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Observational Study
. 2021 Apr 1;4(4):e218559.
doi: 10.1001/jamanetworkopen.2021.8559.

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

Affiliations
Observational Study

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

Lori C Sakoda et al. JAMA Netw Open. .

Abstract

Importance: For 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 ≥65 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 [aOR], 2.78; 95% CI, 1.99-3.88). Another associated factor was age (65-69 vs 55-59 years: aOR, 1.38; 95% CI, 1.07-1.77; 70-74 vs 55-59 years: aOR, 1.47; 95% CI, 1.10-1.96).

Conclusions and relevance: After negative results of a baseline examination, adherence to annual lung cancer screening was suboptimal, although adherence was higher among individuals who were screened through a centralized program. These results support the value of centralized screening programs and the need to further implement strategies that improve adherence to annual screening for lung cancer.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Sakoda, Rivera, and Henderson, Mr Huamani Velasquez, and Ms Lane reported receiving grants from the National Institutes of Health/National Cancer Institute during the conduct of the study. Dr Sakoda reported receiving grants from Kaiser Permanente during the conduct of the study and serving as an invited member of 2 task groups for the National Lung Cancer Roundtable. Dr Rivera reported serving as a member of the advisory panel for bioAffinity Tech and Biodesix and serving as a consultant for Johnson & Johnson outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Percentage Distribution of Time from Baseline to Next Low-Dose Computed Tomography Screening Examination, Overall and by Type of Screening Program
Figure 2.
Figure 2.. Factors Associated With Adherence After Negative Results of Baseline Low-Dose Computed Tomography Examination
COPD indicates chronic obstructive pulmonary disease; and OR, odds ratio. aAssociations for each factor adjusted for all other factors shown and for screening site.

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References

    1. Moyer VA; U.S. Preventive Services Task Force . Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(5):330-338. doi:10.7326/M13-2771 - DOI - PubMed
    1. Centers for Medicare & Medicaid Services . Decision memo for screening for lung cancer with low dose computed tomgraphy (LDCT) (CAG-00439N). Accessed February 17 2021. https://cms.gov/medicare-coverage-database/details/nca-decision-memo.asp...
    1. Wood DE, Kazerooni EA, Baum SL, et al. Lung cancer screening, version 3.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018;16(4):412-441. doi:10.6004/jnccn.2018.0020 - DOI - PMC - PubMed
    1. Aberle DR, Adams AM, Berg CD, et al. ; National Lung Screening Trial Research Team . Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. doi:10.1056/NEJMoa1102873 - DOI - PMC - PubMed
    1. de Koning HJ, van der Aalst CM, de Jong PA, et al. . Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med. 2020;382(6):503-513. doi:10.1056/NEJMoa1911793 - DOI - PubMed

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