Lung Cancer Screening Program Quality Indicators—Review and Recommendations: An International Association for the Study of Lung Cancer Delphi Process Study
Martin C. Tammemägi, Andrea Borondy Kitts, John K. Field, Claudia I. Henschke, Anant Mohan, Anna Kerpel-Fronius, Luigi Ventura, Dawei Yang, Long Jiang, C. Koegelenberg, Milena Čavić, Haval Balata, Lucía Viola, Javier J. Zulueta, Ricardo Sales dos Santos, Witold Rzyman, David F. Yankelevitz, Annette McWilliams, Stephen Lam, Ella A. Kazerooni, Rudolf M. Huber
Abstract
INTRODUCTION: Lung cancer screening (LCS) using low-dose-computed tomography reduces lung cancer mortality in high-risk individuals. Evaluating and monitoring LCS programs are important to ensure and improve quality, efficiency, and participant outcomes. There is no agreement on LCS quality indicators (QIs). METHODS: Twenty multidisciplinary members of the International Association for the Study of Lung Cancer used a Delphi process to develop consensus QIs. They considered 50 QIs during information/discussion sessions and two anonymous voting rounds. In total, 80% or more voting agree or strongly agree on a five-point Likert scale determined consensus. RESULTS: Twenty essential and six desirable QIs were identified in 10 of 11 LCS pathway domain categories (ENTRY: Proportion eligible who got screened; SMOKING_CESSATION: Proportion of current-smoking individuals offered cessation interventions; IMAGING: Proportion screened requiring clinical diagnostic assessment, scan results distribution, proportion scans requiring early follow-up, proportion baseline or regular scans with actionable additional findings; ADHERENCE to: Annual or regular scans, early interim scans, clinical diagnostic assessment; DIAGNOSTIC: Proportion suspicious-for-lung-cancer scans receiving clinical investigation, undergoing invasive diagnostic procedures; OUTCOMES: Cancer detection rate, stage distribution, interval cancer rate; HARMS: Number and proportion of serious complications after invasive procedures, non-lung cancer diagnoses after invasive procedures or surgery, 30-day mortality after invasive procedure; TREATMENT: Proportion early-stage cancers receiving treatment with curative intent; WAIT_TIMES: Suspicious-for-lung-cancer scan to definitive diagnosis, to curative-intent treatment for individuals with early-stage disease, scan completion to reporting results to primary care provider and participant; EQUITY: Race, sex, and socioeconomic differences in adherence to regular screens, early-stage cancer treatment, offer of smoking cessation interventions, clinical investigation of suspicious-for-lung-cancer screens). CONCLUSIONS: A review among panel members provided recommended LCS QIs that should be considered in the development of LCS initiatives.