small percentage of the overall lung cancer screening population. However, communicating the harms and benefits with those considering screening, notably patients interested in LDCT, is a must.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.