JMIR Publications

ABSTRACT

Background:

Surveillance is noted to be an important part of survivorship to detect recurrence and/or second primary lung cancer (SPLC) at a curable stage. However, current surveillance guidelines remain controversial, and the factors providers consider in clinical decision-making are neither well-defined nor consistently applied.

Objective:

This study aims to understand factors that influence lung cancer surveillance and how providers view risk stratification as a potential tool to inform surveillance practices.

Methods:

Eleven physicians and two Advanced Practice Providers involved in treating and surveilling lung cancer patients from the Palo Alto Veterans Affairs medical center and Stanford medicine were interviewed between October 2023 and July 2024. Thematic categories were identified through a qualitative inductive content analysis approach.

Results:

We identified three thematic categories that describe clinicians' sentiments about current surveillance practices and how a risk stratification tool could be utilized in the screening for recurrence and/or SPLC. Clinicians consider a variety of clinical and non-clinical factors (Category 1: factors that influence clinical decision making), and highlighted limits of a risk stratification tool, including concerns about generalizability, accuracy, and validity (Category 2: sentiments toward a hypothetical risk stratification tool). Lastly, concerns were raised about how delivering risk stratification data might impact patient anxiety, misinterpretation, and adherence to surveillance plans (Category 3: delivery of risk stratification data to patients).

Conclusions:

This qualitative analysis illustrates the complexity of lung cancer surveillance decision-making and provider concerns about tool accuracy and delivery, underscoring gaps to be addressed to facilitate development and adoption of risk stratification tools. Though risk stratification tools can serve as supplementary in lung cancer surveillance decision making, further development of such tools should address data quality, tool accuracy considering the wide array of clinical and non-clinical risks factors, and delivery of data to individual patients. Addressing these issues can inform the development and implementation of risk stratification tools in efforts towards efficient, universal and practical risk stratification of SPLC and/or recurrence in cancer survivors.