Racial Disparities in Adherence to Annual Lung Cancer Screening and Recommended Follow-Up Care: A Multicenter Cohort Study

Kim, Roger Y.; Rendle, Katharine A.; Mitra, Nandita; Saia, Chelsea; Neslund‐Dudas, Christine; Greenlee, Robert T.; Burnett‐Hartman, Andrea N.; Honda, Stacey; Simoff, Michael; Schapira, Marilyn M.; Croswell, Jennifer M.; Meza, Rafael; Ritzwoller, Debra P.; Vachani, Anil

doi:10.1513/annalsats.202111-1253oc

Cited by 36 publications

(16 citation statements)

References 48 publications

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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%

“…Receipt of Recommended Follow-up Care After a Positive Lung Cancer Screening Examination Differences in how studies define adherence (ACR Lung-RADS recommended follow-up time vs extended time interval vs any follow-up during an observed time interval) to recommended follow-up either with repeat imaging or biopsy after the screening LDCT has led to substantial variability in the reporting of adherence rates. 19 In a recent study by Kim et al, 23 the overall adherence rate for recommended follow-up after a positive LDCT was 69.9%. The authors used a follow-up timeline from the index LDCT of 4 to 9 months for Lung-RADS 3, 1 to 5 months for Lung-RADS 4A, and within 5 months for Lung-RADS 4B or 4X.…”

Section: Jama Network Open | Oncologymentioning

confidence: 95%

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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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Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Oncologymentioning

confidence: 95%

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

et al. 2022

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“…However, screening uptake is far lower than 100% in real-world settings and varies widely by state ( 71 ) and smoking status, with higher uptake among former smokers ( 72 ). Adherence to recommended annual lung cancer screening and follow-up care also differ by race, baseline screening results, and type of lung screening programs ( 73 ). Hence, it will be important to evaluate the impact of real-world implementation of joint screening and cessation programs in the future.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of a Telephone-Based Smoking Cessation Randomized Trial in the Lung Cancer Screening Setting

Cao

Smith

Mandelblatt

et al. 2022

JNCI Cancer Spectrum

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Background There are limited data on the cost-effectiveness of smoking cessation interventions in lung cancer screening settings. We conducted an economic analysis embedded in a national randomized trial of two telephone counseling cessation interventions. Methods We used a societal perspective to compare the short-term cost per 6-month bio-verified quit and long-term cost-effectiveness of the interventions. Trial data were used to micro-cost intervention delivery, and the data were extended to a lifetime horizon using an established Cancer Intervention Surveillance and Modeling Network lung cancer model. We modeled the impact of screening accompanied by 8-weeks vs. 3-weeks of telephone counseling (plus nicotine replacement) vs. screening alone based on 2021 screening eligibility. Lifetime downstream costs (2021 dollars) and effects (life-years gained, quality-adjusted life-years saved [QALYs]) were discounted at 3%. Sensitivity analyses tested the effects of varying quit rates and costs; all analyses assumed non-relapse after quitting. Results The costs for delivery of the 8-week vs. 3-week protocol were $380.23 vs. $144.93 per person and quit rates were 7.14% vs. 5.96%, respectively. The least costly strategy was a 3-week counseling approach. An 8-week (vs. 3-week) counseling approach increased costs but gained QALYs for an incremental cost-effectiveness ratio of $4,029 per QALY. Screening alone cost more and saved fewer QALYs than either counseling strategy. Conclusions were robust in sensitivity analyses. Conclusions Telephone-based cessation interventions with nicotine replacement are considered cost-effective in the lung screening setting. Integrating smoking cessation interventions with lung screening programs has the potential to maximize long-term health benefits at reasonable costs.

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“…Our recent study of 28,294 veterans found that both Lung-RADS 3 and 4 findings occurred more than twice as frequently on initial LCS examinations as reported in Lung-RADS v1.1 (Lung-RADS 3: 14% versus 5%, Lung-RADS 4: 10% versus 4%) [6]. Other studies have similarly found a higher prevalence of Lung-RADS 3 and 4 findings than what is estimated in Lung-RADS v1.1 (Table 1) [7,8]. It seems that screening-detected findings are more common in populations of real-world patients undergoing LCS, likely due to the greater burden of comorbid illness and heavier smoking histories relative to trial participants.…”

mentioning

confidence: 82%

Time to Update Lung-RADS v1.1? Incorporating evidence from recent observational studies

Núñez

Gould²,

Wiener³

2023

Journal of the American College of Radiology

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Racial Disparities in Adherence to Annual Lung Cancer Screening and Recommended Follow-Up Care: A Multicenter Cohort Study

Cited by 36 publications

References 48 publications

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

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

Cost-Effectiveness of a Telephone-Based Smoking Cessation Randomized Trial in the Lung Cancer Screening Setting

Time to Update Lung-RADS v1.1? Incorporating evidence from recent observational studies

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