Predictors of participant nonadherence in lung cancer screening programs: a systematic review and meta-analysis

Patient Adherence to Screening for Lung Cancer in the US

“…Furthermore, patients have reported feeling as though some health care professionals do not understand how their smoking was affected by the culture and period in which they have lived. 50 White people were more likely to adhere to periodic LCS than people of other races, a finding consistent with disparities seen by others 49 and for other cancer screenings and diagnostic testing. 52,53 Reasons for this disparity are unclear and may relate to insurance status and access to screening facilities, among other factors.…”

“…This finding aligns with previous research reporting lower rates of cancer screening among eligible current smokers (compared with never smokers). 48,49 Stigma may be a key barrier for LCS, with patients feeling judged and blamed and therefore delaying early screening. 50 Prior work 51 suggests that lung cancer stigma is a multilayered issue that spans individual and societal levels and includes placing blame on the individual for smoking as well as public attitudes and policies.…”

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

“…Early descriptions of LCS adherence determinants [31,32] came from clinical trials performed before clear proof that LCS reduced mortality and are difficult to contextualize in an environment in which LCS is a preventive service delivered in community settings and is now covered by most insurance plans. More recent studies in academic [23][24][25][26][27], community [22], or federal health [33] settings have emerged, but no prior studies have used insurance claims to assess LCS adherence [20,21]. Using longitudinal claims data, we found that ages 55 to 64 and 75 to 79, rural residence, and Medicare FFS and Medicaid insurance are associated with reduced adherence to annual LCS.…”

“…Determinants of cancer screening adherence are multifaceted and include both individual factors (demographics, income, beliefs) and health care system factors (insurance, accessibility, clinician recommendation) [10][11][12][13][14][15][16][17][18][19][20][21]. Early reports of real-world screening cohorts describe LCS annual adherence rates outside clinical trials between 37% and 66% [22][23][24][25][26][27].…”

“…Early reports of real-world screening cohorts describe LCS annual adherence rates outside clinical trials between 37% and 66% [22][23][24][25][26][27]. Recent systemic reviews and metaanalyses found higher adherence in participants in their 60s and former (as opposed to current) smokers and lower adherence in racial minorities, individuals with less education, and individuals who lived further from the screening facility [20,21]. However, the quality of evidence supporting most of these associations was moderate or low, and the evidence was largely derived from cohort studies performed in academic settings before the CMS decision to cover screening in the high-risk population defined by the National Lung Screening Trial [20,21].…”