Adherence to annual lung cancer screening with low-dose CT scan in a diverse population.

Abstract

PURPOSE\nOur aim was to develop a novel approach for lung cancer screening among a diverse population that integrates the\xa0Centers for Medicare and Medicaid Services (CMS) recommended components including shared decision making (SDM), low-dose CT (LDCT), reporting of results in a standardized format, smoking cessation, and arrangement of follow-up care.\n\n\nMETHODS\nBetween October of 2015 and March of 2018, we enrolled patients, gathered data on demographics, delivery of SDM, reporting of LDCT results using Lung-RADS, discussion of results, and smoking cessation counseling. We measured adherence to follow-up care, cancer diagnosis, cancer treatment, and smoking cessation at 2\xa0years after initial LDCT.\n\n\nRESULTS\nWe enrolled 505 patients who were 57% African American, 30% Caucasian, 13% Hispanic,\u2009<\u20091% Asian, and 61% were active smokers. All participants participated in SDM, 88.1% used a decision aid, and 96.1% proceeded with LDCT. Of 496 completing LDCT, all received a discussion about results and follow-up recommendations. Overall, 12.9% had Lung-RADS 3 or 4, and 3.2% were diagnosed with lung cancer resulting in a false-positive rate of 10.7%. All 48 patients with positive screens but no cancer diagnosis adhered to follow-up care at 1\xa0year, but only 35.4% adhered to recommended follow-up care at 2\xa0years. The annual follow-up for patients with negative lung cancer screening results (Lung-RADS 1\xa0and 2) was only 23.7% after one year and 2.8% after 2\xa0years. All active smokers received smoking cessation counseling, but only 11% quit smoking.\n\n\nCONCLUSION\nThe findings show that an integrated lung cancer screening program can be safely implemented in a diverse population, but adherence to annual screening is poor.