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Published on: August 9, 2024
Diagnostic Follow-up of Positive Results on Low-Dose Computed Tomography Screening in the Medicare Population
Paul F Pinsky1, Gerard Silvestri2, Raymond Osarogiagbon3
1National Cancer Institute, Bethesda, Maryland (P.F.P., E.M., L.E., P.D.-R.).
Background:
Diagnostic evaluation of positive screening results for lung cancer is critically important for optimal outcomes. Data on such follow-up are limited.
Objective:
To assess the use of diagnostic tests after positive results on lung cancer screening in clinical practice.
Design:
Retrospective cohort study.
Setting:
U.S. institutions performing diagnostic follow-up of lung cancer screening, 2015 to 2022.
Participants:
Persons with a first positive screening result at age 65 years or older who had Medicare fee-for-service coverage.
Measurements:
Rates of diagnostic test use (imaging or invasive procedures) within 1 year of an index positive screening result and rates of receiving guideline-concordant follow-up care and of receiving less or more intensive (than guideline-concordant) care. Multiple logistic regression was used to assess factors associated with less or more intensive care.
Results:
The cohort consisted of 64 555 persons. The rate of guideline-concordant care was 59.7% overall and increased with increasing Lung-RADS score: 49.2% for a score of 3, 68.6% for 4A, 74.1% for 4B, and 79.5% for 4X. Care was less intensive than recommended in 32.3% of participants, generally decreasing with Lung-RADS score: 39.3% for a score of 3, 24.7% for 4A, 25.9% for 4B, and 20.5% for 4X. Rates of more intensive care, applicable only for scores of 3 and 4A, were 11.5% and 6.7%, respectively. Among participants with Lung-RADS scores of 3 and 4A, non-Hispanic Black persons, those who currently smoked, and those undergoing baseline screening had significantly higher rates of less intensive care. Of all participants, 12.4% had a lung cancer diagnosis within 1 year. Invasive procedures were done in 16.2% of all participants and in 7.3% of those without eventual lung cancer.
Limitations:
The cohort was limited to those in fee-for-service Medicare plans. Information on institutional and patient socioeconomic factors was limited.
Conclusion:
About 60% of participants had guideline-concordant care, and about one third had less intensive care. Invasive procedure rates in those without cancer were low.
Primary Funding Source:
None.
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