A Screening Initiative for Early Lung Cancer Detection in Primary Care

Abstract

Problem: Lung cancer remains a prevalent issue in Harford County, Maryland, where it contributes to over 30% of cancer related deaths. Within a small primary care practice in Harford County, Maryland, 26% of the patients are charted as having a social history of smoking, however, none of these patients have a pack-year history documented. Pack-year history is a key component of determining eligibility for Low-Dose Computed Tomography scans (LDCT), the recommended screening for early lung cancer detection. Purpose: This quality improvement (QI) project was to screen patients for their smoking habits and calculate their pack-year history to determine eligibility for lung cancer screening with LDCT. Methods: The Medical Assistant (MA) screened patients using a survey to identify patient smoking status as never, current, or former. Current and former smokers were then asked how many cigarettes they smoked per day. The MA then used the reported number of cigarettes per day to calculate the patients’ pack-year history. Former smokers were also asked how long it has been since they quit. As per guideline recommendations, patients who were current or former smokers, had a 20+ pack year history, had quit less than 15 years ago, and were between the ages of 55-80 were marked as LDCT eligible. Results: 33 current and former smokers were identified out of 102 patients screened. Of the smokers, 39% were eligible for LDCT based on guideline recommendations. None of these patients received a referral for an LDCT scan. All current and former smokers identified had their unique pack-year histories accurately calculated and updated within their chart. Conclusions: Findings suggest that implementing a smoking status screening tool is an effective means of identifying patients eligible for an LDCT scan. These patients should be scanned yearly as part of their preventative care screenings. Ensuring referrals were placed by clinicians proved to be a challenging component of the project and should be a focus of future quality improvement projects.