Patient Adherence to Screening for Lung Cancer in the US: A Systematic Review and Meta-analysis

[..] We included studies that reported LCS [lung cancer screening] adherence rates in the US and/or determinants of LCS adherence. We considered prospective or retrospective studies that screened adult patients at any risk level of developing cancer who opted to initiate LCS and continued to undergo additional screening after the first LDCT (low-dose computed tomography).

[..] Fifteen studies (19 publications) involving a total of 16 863 individuals were included in this systematic review.

[..] 12 studies (80%) did not have a follow-up time that was long enough to adequately assess periodic adherence beyond 1 year. All of the studies reported loss-to-follow-up rates greater than 20%.

[..] The pooled LCS adherence rate across all follow-up periods was 55% (95% CI, 44%-66%). Screening adherence rates across studies ranged from 12% (95% CI, 8%-20%) to 91% (95% CI, 88%-93%). [..] Four studies reported screening adherence 12 months after baseline scan; the pooled rate for those studies was 30% (95% CI, 18%-44%). Six studies reported adherence 15 months after baseline scan; the pooled rate was 70% (95% CI, 55%-84%). Two studies reported adherence 18 months after baseline scan; the pooled rate was 68% (95% CI, 45%-88%). Reports of adherence at 24 and 36 months were provided by 1 study (38% at 24 months and 28% at 36 months were eligible for subsequent screening based on completing the previous year’s scan).

[..] Given the overall low rates of cancer screening adherence within the US population and among high-risk individuals, it is not surprising that LCS adherence was lower than that seen within the controlled setting of clinical trials. Results from the 2018 Behavioral Risk Factor Surveillance System survey indicate that approximately 68.8% of eligible adults in the US are up to date on colon cancer screening, an increase from previous years. According to data from the 2018 National Health Interview Survey, approximately 70% of the eligible population of women underwent breast cancer screening within the past 2 years and approximately 80% of eligible women received cervical cancer screening; this finding sharply contrasts with the 5.9% of eligible adults who underwent LCS in 2015. However, these estimates reflect only whether an individual has undergone screening within a window recommended by screening guidelines and are not indicators of long-term adherence.

The higher screening uptake and adherence rates for colon and breast cancer compared with lung cancer are the results of these tests being available and recommended for many years, and a great deal of effort has gone into educating patients, working with practitioners, and understanding factors that relate to screening behaviors. In contrast, LDCT for LCS is a relatively nascent field with most intervention efforts still focusing on increasing uptake and acceptability among patients and practitioners rather than promoting the importance of annual adherence.”

Full article, Lopez-Olivo MA, Maki KG, Choi NJ et al. JAMA Network Open 2020.11.16