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An Evaluation of Annual Adherence to Lung Cancer Screening in a Large National Cohort

  • Harrison B. Smith
    Affiliations
    Thoracic Oncology Research Group (TORG), Division of Pulmonary and Critical Care, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
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  • Erika Schneider
    Affiliations
    Eon, Denver, Colorado
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  • Nichole T. Tanner
    Correspondence
    Address correspondence to: Nichole T. Tanner, MD, Clinical Sciences Building, CSB, 96 Jonathan Lucas Street, 8th floor, Suite 816, MSC Code 630, Charleston SC 29425.
    Affiliations
    Thoracic Oncology Research Group (TORG), Division of Pulmonary and Critical Care, College of Medicine, Medical University of South Carolina, Charleston, South Carolina

    Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
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      Introduction

      Lung cancer screening reduces mortality in large RCTs where adherence is high. Unfortunately, recently published adherence rates do not replicate those seen in trials. Previous publications support a centralized approach to ensure patient eligibility and improve adherence.

      Methods

      Investigators reviewed a large, geographically diverse cohort of patients from 14 health systems, with 73 centers across the U.S. Lung cancer screening patients were screened from 2015 to 2019 and tracked utilizing a commercial system. Data were analyzed in 2019–2021. Demographics, eligibility, imaging results, and cancer diagnosis were collected. Overall return was calculated for 2 years (Time 0–Time 1 and Time 1–Time 2) on the basis of follow-up through March 31, 2020. Only U.S. Preventive Services Task Force–eligible patients with a normal or benign result (Lung-Reporting and Data System 1 or 2) at baseline (Time 0) were included in annual adherence calculations.

      Results

      A total of 30,166 patients were screened; 50% were male, with a mean age of 65 years. Most individuals currently smoked (58.3%), with an average of 48.3 pack years. A total of 58% were White, 6% were Black, and 34% had race information unavailable. U.S. Preventive Services Task Force eligibility criteria were not met by 10.6%. Of the 26,958 patients eligible at baseline, 76% were Lung-Reporting and Data System 1 or 2. Annual adherence at Year 1 (Time 0–Time 1) was 48.4%. Adherence at Year 2 (Time 1–Time 2) was 44.4%. A total of 93 U.S. Preventive Services Task Force‒eligible patients were diagnosed with lung cancers, mostly during the first annual follow-up.

      Conclusions

      In this large cohort screened and managed primarily using a commercial tracking platform, most patients were U.S. Preventive Services Task Force eligible. However, annual adherence was poor despite this resource, suggesting that additional interventions are needed to recognize the full mortality benefit from screening programs.
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