Presentation at computed tomography (CT) scan of the thorax and first year diagnostic and treatment utilization among patients diagnosed with lung cancer

PLoS One. 2017 Jul 14;12(7):e0181319. doi: 10.1371/journal.pone.0181319. eCollection 2017.


Background: As Medicare expands the use of computed tomography (CT) for diagnosing lung cancer, there is increased opportunity to diagnose lung cancer in asymptomatic patients. This descriptive study characterizes the disease-specific diagnostic and treatment services that patients with a positive diagnosis following CT received, stratified by presentation at CT.

Methods: Patients who were diagnosed with lung cancer following CT in 2013, had no history of lung cancer, survived at least 1 year, were aged 55-80 years, and had Medicare Advantage insurance were included. Patients were grouped based upon presentation at CT: morbidities unrelated to lung cancer, classic lung cancer symptoms, and cancer syndromes. Patients with none of these factors were categorized into a no diagnoses/symptoms group. The type and intensity of services used in the year following the CT was reported for each group.

Results: 1,261 patients were included. Early treatment services were most common in the group with morbidities unrelated to lung cancer (13.7%) and least common in the cancer syndromes group (6.6%). Advanced treatment services were used by 47.3% of the cancer syndromes group versus 23.5% of the no diagnoses/symptoms group.

Conclusions: The intensity of disease-specific diagnostic and treatment services varied by presentation at CT. Patients with no symptoms or morbidities at the time of CT less frequently received advanced interventions. Learning about the utilization patterns of others with a similar presentation at CT may help patients with positive lung cancer diagnoses engage in shared decision making and in norming their experiences against those of other similarly-situated patients.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Databases, Factual
  • Female
  • Humans
  • Lung Neoplasms / diagnosis*
  • Lung Neoplasms / pathology
  • Male
  • Medicare
  • Middle Aged
  • Thorax / diagnostic imaging*
  • Tomography, X-Ray Computed*
  • United States

Grant support

The authors received no specific funding for this work. This study was completed by Humana, Inc. and HealthHelp, and authors worked on it as a part of their duties for their respective organization. HealthHelp and Humana Inc. provided support in the form of paid employment or consulting fees for all the authors. (Humana: BL, LH, and JL. HealthHelp: AP, AM, EK, and AG.). The specific roles of these authors are articulated in the ‘author contributions’ section. This research represents the findings of a quality improvement project conducted by the funding organizations, which were both actively involved in the study design, data collection and analysis, decision to publish, and preparation of the manuscript. URL of HealthHelp:; URL of Humana: