Consecutive Negative Lung Cancer Screening Results Breed Nonadherence to Follow-up

A recent study showed that people who had negative results on consecutive lung cancer screening tests were less likely to adhere to follow-up recommendations. These study findings were reported in JAMA Network Open.

This single-center study was a retrospective cohort analysis conducted by researchers at the University of California, Los Angeles that involved lung cancer screening across 10 sites around the US. Participants underwent at least 1 screening for lung cancer detection during the period from July 31, 2013, to November 30, 2021, with low-dose computed tomography (LDCT) analysis. Nonadherence to follow-up Lung Computed Tomography Screening Reporting & Data System (Lung-RADS) recommendations was the main outcome of the study, involving various follow-up time points.

A total of 1979 participants were included in the analysis. More than half (56.1%) were aged at least 65 years at baseline screening. Those whose baseline Lung-RADS score was 1 or 2 showed higher odds of being nonadherent with follow-up recommendations than did patients with higher baseline Lung-RADS scores. Nonadherence rates were 70.5% with a score 1 or 2, 46.1% with a score of 3, 32.3% with a score of 4A, and 19.7% with a score of 4B/X.

Compared with patients who had a Lung-RADS score of 1 or 2, the adjusted odds ratio (aOR) for nonadherence was 0.35 (95% CI, 0.25-0.50; P <.001) for those with a score of 3, 0.21 (95% CI, 0.13-0.33; P <.001) for those with a score of 4A, and 0.10 for those with a score of 4B/X (95% CI, 0.05-0.19; P <.001).

Participants with a postgraduate degree were also less likely to be nonadherent to recommendations compared with those with a college degree. Additional baseline patient characteristics associated with lower odds of nonadherence included a family history of lung cancer vs no family history, a higher age-adjusted Charlson Comorbidity Index score, a high- vs low-income category, and referral for screening by a physician from a pulmonary/thoracic-related department rather than another department.

However, in a subset of 830 patients who had undergone 2 or more screenings, nonadherence to recommendations after the second screening was more likely in patients with consecutive Lung-RADS scores of 1 or 2 (aOR, 1.38; 95% CI, 1.12-1.69).

“Patients with consecutive negative screening results were at the greatest risk of being nonadherent to a subsequent screening,” the study investigators concluded in their report.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Lin Y, Liang LJ, Ding R, Prosper AE, Aberle DR, Hsu W. Factors associated with nonadherence to lung cancer screening across multiple screening time points. JAMA Netw Open. 2023;6(5):e2315250. doi:10.1001/jamanetworkopen.2023.15250