Lung Cancer Screening Program Quality Indicators-Review and Recommendations: An International Association for the Study of Lung Cancer Delphi Process Study

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.

• Tammemägi, M. C.
• Borondy-Kitts, A.
• Field, J. K.
• Henschke, C. I.
• Mohan, A.
• Kerpel-Fronius, A.
• Ventura, L.
• Yang, D.
• Jiang, L.
• Koegelenberg, C. F. N.
• Cavic, M.
• Balata, H.
• Viola, L.
• Zulueta, J. J.
• Sales Dos Santos, R.
• Rzyman, W.
• Yankelevitz, D. F.
• McWilliams, A.
• Lam, S.
• Kazerooni, E. A.
• Huber, R. M.