Lost to Follow-up: Social Determinants and Patient Perceptions in Lung Cancer Screening Adherence

Area of Science:

• Public Health
• Health Services Research
• Health Disparities

Background:

• Lung cancer screening (LCS) using Low-Dose Computed Tomography (LDCT) is proven to reduce cancer mortality but suffers from low utilization rates.
• Social determinants of health (SDOH) are increasingly recognized as critical factors influencing healthcare access and adherence.

Purpose of the Study:

• To investigate the impact of SDOH, including financial concerns, transportation barriers, and patient-provider trust, on adherence to annual LCS.
• To identify specific barriers contributing to the underutilization of LCS in an urban, safety-net academic health system.

Main Methods:

• A prospective cohort study surveyed 236 participants who initially underwent LDCT but did not adhere to annual follow-up.
• Surveys assessed demographics, financial and transportation concerns, patient-provider relationships, and experiences of racial discrimination.
• Data were analyzed using descriptive statistics, chi-square tests, and Spearman correlations to identify significant associations.

Main Results:

• Cost concerns (54.4%) and transportation access (13.3%) were major barriers to LCS adherence.
• Transportation access was significantly more limited for non-White and female participants compared to White and male participants.
• Non-White and female patients reported higher levels of trust and comfort with providers, while perceived racial discrimination was higher among non-White participants.

Conclusions:

• Despite insurance coverage, cost remains a primary barrier to LCS adherence.
• Patient-provider trust is a crucial element that can be leveraged to address individual barriers and improve LCS adherence.
• Targeted interventions addressing financial and transportation barriers are essential to increase LCS utilization and reduce lung cancer deaths.