Screening Adherence in the Veterans Administration Lung Cancer Screening Demonstration Project

Tanner, Nichole T.; Brasher, Paul Bradley; Wojciechowski, Barbara; Ward, Ralph; Slatore, Christopher G.; Gebregziabher, Mulugeta; Silvestri, Gerard A.

doi:10.1016/j.chest.2020.04.063

Cited by 41 publications

(36 citation statements)

References 29 publications

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“…13,14 Nevertheless, others have reported higher estimates of adherence, up to 82%, when defining adherence as return for LDCT screening within 15 months. 12,15,16 A common feature of these studies showing higher adherence is a centralized program with a dedicated program coordinator to support tracking and follow-up of screened individuals. At an academic medical center, adherence increased from 22% to 66% after hiring of a full-time LCS program coordinator.…”

Section: Discussionmentioning

confidence: 99%

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Patterns and Factors Associated With Adherence to Lung Cancer Screening in Diverse Practice Settings

et al. 2021

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IMPORTANCEFor lung cancer screening to confer mortality benefit, adherence to annual screening with low-dose computed tomography scans is essential. Although the National Lung Screening Trial had an adherence rate of 95%, current data are limited on screening adherence across diverse practice settings in the United States. OBJECTIVE To evaluate patterns and factors associated with adherence to annual screening for lung cancer after negative results of a baseline examination, particularly in centralized vs decentralized screening programs. DESIGN, SETTING, AND PARTICIPANTS This observational cohort study was conducted at 5 academic and community-based sites in North Carolina and California among 2283 individuals screened for lung cancer between July 1, 2014, and March 31, 2018, who met US Preventive Services Task Force eligibility criteria, had negative results of a baseline screening examination (American College of Radiology Lung Imaging Reporting and Data System category 1 or 2), and were eligible to return for a screening examination in 12 months. EXPOSURES To identify factors associated with adherence, the association of adherence with selected baseline demographic and clinical characteristics, including type of screening program, was estimated using multivariable logistic regression. Screening program type was classified as centralized if individuals were referred through a lung cancer screening clinic or program and as decentralized if individuals had a direct clinician referral for the baseline low-dose computed tomography scan. MAIN OUTCOMES AND MEASURES Adherence to annual lung cancer screening, defined as a second low-dose computed tomography scan within 11 to 15 months after baseline screening. RESULTS Among the 2283 eligible individuals (1294 men [56.7%]; mean [SD] age, 64.9 [5.8] years; 1160 [50.8%] aged Ն65 years) who had negative screening results at baseline, overall adherence was 40.2% (n = 917), with higher adherence among those who underwent screening through centralized (46.0% [478 of 1039]) vs decentralized (35.3% [439 of 1244]) programs. The independent factor most strongly associated with adherence was type of screening program, with a 2.8-fold increased likelihood of adherence associated with centralized screening (adjusted odds ratio [

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Section: Discussionmentioning

confidence: 99%

“…12,15 In other studies, however, these and other demographic factors, including sex, race/ethnicity, and insurance status, have not been associated with adherence. 13,16,17 Older individuals may be more adherent because they have better health care coverage (from Medicare)…”

Section: Discussionmentioning

confidence: 99%

Patterns and Factors Associated With Adherence to Lung Cancer Screening in Diverse Practice Settings

et al. 2021

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“…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.…”

Section: Discussionmentioning

confidence: 80%

“…In breast and colon cancer screening, increased contact with the health care system has been associated with improved adherence [14,44]. Although higher comorbidity burden has been associated with reduced adherence in breast cancer screening [45], a recent study failed to identify an association between LCS adherence and comorbidity burden in a veteran population [33].…”

Section: Discussionmentioning

confidence: 99%

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

Hirsch

Barón

Risendal

et al. 2021

Journal of the American College of Radiology

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“…Despite the growing evidence, uptake of screening in the USA remains very low and in the order of 5–14% of those eligible ( Montes et al, 2007 , Zahnd and Eberth, 2019 , Richards et al, 2020 ). While there may be many reasons for this low uptake, engagement of high risk smokers remains a challenge ( Zahnd and Eberth, 2019 , Richards et al, 2020 , Fedewa et al, 2020 , Cattaneo et al, 2018 , Hirsch et al, 2019 , Tanner et al, 2020 , Lopez-Olivo et al, 2020 , Patel et al, 2012 , Young and Hopkins, 2012 , Griffiths et al, 2012 , Silvestri et al, 2007 , Kim et al, 2008 , Schnoll et al, 2003 , Hahn et al, 2006 ).…”

Section: Introductionmentioning

confidence: 99%

Utility of incorporating a gene-based lung cancer risk test on uptake and adherence in a community-based lung cancer screening pilot study

Lam

Scott

Billings

et al. 2021

Preventive Medicine Reports

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Based on the results of randomized control trials, screening for lung cancer using computed tomography (CT) is now widely recommended. However, adherence to screening remains an issue outside the clinical trial setting. This study examines the utility of biomarker-based risk assessment on uptake and subsequent adherence in a community screening study. In a single arm pilot study, current or former smokers > 50 years old with 20 + pack year history were recruited following local advertising. One hundred and fifty seven participants volunteered to participate in the study that offered an optional gene-based lung cancer risk assessment followed by low-dose CT according to a standardised screening protocol. All 157 volunteers who attended visit 1 underwent the gene-based risk assessment comprising of a clinical questionnaire and buccal swab. Of this group, 154 subsequently attended for CT screening (98%) and were followed prospectively for a median of 2.7 years. A participant’s adherence to screening was influenced by their baseline lung cancer risk category, with overall adherence in those with a positive scan being significantly greater in the “very high” risk group compared to “moderate” and “high” risk categories (71% vs 52%, Odds ratio = 2.27, 95% confidence interval of 1.02–5.05, P = 0.047). Those in the “moderate” risk group were not different to those in the “high” risk group (52% and 52%, P > 0.05). In this proof-of-concept study, personalised gene-based lung cancer risk assessment was well accepted, associated with a 98% uptake for screening and increased adherence for those in the highest risk group.

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Screening Adherence in the Veterans Administration Lung Cancer Screening Demonstration Project

Cited by 41 publications

References 29 publications

Patterns and Factors Associated With Adherence to Lung Cancer Screening in Diverse Practice Settings

Patterns and Factors Associated With Adherence to Lung Cancer Screening in Diverse Practice Settings

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

Utility of incorporating a gene-based lung cancer risk test on uptake and adherence in a community-based lung cancer screening pilot study

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