Delays in Recommended Follow-Up after Positive Findings in Lung Cancer Screening

Ahmed, Alwiya; Hippe, Daniel S.; Snidarich, Madison; Crothers, Kristina; Triplette, Matthew

doi:10.1513/annalsats.202210-891oc

Cited by 5 publications

(6 citation statements)

References 31 publications

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“…Delays in care following low-dose screening computed tomography (CT) scans appear to be common despite the presence of infrastructure dedicated for follow-up. 19 , 20 In one study of 337 patients with abnormal CT findings, only 55% of the 184 patients requiring a follow-up had a timely follow-up, and only two-thirds of those patients diagnosed with cancer had an oncology visit within 30 days. 21 Another study of 28,000 veterans found that 33% had delay in follow-up care after screening.…”

Section: Lung Cancer Screeningmentioning

confidence: 99%

“…Factors associated with delay include patients who were currently smoking, patients with substance abuse, who had low income, patients who were an increased distance from health care facilities, and patients who identified as African American. 19 , 20 Lung cancer screening has potential to avert lung cancer death, but only if those with concerning findings follow through with guideline-directed treatment. Resources for follow-up care after screening must be enhanced.…”

Section: Lung Cancer Screeningmentioning

confidence: 99%

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Death by a thousand delays

Sadeghi,

Reza,

Miller

et al. 2024

JTCVS Open

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Section: Lung Cancer Screeningmentioning

confidence: 99%

Section: Lung Cancer Screeningmentioning

confidence: 99%

Death by a thousand delays

Sadeghi,

Reza,

Miller

et al. 2024

JTCVS Open

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“…Among high-risk patients, lung cancer screening (LCS) with low-dose chest CT (LDCT) has been recommended by the United States Preventive Services Task Force (USPSTF) since 2013, with eligibility expanded in 2021 [1]. Despite strong evidence, implementation in real-world settings has been poor, with low uptake and suboptimal adherence to annual LDCT and follow-up for those with high-risk findings [2][3][4][5][6][7][8]. A recent meta-analysis of LCS adherence showed that the pooled adherence to follow-up in clinical programs is quite low (37%) and our own work demonstrates that nearly half of all patients with positive findings have delayed follow-up [2,8].…”

Section: Introductionmentioning

confidence: 99%

“…Despite strong evidence, implementation in real-world settings has been poor, with low uptake and suboptimal adherence to annual LDCT and follow-up for those with high-risk findings [ 2 – 8 ]. A recent meta-analysis of LCS adherence showed that the pooled adherence to follow-up in clinical programs is quite low (37%) and our own work demonstrates that nearly half of all patients with positive findings have delayed follow-up [ 2 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

An alternating-intervention pilot trial on the impact of an informational handout on patient-reported outcomes and follow-up after lung cancer screening

Triplette,

Kross,

Snidarich

et al. 2024

PLoS ONE

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Introduction Lung cancer screening (LCS) can reduce lung cancer mortality; however, poor understanding of results may impact patient experience and follow-up. We sought to determine whether an informational handout accompanying LCS results can improve patient-reported outcomes and adherence to follow-up. Study design This was a prospective alternating intervention pilot trial of a handout to accompany LCS results delivery. Setting/Participants Patients undergoing LCS in a multisite program over a 6-month period received a mailing containing either: 1) a standardized form letter of LCS results (control) or 2) the LCS results letter and the handout (intervention). Intervention A two-sided informational handout on commonly asked questions after LCS created through iterative mixed-methods evaluation with both LCS patients and providers. Outcome measures The primary outcomes of 1)patient understanding of LCS results, 2)correct identification of next steps in screening, and 3)patient distress were measured through survey. Adherence to recommended follow-up after LCS was determined through chart review. Outcomes were compared between the intervention and control group using generalized estimating equations. Results 389 patients were eligible and enrolled with survey responses from 230 participants (59% response rate). We found no differences in understanding of results, identification of next steps in follow-up or distress but did find higher levels of knowledge and understanding on questions assessing individual components of LCS in the intervention group. Follow-up adherence was overall similar between the two arms, though was higher in the intervention group among those with positive findings (p = 0.007). Conclusions There were no differences in self-reported outcomes between the groups or overall follow-up adherence. Those receiving the intervention did report greater understanding and knowledge of key LCS components, and those with positive results had a higher rate of follow-up. This may represent a feasible component of a multi-level intervention to address knowledge and follow-up for LCS. Trial registration ClinicalTrials.gov NCT05265897.

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“…In the retrospective study accompanying this editorial in this issue of AnnalsATS , Ahmed and colleagues (pp. 1175–1181 ) evaluated delays in follow-up after a positive LCS examination (defined as Lung-RADS category 3, 4A, 4B, or 4X) among 369 patients enrolled in a multisite LCS program in the Seattle area ( 8 ). The authors defined the recommended follow-up interval as follow-up 30 days beyond the ACR-recommended timeline (for Lung-RADS category 3, 6 mo + 30 d; for category 4A, 3 mo + 30 d; and for categories 4B and 4X, 30 d) and defined delayed follow-up as the time to follow-up exceeding the study’s defined time intervals, death, or censoring.…”

mentioning

confidence: 99%