A new expert panel consensus statement offers guidance for clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic.
The statement was published jointly in Radiology: Imaging Cancer, Chest, and the Journal of the American College of Radiology (online April 23, 2020; doi:10.1016/j.jacr.2020.04.024).
During the COVID-19 pandemic, clinicians have had to balance the risk of delaying necessary medical exams against the risk of exposing patients and health care workers to the virus. Performing a lung cancer screening exam or evaluating lung nodules carry additional risks, including added contact during testing and recovery after surgical resection being influenced by asymptomatic carriage of the virus.
An expert panel of 24 members led by Peter J Mazzone, MD, MPH, FCCP, respiratory institute, Cleveland Clinic, sought to develop a consensus statement to guide clinicians who are managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. Included in the panel were pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2).
Panelists were tasked with voting on statements related to common clinical scenarios. A pre-defined threshold of 70% of panel members voting “agree” or “strongly agree” was used to determine consensus.
Twelve statement related to baseline and annual lung cancer screening, surveillance of previously detected lung nodules, evaluation of intermediate- and high-risk lung nodules, and management of clinical stage I non-small cell lung cancer were developed and modified. Among the key recommendations were to delay baseline or repeat annual screening, to delay the evaluation of pulmonary nodules detected incidentally or by screening that have a low likelihood of cancer or are likely to be an indolent cancer, and to delay or modify the evaluation and management of patients with nodules measuring greater than 8 mm in average diameter.
The expert panel acknowledged that these recommendations are not “one-size-fits-all” and reinforced that patient preferences should be considered in all scenarios. Additionally, they stated that it is not currently possible to determine when it will be advisable to return to usual care practices due to the fluidity of the situation.
“We hope these statements are helpful and provide some reassurance and direction to individuals who are eligible for lung cancer screening, patients with lung nodules, and the clinicians who care for them,” authors of the consensus statement concluded.—Zachary Bessette
