Establishing a Pulmonary Nodule Clinic Service for Early Diagnosis of Lung Cancer - Review of International Options and Considerations for Greece.

Early diagnosis of lung cancer in pulmonary nodules identified by computed tomography (CT) may be critical in reducing the epidemiological burden of the disease, particularly in countries where such a burden is considerably high and risk factors for lung cancer very prevalent. The establishment and operation of pulmonary nodule clinics (PNCs), ie, multidisciplinary services that watch and evaluate nodules found through deliberate screening efforts or as incidental findings, is increasingly becoming a key tool to implement such early-intervention, cancer-risk management policies elsewhere in the world. This review aims to research and present in a structured manner findings from published sources on options and considerations for setting up a PNC in a country such as Greece. These refer to the type of services a PNC would provide to optimize diagnosis of suspect pulmonary nodules, its structure and organization, including processes, human resources and technology infrastructure, its target audience, ie, who would be eligible to use its services, and the expected outcomes of its operation, in terms of a set of key performance indicators. Our review also revealed critical key success factors that should be considered when designing the introduction of a PNC in a health care setting, including optimal referral pathways, aligned clinical decision making and patient preferences and participation/empowerment. Our findings may inform health care systems with a high lung cancer burden and no available PNC service on options and considerations before introducing such a service in their respective settings.

Lung Cancer Screening in Greece: A Modelling Study to Estimate the Impact on Lung Cancer Life Years.

(1) Background: Lung cancer causes a substantial epidemiological burden in Greece. Yet, no formal national lung cancer screening program has been introduced to date. This study modeled the impact on lung cancer life years (LCLY) of a hypothetical scenario of comprehensive screening for lung cancer with low-dose computed tomography (LDCT) of the high-risk population in Greece, as defined by the US Preventive Services Taskforce, would be screened and linked to care (SLTC) for lung cancer versus the current scenario of background (opportunistic) screening only; (2) Methods: A stochastic model was built to monitor a hypothetical cohort of 100,000 high-risk men and women as they transitioned between health states (without cancer, with cancer, alive, dead) over 5 years. Transition probabilities were based on clinical expert opinion. Cancer cases, cancer-related deaths, and LCLYs lost were modeled in current and hypothetical scenarios. The difference in outcomes between the two scenarios was calculated. 150 iterations of simulation scenarios were conducted for 100,000 persons; (3) Results: Increasing SLTC to a hypothetical 100% of eligible high-risk people in Greece leads to a statistically significant reduction in deaths and in total years lost due to lung cancer, when compared with the current SLTC paradigm. Over 5 years, the model predicted a difference of 339 deaths and 944 lost years between the hypothetical and current scenario. More specifically, the hypothetical scenario led to fewer deaths (−24.56%, p < 0.001) and fewer life years lost (−31.01%, p < 0.001). It also led to a shift to lower-stage cancers at the time of diagnosis; (4) Conclusions: Our study suggests that applying a 100% screening strategy amongst high-risk adults aged 50−80, would result in additional averted deaths and LCLYs gained over 5 years in Greece.

Access of People Living with HIV to Testing Services in Greece: A Challenge for Equity in Care.

(1) Background: Access to laboratory testing services for HIV in Greece is persistently challenged and this impacts both the continuum of care and, potentially, equity in access. (2) Methods: A cross-sectional study with two parts (first part: HIV-positive people/PLWHIV; second part: HIV clinicians) was conducted in Greece to quantify challenges regarding access to laboratory testing for HIV. Data were collected through online surveys, during a one-month period, between 2019 and 2020. The total sample consisted of 153 PLWHIV and 26 HIV clinicians. (3) Results: Access to viral load testing varied significantly according to place of residence (p = 0.029) and year of diagnosis (p = 0.054). Patients diagnosed after 2015 reported worse access to viral load testing (72.7% vs. 85.9%). Over one third of respondents perceived viral load tests as being not at all accessible (11.4%) or somewhat accessible, only after facing multiple systemic obstacles (24.2%). Equally, most of HIV clinicians reported barriers or no access to baseline viral load testing (80%) and baseline genotype resistance tests (96%). (4) Conclusions: Access of people diagnosed with HIV to CD4 lymphocyte tests and genotype resistance screening is significantly challenged in Greece, especially after 2015. Addressing this challenge is critical in removing access barriers and achieving the UNAIDS 95-95-95 HIV elimination goals.

Public Awareness on Cancer-Associated Thrombosis among the Greek Population: First Findings from the ROADMAP-CAT Awareness Study.

Background Cancer-associated thrombosis (CAT) is the second cause of mortality after cancer itself. CAT is underestimated as a health challenge among oncologists, whereas the levels of awareness among patients and the public have not been systematically assessed and followed in the European Union countries. Aim The Prospective Risk Assessment and Management of Patient with CAT (ROADMAP-CAT) Awareness study is an investigator-initiated, descriptive and nonexperimental study with a cross-sectional design and it explores CAT risk awareness among cancer patients and the general public in Greece to provide an impetus for health policy interventions and a benchmark against which impact of any future interventions may be assessed. Methods A total of 1,003 participants aged above 18 years were contacted by phone after random selection from the national telephone catalogue. Participation was voluntary and completely anonymous, and a structured questionnaire was used to elicit responses. Data were analyzed using IBM SPSS version 25. Results Among respondents, almost one-third (32.3%) reported CAT awareness, while only one in five (21.7%) were aware of the signs and symptoms of venous thromboembolism (VTE). Among patients with a personal history of cancer or of VTE, 47 and 58%, respectively, were aware of CAT risk. Of those aware of the association, 35.2% identified their treating physician as the main source of information. The level of awareness did not significantly differ by responders' demographics. Conclusion The ROADMAP-CAT Awareness study revealed very low levels of awareness on CAT and VTE risk both among the general public and cancer patients in Greece. Awareness of the signs and symptoms of VTE was also particularly low. Treating physicians are not actively engaging in educating their patients about CAT. Public awareness of the increased risk of VTE among cancer patients is critical to prevent and diagnose the disease early. It is imperative that a structured campaign supports medical professionals to take the time to increase awareness and educate their patients on this matter if to improve morbidity and mortality of cancer patients.

Data analysis of the benefits of an electronic registry of information in a neonatal intensive care unit in Greece.

OBJECTIVES: This study assesses the results of implementation of a software program that allows for input of admission/discharge summary data (including cost) in a neonatal intensive care unit (NICU) in Greece, based on the establishment of a baseline statistical database for infants treated in a NICU and the statistical analysis of epidemiological and resource utilization data thus collected. METHODS: A software tool was designed, developed, and implemented between April 2004 and March 2005 in the NICU of the LITO private maternity hospital in Athens, Greece, to allow for the first time for step-by-step collection and management of summary treatment data. Data collected over this period were subsequently analyzed using defined indicators as a basis to extract results related to treatment options, treatment duration, and relative resource utilization. RESULTS AND DISCUSSION: Data for 499 babies were entered in the tool and processed. Information on medical costs (e.g., mean total cost +/- SD of treatment was euro310.44 +/- 249.17 and euro6704.27 +/- 4079.53 for babies weighing more than 2500 g and 1000-1500 g respectively), incidence of complications or disease (e.g., 4.3 percent and 14.3 percent of study babies weighing 1,000 to 1,500 g suffered from cerebral bleeding [grade I] and bronchopulmonary dysplasia, respectively, while overall 6.0 percent had microbial infections), and medical statistics (e.g., perinatal mortality was 6.8 percent) was obtained in a quick and robust manner. CONCLUSIONS: The software tool allowed for collection and analysis of data traditionally maintained in paper medical records in the NICU with greater ease and accuracy. Data codification and analysis led to significant findings at the epidemiological, medical resource utilization, and respective hospital cost levels that allowed comparisons with literature findings for the first time in Greece. The tool thus contributed to a clearer understanding of treatment practices in the NICU and set the baseline for the assessment of the impact of future interventions at the policy or hospital level.