Efficacy of Interventions Intended to Increase Lung Cancer Screening Rates: A Systematic Review and Meta-analysis.

Area of Science:

• Pulmonary Medicine
• Public Health
• Clinical Trials

Background:

• Low patient participation in lung cancer screening (LCS) with low-dose computed tomography (LDCT) is a significant issue in the United States.
• Effective strategies to enhance LCS uptake are crucial for early lung cancer detection.

Purpose of the Study:

• To systematically review and evaluate the efficacy of interventions designed to increase patient participation in LCS.

Main Methods:

• A comprehensive systematic review and meta-analysis of studies published from 1946 to October 2021.
• Searched multiple databases including MEDLINE, Embase, Cochrane, and ClinicalTrials.gov.
• Included five randomized controlled trials and one prospective observational study, analyzing intention-to-treat data and assessing risk of bias.

Main Results:

• Overall, interventions did not significantly improve the proportion of LCS LDCTs performed (RR 1.30 [95% CI 0.74, 2.29]), with high heterogeneity observed (I²=91%).
• Subgroup analysis indicated that multi-step interventions, targeting multiple barriers, showed a significant benefit (RR 2.68 [95% CI 1.77, 4.05]) compared to single-step interventions (RR 0.99 [95% CI 0.89, 1.10]).
• Three of five RCTs exhibited some concerns or high risk of bias, and studies predominantly included non-diverse populations.

Conclusions:

• The evidence for interventions increasing LCS participation is limited by the small number of studies, non-diverse participant groups, and significant risk of bias.
• While overall interventions were not effective, strategies addressing multiple barriers to screening show potential for improving LCS uptake.