In a single-institution retrospective cohort study reported in JAMA Network Open, Lin et al identified factors associated with nonadherence to lung cancer screening recommendations among patients undergoing screening—and found that negative findings on two successive screenings were associated with subsequent nonadherence.
As stated by the investigators, “Screening with low-dose computed tomography (CT) has been shown to reduce mortality from lung cancer in randomized clinical trials in which the rate of adherence to follow-up recommendations was over 90%; however, adherence to Lung Computed Tomography Screening Reporting & Data System (Lung-RADS) recommendations has been low in practice.”
Study Details
The study enrolled 1,979 patients who underwent low-dose CT screening at a single U.S. academic medical center (University of California, Los Angeles) across 10 geographically distributed sites where screening is offered between July 2013 and November 2021. The main outcome measure was nonadherence to follow-up recommendations for screening, defined as failing to complete a recommended or more invasive follow-up examination (ie, diagnostic dose CT, positron-emission tomography/CT, or tissue sampling vs low-dose CT) within 15 months for Lung-RADS scores of 1 or 2; 9 months for a Lung-RADS score of 3; 5 months for a score of 4A; or 3 months for a score of 4B/X.
Key Findings
Patients with a baseline Lung-RADS score of 1 or 2 had lower odds of being nonadherent vs those with a score of 3 (adjusted odds ratio [aOR] = 0.35, 95% confidence interval [CI] = 0.25–0.50), a score of 4A (aOR = 0.21, 95% CI = 0.13–0.33), or a score of 4B/X (aOR = 0.10, 95% CI = 0.05–0.19).
Lower odds of being nonadherent were also observed for those with a postgraduate vs college degree (aOR = 0.70, 95% CI = 0.53–0.92); a family history of lung cancer vs no family history (aOR = 0.74, 95% CI = 0.59–0.93); a high (≥ 4) age-adjusted Charlson Comorbidity Index score vs low (0–1) score (aOR = 0.67, 95% CI = 0.46–0.98); a high vs low income category (aOR = 0.79, 95% CI = 0.65–0.98); and a referral by physicians from pulmonary or thoracic-related departments vs another department (aOR = 0.56, 95% CI = 0.44–0.73).
Among 830 patients who had completed at least two screening examinations, the odds of being nonadherent to Lung-RADS recommendations at the following screening were increased in those with consecutive Lung-RADS scores of 1 to 2 (aOR = 1.38, 95% CI = 1.12–1.69).
The investigators concluded, “In this retrospective cohort study, patients with consecutive negative lung cancer screening results were more likely to be nonadherent with follow-up recommendations. These individuals are potential candidates for tailored outreach to improve adherence to recommended annual lung cancer screening.”
Yannan Lin, MD, MPH, of the Department of Bioengineering, University of California, Los Angeles, is the corresponding author for the JAMA Network Open article.
Disclosure: The study was funded by the V Foundation, grants from the National Institutes of Health, and others. For full disclosures of the study authors, visit jamanetwork.com.
