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

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Abstract

Purpose

Our aim was to develop a novel approach for lung cancer screening among a diverse population that integrates the Centers 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.

Methods

Between 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 years after initial LDCT.

Results

We enrolled 505 patients who were 57% African American, 30% Caucasian, 13% Hispanic, < 1% 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 year, but only 35.4% adhered to recommended follow-up care at 2 years. The annual follow-up for patients with negative lung cancer screening results (Lung-RADS 1 and 2) was only 23.7% after one year and 2.8% after 2 years. All active smokers received smoking cessation counseling, but only 11% quit smoking.

Conclusion

The findings show that an integrated lung cancer screening program can be safely implemented in a diverse population, but adherence to annual screening is poor.

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Acknowledgments

This project was partially supported by TUFCCC/HC Regional Comprehensive Cancer Health Disparity Partnership, Award Number U54 CA221704(5) from the National Cancer Institute of National Institutes of Health (NCI/NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCI/NIH.

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Authors and Affiliations

  1. Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Parkinson Pavilion, Zone C, Suite 501, 3401 N. Broad Street, Philadelphia, PA, 19140, USA

    Cherie P. Erkmen & Larry R. Kaiser

  2. Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, USA

    Farouk Dako & Chandra Dass

  3. Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, USA

    Ryan Moore

  4. Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, USA

    Mark G. Weiner & Grace X. Ma

  5. Center for Asian Health, Lewis Katz School of Medicine at Temple University, Kresge Science Hall, Suite 320, 3440 N. Broad Street, Philadelphia, PA, 19140, USA

    Cherie P. Erkmen & Grace X. Ma

Authors
  1. Cherie P. Erkmen
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  2. Farouk Dako
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  5. Mark G. Weiner
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  7. Grace X. Ma
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Correspondence to Grace X. Ma.

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Erkmen, C.P., Dako, F., Moore, R. et al. Adherence to annual lung cancer screening with low-dose CT scan in a diverse population. Cancer Causes Control 32, 291–298 (2021). https://doi.org/10.1007/s10552-020-01383-0

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  • DOI: https://doi.org/10.1007/s10552-020-01383-0

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