Patient motivations for non-adherence to lung cancer screening in a military population

Abstract

Background: Lung cancer remains the leading cause of cancer deaths in the United States, and lung cancer screening has been shown to decrease this mortality. Adherence to lung cancer screening is paramount to realize the mortality benefit, and reported adherence rates vary widely. Few reports address non-adherence to screening, and our study sought to understand the non-compliant patients in our military population. Methods: This Institutional Review Board approved retrospective review of patients enrolled in our screening program from 2013-2019 identified patients who failed to obtain a subsequent Low Dose CT scan (LDCT) within 15 months of their prior scan. Attempts were made to contact these patients and elucidate motivations for non-adherence via telephone. Results: Of the 242 patients enrolled, 183 (76%) patients were adherent to the protocol. Significant predictors of non-adherence versus adherence were younger age (P=0.008), female sex (P=0.005), and enlisted officer rank (P=0.03). There was no difference with regards to race, smoking status, pack-years, negative screens, lung-RADS level, or nodule size. 31 (52%) non-adherent patients were contacted, and 24 (77%) reported their reason for non-adherence was lack of follow-up for a LDCT. Twenty (64%) were interested in re-enrollment. Of the total screening cohort, 15 interventions were performed, with lung cancer identified in 5 (2%)-a 67% false positive rate. One stage IV lung cancer was found in a non-adherent patient who re-enrolled. Conclusions: Lack of perceived contact for follow-up was expressed as the primary reason for noncompliance in our screening program. Compliance is critical to the efficacy of any screening modality, and adherence rates to lung cancer screening may be increased through improved contact with patients via multiple avenues (i.e., phone, email, and letter). There is benefit in contacting non-adherent patients as high rates of re-enrollment are possible.

Patient Adherence to Lung CT Screening Reporting & Data System–Recommended Screening Intervals in the United States: A Systematic Review and Meta-Analysis

“…Among the 557 references that underwent title and abstract screen, 510 studies were irrelevant to LCS adherence. Of the 47 studies that underwent full-text review, 24 studies 3,4,[12][13][14][15][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] were included in qualitative synthesis, whereas 21 3,4,[12][13][14][15]26,27,[29][30][31][32][33][34][35][36][37][38][39][40]42 studies were eligible for quantitative synthesis (meta-analysis) (Fig. 1).…”

“…In the meta-analysis, we focused on the adherence rate at the first screen or examination after the T0 screen, because there was insufficient data on the adherence rates at the second annual incidence screen or beyond. We contacted the authors of the four studies [12][13][14][15] to clarify which time intervals formed the basis for their calculated adherence rates. We received responses from all authors.…”

“…The characteristics of the 24 included studies 3,4,[12][13][14][15][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] are summarized in Table 1. Among the 24 studies, the distribution of institutional settings was 17 academic, [12][13][14]25,27,[30][31][32][33][34][35][36][37][38][40][41][42] four community, 3,4,26,29 two Kaiser Permanente, 28,39 and one Veterans Affairs, 15 with most being ---2021…”

“…Adherence to Lung-RADS Recommendations' retrospective studies. 3,4,[12][13][14][15][25][26][27][28][29][30][32][33][34][36][37][38][39][40][41][42] The study period varied for each individual study. Eligibility criteria for LCS mentioned in the studies included guidelines from the American Association for Thoracic Surgery, 12 American Cancer Society, 12 Centers for Medicare and Medicaid Services, 29,31,34 National Comprehensive Cancer Network, 12,14,30,31,33,37 National Cancer Institute, 12 NLST, 4,35,38 and the United States Preventive Services Task Force.…”

“…Eligibility criteria for LCS mentioned in the studies included guidelines from the American Association for Thoracic Surgery, 12 American Cancer Society, 12 Centers for Medicare and Medicaid Services, 29,31,34 National Comprehensive Cancer Network, 12,14,30,31,33,37 National Cancer Institute, 12 NLST, 4,35,38 and the United States Preventive Services Task Force. 12,15,27,31,37,41 There were 20 studies 4,12,14,15,[25][26][27][29][30][31][33][34][35][36][37][38][39][40][41][42] that described LCS program resources, which included program coordinators/navigators, shared decision-making services, smoking cessation services, and use of a dedicated clinical LCS database. Additional details are reported in Supplementary Table 7, such as publication type, additional inclusion criteria, exclusion criteria, referral types, retrospective assignment of Lung-RADS scores, adherence determination for certain subgroups (e.g., died or became ineligible during follow-up), and reasons for nonadherence.…”