Chest | 2021
Guideline Recommended Lung Cancer Screening Adherence is Superior with Centralized Approach.
Abstract
BACKGROUND\nIn order to fully recognize the benefit of lung cancer screening annual adherence must approach the high levels seen in the National Lung Screening Trial. Emerging data suggests annual adherence is poor and that a centralized approach to screening improves adherence.\n\n\nRESEARCH QUESTION\nIs there a difference in adherence between a centralized and decentralized approach to lung cancer screening within a hybrid program and what are predictors of adherence?\n\n\nSTUDY DESIGN\nA retrospective evaluation of a single center hybrid lung cancer screening program was conducted to compare outcomes including patient eligibility and adherence between the centralized and decentralized approach.\n\n\nMETHODS\nPatient demographics and outcomes were compared between those screened with centralized and decentralized approach and between adherent and non-adherent patients using 2-sample t-tests, chi-square tests, or ANOVA analyses, as appropriate. Annual adherence analysis was conducted utilizing data from patients who remained eligible for screening with a baseline LungRADS score of 1 or 2. Logistic regression was used to estimate the association between adherence and the primary exposure, adjusting for potential confounders.\n\n\nRESULTS\nA cohort of 1117 underwent baseline LDCT. There were 211 (19%) patients ineligible by USPSTF criteria and most (90%) were screened by the decentralized approach. Following exclusions, there were 765 patients with LungRADS 1 or 2 that remained eligible for annual screening; overall adherence was 56%, however adherence in the centralized program was 70% compared to 41% by the decentralized approach (p<0.001). Individuals screened in a decentralized approach were 73% less likely to be adherent (OR: 0.27, 95% CI; 0.19, 0.37). A greater proportion of patients with ≥ 3 comorbidities were screened outside the centralized program.\n\n\nINTERPRETATION\nThose screened utilizing a centralized approach are more likely to meet eligibility criteria for LCS and more likely to return for annual screening then those screened using a decentralized approach.