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Area of Science:

  • Oncology
  • Public Health
  • Health Services Research

Background:

  • Lung cancer screening (LCS) reduces mortality but adherence to follow-up is crucial.
  • Real-world data on factors influencing LCS follow-up adherence are limited.
  • Understanding adherence is key to optimizing LCS effectiveness.

Purpose of the Study:

  • To analyze adherence to standardized follow-up recommendations after LCS in a national veteran cohort.
  • To identify patient- and facility-level factors associated with delayed or absent follow-up.

Main Methods:

  • Retrospective cohort study of US Veterans Health Administration (VHA) facilities (2015-2019).
  • Analysis of adherence to Lung-RADS category-based follow-up using VHA and Medicare claims.
  • Logistic regression models to identify factors associated with follow-up adherence.

Main Results:

  • Only 63.1% of 28,294 veterans received timely follow-up after initial LCS.
  • Black veterans, those with PTSD or substance use disorders, and those with lower income or greater distance to VHA facilities had higher rates of delayed/absent follow-up.
  • Higher risk findings (Lung-RADS 4) and screening at high-volume or academic facilities were associated with better adherence.

Conclusions:

  • Timely follow-up after LCS is suboptimal, affecting less than two-thirds of patients.
  • Marginalized populations experience higher risks of delayed or absent follow-up, exacerbating existing lung cancer outcome disparities.
  • Future efforts should identify and disseminate strategies to improve adherence and promote equity in LCS.