Centralized lung cancer screening programs boost adherence

2020 11 11 23 52 7893 Lung Cancer Ct 3d 400

Referral to a centralized CT lung cancer screening program appears to boost adherence to repeat rounds of screening, even if the initial CT scan is negative, according to a study published April 30 in JAMA Network Open.

The study results point to an effective way to tackle the follow-through problem for CT lung cancer screening, wrote a team led by Lori Sakoda, PhD, of Kaiser Permanente Northern California in Oakland, CA.

"[Our] results support the value of centralized screening programs and the need to further implement strategies that improve adherence to annual screening for lung cancer," the group noted.

Annual low-dose CT lung cancer screening is considered beneficial, and its uptake has been increasing. In fact, in March, the U.S. Preventive Services Task Force (USPSTF) expanded the pool of people eligible for lung cancer screening, lowering the starting age from 55 to 50 and adjusting smoking history from 30 pack years to 20 pack years.

But even if more individuals are eligible, lung cancer screening is only successful if people return for regular screening.

Sakoda's team investigated patterns and factors associated with CT lung cancer screening adherence in people with an initial negative exam. Their study included data from 2,283 people who underwent baseline CT exams between July 2014 and March 2018 at one of five academic and community-based sites in North Carolina and California. Of these, 1,160 had negative screening results at this initial exam.

The researchers examined the study data through the lens of "centralized" versus "decentralized" screening programs, defining a centralized program as one to which a person was referred through a lung cancer screening clinic, and a decentralized program as a direct clinician-to-patient referral.

Of the 1,160 people with negative baseline CT, the overall repeat screening rate was 40.2%. But those who underwent repeat screening through a centralized program had higher adherence than those who underwent screening after being referred by their clinician.

Repeat screening adherence after negative baseline lung cancer CT by type of program
Factor Overall Decentralized program Centralized program
Adherence 40.2% 35.3% 46%

Of concern, the group also found that people screened through a decentralized program were more likely to be Black or people of color, previous smokers, urban dwellers, and to have a history of chronic obstructive pulmonary disease.

"Our data raise some concern that individuals from racial/ethnic minority groups may have lower rates of adherence to lung cancer screening, particularly when they are screened through a decentralized program," the team noted. "Among minority groups, the lowest adherence was noted for Asian individuals. This disparity most likely arose from barriers in communication between patients and clinicians because adherence was substantially lower for those having a preferred language other than English."

This last finding underscores the need for targeted interventions, according to Sakoda and colleagues.

"Given the importance of high adherence to follow-up lung cancer screening, further work is needed to evaluate multilevel barriers to screening adherence, as well as to develop and implement effective interventions to overcome them," they concluded.

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