Patient Adherence to Screening for Lung Cancer in the US

Abstract

IMPORTANCE To be effective in reducing deaths from lung cancer among high-risk current and former smokers, screening with low-dose computed tomography must be performed periodically. OBJECTIVE To examine lung cancer screening (LCS) adherence rates reported in the US, patient characteristics associated with adherence, and diagnostic testing rates after screening.

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

“…Our observation that individuals 65 to 70 years old are most adherent to LCS is relatively consistent with recent LCS adherence meta-analyses that found that individuals 60 to 75 years old are most adherent [20,21]. Reduced adherence among older individuals is likely explained by multiple recommendations to stop LCS as individuals reach their mid-70s [5,[34][35][36][37], and an increasing proportion of patients who may have a shorter life expectancy and hence derive less screening benefit [38].…”

“…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.…”

“…Determinants of cancer screening adherence are multifaceted and include both individual factors (demographics, income, beliefs) and health care system factors (insurance, accessibility, clinician recommendation) [10][11][12][13][14][15][16][17][18][19][20][21]. Early reports of real-world screening cohorts describe LCS annual adherence rates outside clinical trials between 37% and 66% [22][23][24][25][26][27].…”

“…Early reports of real-world screening cohorts describe LCS annual adherence rates outside clinical trials between 37% and 66% [22][23][24][25][26][27]. Recent systemic reviews and metaanalyses found higher adherence in participants in their 60s and former (as opposed to current) smokers and lower adherence in racial minorities, individuals with less education, and individuals who lived further from the screening facility [20,21]. However, the quality of evidence supporting most of these associations was moderate or low, and the evidence was largely derived from cohort studies performed in academic settings before the CMS decision to cover screening in the high-risk population defined by the National Lung Screening Trial [20,21].…”

The 2021 US Preventive Services Task Force Recommendation on Lung Cancer Screening

“…The models assumed that 100% of eligible people would participate in LCS and that they would be 100% adherent-an assumption that has not been borne out in practice, where uptake of LCS hovers at 5% and reported adherence varies between 12% and 91%. 12,13 Moreover, uptake and adherence are very unlikely to be equally distributed across all groups. In fact, national data from the Veterans Health Administration suggests that marginalized groups, such as Black veterans and those with mental health comorbidities, are less likely to receive recommended follow-up after initial screening in a timely fashion.…”