What Should Be Done When a Patient’s Lung Cancer Screening Benefit Is ‘Marginal’?

Patients with multimorbidity and limited life expectancy are often “unaware of their higher risk of downstream harm” when accepting lung cancer screening (LCS), according to new research.

Eduardo Ramon Nunez, MD, MS, of the University of Massachusetts Chan Medical School–Baystate, and colleagues conducted the study and presented their findings during the American Thoracic Society 2024 International Conference. They explained why it was critical to address LCS uptake in this population of patients.

“[LCS] has less benefit and greater potential for iatrogenic harm among people with multiple comorbidities and limited life expectancy,” Dr. Nunez and colleagues explained. “Yet such individuals are more likely to undergo screening than healthier LCS-eligible people.”

They aimed to “understand how patients with marginal LCS benefit conceptualize their health and make decisions about LCS” by interviewing 40 people who had multimorbidity and limited life expectancy. The researchers recruited patients who had discussed LCS with their health care provider. The patients were seen at 6 Veterans Health Administration facilities. They conducted a thematic analysis to explore the factors that influence LCS decision-making using constant comparison.

The analysis showed that patients “frequently held positive beliefs about screening and perceived LCS to be noninvasive,” Dr. Nunez and colleagues reported. For example, when patients were “posed with hypothetical scenarios of limited benefit” of LCS, they “emphasized the nonlongevity benefits of LCS,” such as peace of mind and planning for the future, the researchers explained. However, patients “generally didn’t consider their health status or life expectancy when making LCS decisions,” according to Dr. Nunez and colleagues.

In addition, most patients were “unaware of possible downstream evaluations or treatment of screen-detected findings, but when probed further, many expressed concerns about the potential need for multiple evaluations, referrals, or invasive procedures,” the presenters explained.

Dr. Nunez and colleagues reflected on the study results and concluded by explaining how health care providers can apply the findings of the study to daily practice.

“Patients in this study with multimorbidity and limited life expectancy were unaware of their higher risk of downstream harm when accepting LCS,” the presenters said. “Given patient trust in clinician recommendations, it is important that clinicians engage patients with marginal LCS benefit in shared decision-making, ensuring that their values of desiring more information about their health are weighed against potential harms from downstream evaluations.”

Reference

Nunez ER, Bolton RE, Boudreau J, et al. “It can’t hurt!”: why many patients with multiple comorbidities and limited life expectancy decide to accept lung cancer screening. Presented at the American Thoracic Society 2024 International Conference; May 17-22, 2024; San Diego, California.