A100-02 Optimizing Who to Screen for Lung Cancer by Accounting for Differential Benefits by Comorbidity Burden: Life Gained From Screening Among N = 171,686 Patients

Abstract Rationale Lung cancer screening (LCS) reduces lung cancer mortality. Analyses of the National Lung Screening Trial suggest LCS’ mortality benefit is greatest among those with moderate comorbidity burden. However, the life gained from screening calculator (Life Years Gained from Screening via CT, LYFS-CT) assumes constant benefit of screening across all individuals. This calculator is embraced by the American College of Chest Physicians to identify “high benefit” patients, used in clinical care, and informs a Department of Veterans Affairs (VA) trial (ClinicalTrials.gov NCT06538636). We tested whether calculation of life years gained and the identification of “high benefit” patients would differ after incorporating comorbidity-based estimates of LCS’ mortality reduction. Methods We constructed a cohort of LCS-eligible VA primary care patients during 1/1/2015-9/30/2023 who were deemed healthy enough for LCS by their provider as documented in the LCS clinical reminder. We excluded patients in hospice/palliative care or with prior lung cancer. At eligibility assessment, we captured chronic obstructive pulmonary disease with hypoxia, life expectancy (5 years, ≤5 years), and comorbidity index derived from the Prostate, Lung, Colorectal, and Ovarian trial (PLCO-ci). We examined mean life gained from screening in days using the original LYFS-CT, and with tailored benefit estimates by comorbidity index. The proportion deemed high benefit in original vs. updated models was compared using chi-squared tests of independence. Results Among 171,686 patients who met inclusion criteria, mean age was 65.6 years, 93% were male, 78% self-identified as non-Hispanic white, and 54% were in the highest comorbidity index category. The original calculator estimated 69% of patients would derive high benefit from LCS (119,317/171,686). Estimated life gained was higher for patients with COPD requiring oxygen, ≤5 years’ life expectancy, or higher comorbidity index (Table). After applying tailored benefits by comorbidity index, 63,742 (53.4%) of 119,317 patients previously considered “high benefit” no longer met this threshold. The estimated benefit from LCS changed significantly in all categories of comorbidity index (p 0.0001 for all; Table). In the highest comorbidity category, the proportion deemed high benefit decreased from 84% to 0% (p 0.0001). Conclusions The widely used LYFS-CT calculator prioritized screening VA patients with advanced COPD, shorter life expectancy, and higher comorbidity burden. Incorporating estimates of LCS’ mortality reduction tailored to comorbidity index significantly altered life gained from screening and decreased the number of patients identified as “high benefit.” Accurately measuring the benefit of LCS across the health spectrum may help prioritize LCS among patients most likely to benefit. This abstract is funded by: This work was supported in part by Career Development Award Number CX002713 from the United States (U.S.) Department of Veterans Affairs Clinical Science Research and Development Service (Dr. Rustagi). Dr. Rustagi also received support from the National Institute on Aging (1R03AG082924), VA’s Lung Precision Oncology Program, and VA’s VISN21 Early Career Award Program. The analysis was approved in accordance with all regulations by the Human Research Protection Program at the University of California, San Francisco and the San Francisco VA Health Care System (#24-41009). The study sponsors had no role in the study design; collection, analysis, or interpretation of data; writing the report; or the decision to submit the manuscript for publication. The opinions expressed herein are those of the authors and not their employers, the U.S. Department of Veterans Affairs, the U.S. government, or the study sponsors.