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Factors Affecting Patient Adherence to Lung Cancer Screening
Christina Bellinger1, Kristie Foley1, Frank Genese1
1From the Division of Pulmonary and Critical Care Medicine and the Department of Public Health Sciences, Wake Forest University School of Medicine, Wake Forest Baptist Health, Winston-Salem, North Carolina, Pulmonary Medicine and Critical Care, Rochester Regional Health, Rochester, New York, the Department of Pulmonary and Critical Care Medicine, University of Rochester, Rochester, New York, and the Division of Pulmonary and Critical Care Medicine, Stony Brook University Hospital/Renaissance School of Medicine, Stony Brook, New York.
Objectives:
The National Lung Screening Trial (NLST) demonstrated a 20% reduction in mortality with low-dose computed tomography (CT) for lung cancer screening (LCS). The NLST found the greatest benefit to LCS for patients who underwent annual screening for a full 3-year follow-up period. The adherence to serial imaging in the NLST was 95%.
Methods:
We conducted a prospective study of 268 patients who presented for LCS and who were not enrolled in a research study to determine the adherence to recommended follow-up imaging and biopsy at a single center. We evaluated the correlations among sociodemographic characteristics, Lung Imaging and Reporting Data System, and adherence.
Results:
Only 48% of the patient population received recommended follow-up (either imaging or biopsy) after their referent LCS. Patients with abnormal LCS (Lung Imaging and Reporting Data System 3 or 4) were more likely to adhere to the recommended follow-up (additional imaging or biopsy) compared with those with negative screens. Sex, ethnicity, smoking status, and household income were not correlated with adherence to screening and biopsy.
Conclusions:
The benefits from LCS observed in the NLST may be undermined by low adherence to follow-up screening. Studies targeting LCS patients to bolster adherence to follow-up are needed.
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