PRIMARY CARE PHYSICIANS' LUNG CANCER SCREENING PRACTICES: COMPARISONS BEFORE AND AFTER THE CENTERS FOR MEDICARE & MEDICAID'S NATIONAL COVERAGE DETERMINATION

Purpose: This study’s purpose was to compare primary care physicians’ (PCPs) lung cancer screening (LCS) practices prior to and following the Centers for Medicare & Medicaid Services’ (CMS) national coverage determination on screening for lung cancer with low-dose computed tomography (CT).

Method: A convenience sample of PCPs completed a survey from two conferences in 2014 (Wave I) and one conference in 2016 (Wave II). The survey assessed their LCS practices prior to (Wave I) and after (Wave II) CMS released its national coverage determination in February of 2015. Descriptive statistics characterized the two waves. PCPs were asked about their current practice related to six components of a structured LCS program: identifying eligible patients, engaging in shared decision making, referring to certified LCS centers, following-up on abnormal findings, managing other health problems during cancer treatment, and providing tobacco treatment services to smokers. An overall score was computed as a count of “yes” responses to the current practice questions. Chi-square tests assessed for temporal trends in PCPs’ lung cancer screening practices.

Result: The analytic sample included 350 PCPs from Wave I and 98 from Wave II. Analysis dropped three retired respondents and one specialist from Wave I and one retired respondent from Wave II. Wave I PCPs had been practicing for a median of 14 years (inter quartile range, IQR=7-24 years), and Wave II PCPs had been practicing for a median of 19 years (IQR=11-31 years). The majority were not affiliated with a residency program (Wave I=83%, Wave II=77%) and were based in non-hospital settings (Wave I=86%, Wave II=87%). Wave II PCPs’ had more components of a structured LCS program than Wave I PCPs (mean=4.3 vs 3.4, p-value<0.01). Compared to Wave I, more Wave II PCPs reported that they identified eligible patients (33% vs 63%, p-value<0.01), engaged patients in shared decision making (41% vs 65%, p-value<0.01), referred to certified LCS centers (26% vs 37%, p-value<0.01), and followed-up on positive findings (61% vs 79%, p-value=0.01). The majority of PCPs from both waves provided smoking cessation services to smokers (87% vs 93%, p-value=0.47) and managed other health problems during cancer treatment (83% vs 85%, p-value=0.32).

Conclusion: Following the CMS national coverage determination for LCS with low-dose CT, PCPs reported more practices consistent with a structured LCS program.