Determinants Associated With Longitudinal Adherence to Annual Lung Cancer Screening: A Retrospective Analysis of Claims Data

Hirsch, Erin; Barón, Anna E.; Risendal, Betsy; Studts, Jamie L.; New, Melissa; Malkoski, Stephen P.

doi:10.1016/j.jacr.2021.03.003

Cited by 12 publications

(6 citation statements)

References 58 publications

(87 reference statements)

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“…However, this analysis did not stratify into Lung-RADS 4A vs 4B or 4X, and the suspicion for cancer varies in these groups. 19 Factors associated with increased adherence rates after LCS examinations include higher Lung-RADS assessment after a baseline LDCT, 20 , 21 White race, 6 , 11 type of program (centralized vs decentralized or having a nurse navigator), 10 , 22 , 23 and former smoking status. 20 Two studies reported individuals with Lung-RADS 3 and Lung-RADS 4 were more likely to be adherent to recommended follow-up than those with Lung-RADS 1, with Lung-RADS 3 individuals 3 to 5 more likely and Lung-RADS 4 individuals 14 to 29 times more likely.…”

Section: Discussionmentioning

confidence: 99%

“…18 Adherence to positive LCS examinations at the population level has been heterogeneous. [4][5][6][7][8][9][10][11] In a recent meta-analysis, the pooled adherence rate in 557 individuals with Lung-RADS 3 or 4 was 74% (95% CI, 65%-83%). However, this analysis did not stratify into Lung-RADS 4A vs 4B or 4X, and the suspicion for cancer varies in these groups.…”

Section: Discussionmentioning

confidence: 99%

“…However, achieving the high adherence rates observed in clinical trials has been difficult at the population level, with reported rates varying from 28% to 82%. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 Many prior studies combined adherence to annual lung cancer screening (LCS) after a negative LDCT and adherence to recommended follow-up after a positive LDCT, leading to challenges in interpreting study results since recommended follow-up timing and imaging or diagnostic tests differ by screening result. 12 Several studies reported that adherence to recommended follow-up is higher among individuals with a nodule detected on LDCT.…”

Section: Introductionmentioning

confidence: 99%

“…High adherence rates of 95% to 88% across multiple rounds of screening in the National Lung Screening Trial (NLST) and the Nederlands–Leuvens Longkanker Screenings Onderzoek (NELSON) trial contributed to the observed mortality reduction of screening. However, achieving the high adherence rates observed in clinical trials has been difficult at the population level, with reported rates varying from 28% to 82% . Many prior studies combined adherence to annual lung cancer screening (LCS) after a negative LDCT and adherence to recommended follow-up after a positive LDCT, leading to challenges in interpreting study results since recommended follow-up timing and imaging or diagnostic tests differ by screening result .…”

Section: Introductionmentioning

confidence: 99%

“…Time until follow-up, median (IQR), d Among those with chest CT with or without contrast or PET/CT or biopsy within 4 wk 14(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) Among those with chest CT with or without contrast or PET/CT or biopsy within 1 y 60.5 (41.5-116.5)a Per American College of Radiology Lung-RADS.b Timeline we selected for Lung-RADS 4B or 4X as ACR Lung-RADS does not give a specific timeframe.c Per British Thoracic Society recommended timeline from "abnormal radiograph to surgery" for non-screen detected radiographic findings suspicious for lung cancer.…”

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confidence: 99%

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Receipt of Recommended Follow-up Care After a Positive Lung Cancer Screening Examination

et al. 2022

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ImportanceMaximizing benefits of lung cancer screening requires timely follow-up after a positive screening test. The American College of Radiology (ACR) Lung CT Screening Reporting and Data System (Lung-RADS) recommends testing and follow-up timing based on the screening result.ObjectiveTo determine rates of and factors associated with recommended follow-up after a positive lung cancer screening examination by Lung-RADS category.Design, Setting, and ParticipantsThis prospective cohort study of lung cancer screening examinations performed from January 1, 2015, through July 31, 2020, with follow-up through July 31, 2021, was conducted at 5 academic and community lung cancer screening sites in North Carolina. Participants included 685 adults with a positive screening examination, Lung-RADS categories 3, 4A, 4B, or 4X. Statistical analysis was performed from December 2020 to March 2022.ExposuresIndividual age, race, sex, smoking exposure, year of lung cancer screening examination, chronic obstructive pulmonary disease, body mass index, referring clinician specialty, rural or urban residence.Main Outcomes and MeasuresAdherence, defined as receipt of recommended follow-up test or procedure after the positive screen per ACR Lung-RADS timeframes: 6 months for Lung-RADS 3 and 3 months for Lung-RADS 4A. For Lung-RADS 4B or 4X, adherence was defined as follow-up care within 4 weeks, as ACR Lung-RADS does not specify a timeframe.ResultsAmong the 685 individuals included in this study who underwent lung cancer screening with low-dose computed tomography, 416 (60.7%) were aged at least 65 years, 123 (18.0%) were Black, 562 (82.0%) were White, and 352 (51.4%) were male. Overall adherence to recommended follow-up was 42.6% (292 of 685) and varied by Lung-RADS category: Lung-RADS 3 = 30.0% (109 of 363), Lung-RADS 4A = 49.5% (96 of 194), Lung-RADS 4B or 4X = 68.0% (87 of 128). Extending the follow-up time increased adherence: Lung-RADS 3 = 68.6% (249 of 363) within 9 months, Lung-RADS 4A = 77.3% (150 of 194) within 5 months, and Lung-RADS 4B or 4X = 80.5% (103 of 128) within 62 days. For Lung-RADS 3, recommended follow-up was less likely among those currently smoking vs those who quit (adjusted odds ratio [aOR], 0.48; 95% CI, 0.29-0.78). In Lung-RADS 4A, recommended follow-up was less likely in Black individuals vs White individuals (aOR, 0.35; 95% CI, 0.15-0.86). For Lung-RADS 4B or 4X, recommended follow-up was more likely in female individuals vs male individuals (aOR, 2.82; 95% CI, 1.09-7.28) and less likely in those currently smoking vs those who quit (aOR, 0.31; 95% CI, 0.12-0.80).Conclusions and RelevanceIn this cohort study, adherence to recommended follow-up after a positive screening examination was low but improved among nodules with a higher suspicion of cancer and after extending the follow-up timeline. However, the association of extending the follow-up time of screen-detected nodules with outcomes at the population level, outside of a clinical trial, is unknown. These findings suggest that studies to understand why recommended follow-up is lower in Black individuals, male individuals, and individuals currently smoking are needed to develop strategies to improve adherence.

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