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21-expert panel outlined 12 recommendations for when you can delay lung cancer screenings and lung nodule evaluations.
Much attention has been given during the COVID-19 pandemic to postponing screening services, largely focusing on breast imaging. However, lung cancer screenings also fall into this category and should be delayed in an effort to protect patients and conserve valuable medical sources, according to new guidance from an international expert panel.
Published in the Journal of the American College of Radiology, a group of 21 pulmonologists, thoracic radiologists, and thoracic surgeons drafted a consensus statement on the management of lung nodules and lung cancer screenings during the pandemic.
“There was a consensus that during the COVID-19 pandemic it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource allocation,” wrote the panel, led by Peter Mazzone, M.D., MPH, director of the Cleveland Clinic Lung Cancer Program and Lung Cancer Screening Program for the Respiratory Institute. “There are multiple local, regional, and patient related factors that should be considered when applying these statements to individual patient care.”
The consensus statement was created in accordance with current COVID-19 guidance from the Centers for Disease Control & Prevention, and it touches on how providers should handle CT lung cancer screenings, as well as the management of patients who have lung nodules during this outbreak. The guidance also appeared concurrently on April 24 in CHEST and Radiology: Imaging Cancer.
Based on two video conferences, the panel compiled 12 recommendations that fall under four areas. Each recommendation achieved at least 70-percent agreement among the panelists.
Baseline and Annual Lung Cancer Screening
Surveillance of a Previously Detected Lung Nodule
Evaluation of Intermediate and High-Risk Lung Nodules
Management of Clinical Stage I Non-Small Cell Lung Cancer
Although these recommendations fall in line with guidance from the CDC, the panel also encouraged providers to discuss the course of treatment with patients.
“Patient preferences should be taken into account in all of the scenarios, because individual patients are likely to differ in how they perceive the potential benefits and harms associated with delayed or modified evaluation and management,” they wrote. “This highlights the importance of communication about the rationale for decisions with our patients.”
Decisions should also be based, they said, upon the prevalence of COVID-19 in the community, availability of rapid testing, levels of resources, local policies, and the presence of other care environments less impacted by the virus.