Adherence to Annual Lung Cancer Screening Needs Improvement

October 3, 2018 —A study of adherence to annual low-dose computed tomography (LDCT) screening within the Veteran Health Administration Lung Cancer Screening Demonstration Project (LCDSDP) revealed only 77.6 percent of those eligible for annual repeat scans returned. The study, from the Thoracic Oncology Research Group (TROG), Division of Pulmonary Critical Care, Medical University of South Carolina, will be presented at the CHEST Annual Meeting 2018, Oct. 6-10 in San Antonio.

A discussion will also take place highlighting the latest updates made to the CHEST Lung Cancer Screening Guidelines.

The original project was conducted from July 1, 2013 through June 30, 2015 at eight geographically diverse Veterans Affairs hospitals. Screening was performed in current and former smokers (quit within the past 15 years) ages 55-80 with at least a 30-pack year smoking history. Researchers utilized data generated from the LCSDP and 18 months following its completion stored in the VHA Corporate Data Warehouse. Adherence to screening was defined as it was in the National Lung Screening Trial as having undergone a follow-up LDCT within 15 months from baseline scan.

A total of 2,106 Veterans underwent a baseline LDCT across all sites; 60 percent had scans negative for nodules greater than or equal to 4mm in size and repeat annual LDCT was recommended. In this group with a negative baseline scan, 149 were considered no longer eligible for screening because they:

• Had been diagnosed with lung cancer;
• Were undergoing evaluation for cancer;
• No longer met the target age or years of cessation;
• Were considered to have other life-limiting disease; or
• Were no longer interested in participating.

Of the 1,120 remaining eligible for repeat annual LDCT, 880 went on to undergo the follow-up scan yielding a 77.6 percent adherence rate from annual screening in those with a normal baseline scan.

"Our study demonstrates that even within the context of a well-designed, implemented and guideline adherent LDCT screening program, adherence is not optimal and does not reach the reported 95 percent of the NLST when the baseline scan is negative," said lead researcher Paul B. Brasher, M.D. "Both mortality benefit and cost-efficacy are likely to suffer without better adherence."

Study abstracts can be viewed on the journal CHEST website.1

For more information: www.journal.chestnet.org

Reference

1. Brasher P., Tanner N., Yeager D., Silvestri G. Adherence to Annual Lung Cancer Screening Within the Veterans Health Administration Lung Cancer Screening Demonstration Project. CHEST, October 2018. DOI: https://doi.org/10.1016/j.chest.2018.08.576