The Department congratulates Professor of Radiology Louise Henderson, PhD, for receiving a National Cancer Institute (NCI) R01 grant ($1.5M+) as Co-P.I. of an investigation entitled, “Comorbidity and Functional Status in a Population Undergoing Lung Cancer Screening” (Co-P.I.: UNC Professor of Medicine Maria Patricia Rivera, MD / Pulmonology). Over four years (7/15/2020 – 6/30/2024), the proposed study will generate population-based data on effectiveness of lung cancer screening (LCS) in patients with pre-existing medical co-morbidities and functional limitations.

The National Lung Screening Trial (NLST) showed a 20% relative reduction in lung cancer mortality for LCS with low dose computed tomography (LDCT) versus chest radiography. In 2013, the U.S. Preventive Services Task Force began recommending annual LDCT LCS in current or former heavy smokers ages 55-80 years.  However, the NLST provides limited evidence on the effectiveness of LCS in patients with comorbid conditions as trial participants were required to be healthy enough to undergo surgical resection, which resulted in the enrollment of fairly healthy participants. While older patients with significant smoking exposure have higher risk of developing lung cancer, they also tend to have more comorbid illness, functional limitations, and shorter life expectancy, often making them ineligible for standard early-stage lung cancer treatments. Research to understand the effectiveness of LCS in patients with pre-existing medical comorbidities and functional limitations is needed.

Over four years, Dr. Henderson’s multi-disciplinary team will use population-based data to aid determination of LCS benefit-to-harm ratio among subgroups of patients with risk-based, pre-existing comorbid conditions and functional limitations. This study aims to provide evidence-based, real-world data that inform LCS in clinical practice, across patient subgroups, by baseline risk, comorbid conditions, and functional status. Given limited study to date in this emerging, translational cancer screening area, this study is relevant to the National Cancer Institute’s mission of supporting cancer control.

Dr. Henderson notes: “A significant challenge in LCS implementation is how to incorporate co-morbid disease and variation in patients’ functional status into decisions around screening, to improve the benefit-harm ratio. Our study findings have the potential to inform and refine screening guidelines to incorporate recommendations that consider underlying health status in the context of lung cancer screening.”

 

* Additional UNC faculty investigators on this study include: Associate Professor of Epidemiology Jennifer Lund, Professor of Medicine Daniel Reuland, MD, Research Assistant Professor of Epidemiology Christopher Baggett, MD.