Longitudinal Adherence to Recommended Lung Cancer Screening Follow-up: A Multicenter Cohort Study
Recommended Citation
Kim RY, Rendle KA, Mitra N, Neslund-Dudas C, Greenlee RT, Burnett-Hartman AN, Honda SA, Simoff MJ, Schapira MM, Croswell JM, Jeon J, Meza R, Ritzwoller DP, Vachani A. Longitudinal Adherence to Recommended Lung Cancer Screening Follow-up: A Multicenter Cohort Study. Am J Respir Crit Care Med 2024; 209:A4955.
Document Type
Conference Proceeding
Publication Date
6-1-2024
Publication Title
Am J Respir Crit Care Med
Abstract
RATIONALE: Disparities in lung cancer screening (LCS) adherence by type of screening program and patient race across one round of LCS have previously been identified. However, real-world data are limited regarding adherence to LCS recommendations across multiple rounds of screening. We sought to determine adherence to Lung Imaging Reporting and Data System (Lung- RADS) recommendations across two rounds of LCS, stratified by program centralization and patient race. METHODS: We performed a multicenter retrospective cohort study of 55-75 year-old patients who formerly or currently smoked and received baseline LCS (T0) between 1/1/2015 and 6/30/2019 at healthcare systems within the Population-based Research to Optimize the Screening Process (PROSPR)-Lung Consortium. We collected electronic health record and billing data to calculate adherence to Lung-RADS recommendations across two LCS rounds (T1, T2) via a previously validated approach. Among individuals adherent at T1, T2 adherence was determined based on T1 Lung-RADS score if available or any follow-up chest CT or relevant diagnostic procedure within 15 months of T1. We used descriptive statistics and stratified multivariable modified Poisson regression models to assess differences in T2 adherence by LCS program type and patient race. RESULTS: Of the 12,310 individuals receiving LCS (median age: 65 years [IQR: 60-69 years]; 73.2% White; 14.1% Black), 7,755 (63.0%) were screened at decentralized and 4,555 (37.0%) at centralized programs. Adherence to Lung-RADS recommendations was higher at centralized compared to decentralized programs at both T1 (72.3% vs 41.4%; P<0.001) and T2 (74.0% vs 63.0%; P<0.001). Among the 6,506 individuals adherent at T1, there was no significant difference in T2 adherence by race at either decentralized (Black: 60.9% vs White: 63.5%; P=0.254) or centralized programs (Black: 74.7% vs White: 72.3%; P=0.599). Overall adjusted T2 adherence rates for Black and White patients were 54.5% vs 56.6% (P=0.138) and 86.9% vs 84.1% (P=0.095) at decentralized and centralized programs, respectively (Figure). When stratifying by baseline Lung-RADS score and controlling for all measured confounders, there was no difference in T2 adherence by race, except for slightly higher adherence among Black compared to White patients screened at centralized programs with positive baseline screens (adjusted risk ratio: 1.17 [95% CI: 1.05-1.31]). CONCLUSIONS: LCS program centralization is associated with increased longitudinal LCS adherence to Lung-RADS recommendations across two rounds of LCS. We did not observe any significant racial disparities in longitudinal LCS adherence among individuals who were adherent during the first round of screening, regardless of baseline screening result or program centralization.
Volume
209
First Page
A4955
