Lung cancer screening program quality indicators - review & recommendations - An International Association for the Study of Lung Cancer Delphi process study.

Introduction: Lung cancer screening (LCS) using low-dose-computed tomography reduces lung cancer mortality in high-risk individuals. Evaluating and monitoring LCS programs are important to ensure and improve quality, efficiency and participant outcomes. There is no agreement on LCS quality indicators (QIs).

Methods: Twenty multidisciplinary members of IASLC used a Delphi process to develop consensus Qis. They considered 50 Qis during information/discussion sessions and two anonymous voting rounds. ≥80% voting agree/strongly agree on a five-point Likert scale determined consensus.

Results: Twenty essential and six desirable QIs were identified in 10 of 11 LCS pathway domain categories: ENTRY: Proportion eligible who got screened. SMOKING_CESSATION: Proportion current-smoking individuals offered cessation interventions.

Imaging: Proportion screened requiring clinical diagnostic assessment, scans results distribution, proportion scans requiring early follow-up, proportion baseline/regular scans with actionable additional findings.

Adherence To: Annual/regular scans, early interim scans, clinical diagnostic assessment.

Diagnostic: Proportion suspicious-for-lung-cancer scans receiving clinical investigation, undergoing invasive diagnostic procedures.

Outcomes: Cancer detection rate, stage distribution, interval cancer rate HARMS: Number/proportion of serious complications following invasive procedures, non-lung cancer diagnoses following invasive procedures, or following surgery, 30-day mortality following invasive procedure.

Treatment: Proportion early-stage cancers receiving treatment with curative intent. WAIT_TIMES: Suspicious-for-lung-cancer scan to definitive diagnosis, curative-intent treatment for individuals with early-stage disease, scan completion to reporting results to PCP/participant.

Equity: Race/sex/socioeconomic differences in adherence to regular screens, early-stage cancer treatment, offer of smoking cessation interventions, clinical investigation of suspicious-for-lung-cancer screens.

Discussion: Review among panel members provide recommended LCS QIs that should be considered in development of LCS initiatives .