What should family members of patients with lung cancer (lung carcinoma) know about the disease and its screening, such as low-dose computed tomography (LDCT)?

From the Guidelines

Family members of patients with lung cancer should understand that early detection through screening can significantly improve survival rates, and low-dose computed tomography (LDCT) is recommended annually for high-risk individuals aged 55-80 with a 30 pack-year smoking history who currently smoke or have quit within the past 15 years, as supported by the most recent guidelines from the American Cancer Society and the US Preventive Services Task Force 1. The goal of screening is to detect disease at a stage when it is not causing symptoms and when treatment is most successful, thereby improving outcome, quality of life, and reducing mortality from lung cancer. Some key points to consider include:

• The importance of identifying high-risk individuals for screening, such as those with a significant smoking history or exposure to environmental risk factors like secondhand smoke, radon, or asbestos.
• The potential benefits and harms of screening, including the risk of false-positive results, overdiagnosis, and unnecessary invasive testing, as discussed in the guidelines from the National Comprehensive Cancer Network 1.
• The need for informed and shared decision-making between clinicians and patients regarding the potential benefits, limitations, and harms associated with screening for lung cancer with LDCT, as emphasized by the American Cancer Society 1.
• The role of family members in providing support and encouragement for patients undergoing screening and treatment, including helping manage medications, encouraging healthy lifestyle choices, and assisting with daily activities during treatment.
• The importance of understanding that lung cancer is not just a "smoker's disease," but can also be caused by exposure to environmental risk factors, even in non-smokers, as highlighted in the guidelines from the US Preventive Services Task Force 1. Common symptoms to watch for include persistent cough, chest pain, shortness of breath, unexplained weight loss, and coughing up blood, and treatment options vary based on cancer type, stage, and patient health, ranging from surgery and radiation to chemotherapy, targeted therapy, and immunotherapy. Overall, family members of patients with lung cancer should prioritize understanding the importance of early detection and screening, as well as the potential benefits and harms, in order to provide informed support and encouragement for their loved ones, as supported by the most recent and highest quality evidence 1.

From the Research

Knowledge and Perceptions of Family Members

• Family members of patients with lung cancer are interested in discussing risk factors, prevention, and diagnoses, and would like access to supportive services to cope with the stresses and barriers they experience in the family lung cancer journey 2.
• The diagnosis of lung cancer represents a potential teachable moment with the opportunity to reduce the risk of lung cancer development or improve early detection in family members 2.

Lung Cancer Screening

• Low-dose computed tomography (LDCT) screening is promising for the early detection of lung cancer and the reduction of lung cancer-related mortality 3, 4, 5.
• The U.S. Preventive Services Task Force recommends lung cancer screening using LDCT in high-risk patients, but the American Academy of Family Physicians concludes that the evidence is insufficient to recommend for or against screening 6.
• Studies have shown that LDCT screening can detect lung cancer at an early stage and reduce the risk of dying from lung cancer, but false-positive findings and unnecessary workup and intervention remain significant concerns 4, 5.

Family Members and Screening

• Patients with lung cancer can act as advocates to enroll their family members and close contacts into lung cancer screening, and this strategy may increase screening uptake at the population level 3.
• Family members of patients with lung cancer may be more likely to undergo screening if they are educated about the benefits of screening and have access to supportive services 2, 3.
• The use of risk prediction models, such as the PLCOm2012 model, can help identify family members who are at high risk of developing lung cancer and may benefit from screening 3.

Barriers and Facilitators to Screening

• Barriers to lung cancer screening include lack of awareness, lack of access to screening services, and concerns about false-positive findings and unnecessary workup and intervention 3, 5.
• Facilitators to screening include education about the benefits of screening, access to supportive services, and the use of risk prediction models to identify high-risk individuals 2, 3, 4.