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Meta-Analysis
. 2020 Nov 2;3(11):e2025102.
doi: 10.1001/jamanetworkopen.2020.25102.

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

Maria A Lopez-Olivo  1 , Kristin G Maki  1 , Noah J Choi  1 , Richard M Hoffman  2 , Ya-Chen Tina Shih  1 , Lisa M Lowenstein  1 , Rachel S Hicklen  3 , Robert J Volk  1
Affiliations
Meta-Analysis

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

Maria A Lopez-Olivo et al. JAMA Netw Open. .

Abstract

Importance: To be effective in reducing deaths from lung cancer among high-risk current and former smokers, screening with low-dose computed tomography must be performed periodically.

Objective: To examine lung cancer screening (LCS) adherence rates reported in the US, patient characteristics associated with adherence, and diagnostic testing rates after screening.

Data sources: Five electronic databases (MEDLINE, Embase, Scopus, CINAHL, and Web of Science) were searched for articles published in the English language from January 1, 2011, through February 28, 2020.

Study selection: Two reviewers independently selected prospective and retrospective cohort studies from 95 potentially relevant studies reporting patient LCS adherence.

Data extraction and synthesis: Quality appraisal and data extraction were performed independently by 2 reviewers using the Newcastle-Ottawa Scale for quality assessment. A random-effects model meta-analysis was conducted when at least 2 studies reported on the same outcome. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guideline.

Main outcomes and measures: The primary outcome was LCS adherence after a baseline screening. Secondary measures were the patient characteristics associated with adherence and the rate of diagnostic testing after screening.

Results: Fifteen studies with a total of 16 863 individuals were included in this systematic review and meta-analysis. The pooled LCS adherence rate across all follow-up periods (range, 12-36 months) was 55% (95% CI, 44%-66%). Regarding patient characteristics associated with adherence rates, current smokers were less likely to adhere to LCS than former smokers (odds ratio [OR], 0.70; 95% CI, 0.62-0.80); White patients were more likely to adhere to LCS than patients of races other than White (OR, 2.0; 95% CI, 1.6-2.6); people 65 to 73 years of age were more likely to adhere to LCS than people 50 to 64 years of age (OR, 1.4; 95% CI, 1.0-1.9); and completion of 4 or more years of college was also associated with increased adherence compared with people not completing college (OR, 1.5; 95% CI, 1.1-2.1). Evidence was insufficient to evaluate diagnostic testing rates after abnormal screening scan results. The main source of variation was attributable to the eligibility criteria for screening used across studies.

Conclusions and relevance: In this study, the pooled LCS adherence rate after a baseline screening was far lower than those observed in large randomized clinical trials of screening. Interventions to promote adherence to screening should prioritize current smokers and smokers from minority populations.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Maki reported receiving a postdoctoral cancer prevention fellowship that is supported by the Cancer Prevention and Research Institute of Texas and an MD Anderson Cancer Center Support Grant. Dr Shih reported receiving consulting fees and travel and accommodations support for serving on a grants review panel for Pfizer Inc and an advisory board for AstraZeneca in 2019. Dr Lowenstein reported receiving grants from the National Cancer Institute and the Cancer Prevention and Research Institute of Texas during the conduct of the study. Dr. Volk reported receiving grants from the Cancer Prevention and Research Institute of Texas, the National Cancer Institute, and The University of Texas MD Anderson Cancer Center Duncan Family Institute for Cancer Prevention and Risk Assessment. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of Study Disposition
LDCT indicates low-dose computed tomography.
Figure 2.
Figure 2.. Lung Cancer Screening Adherence Rates at Any Time Point
Lung-RADS is a categorization tool designed to standardize the reporting of screening-detected lung nodules. This figure shows the adherence rates reported per study. The first column represents the studies included in the analysis. The adherence rates were sorted from lowest to highest. The boxes represent the adherence rate reported per study after initial lung cancer screening (second screening regardless of the time point used). The horizontal lines represent 95% CIs. The diamond represents the overall adherence rate (pooled adherence rate) and the width of the diamond the 95% CI. The dotted line indicates where the overall effect estimate (pooled adherence rate) lies. ES indicates effect size.
See this image and copyright information in PMC

References

    1. Humphrey LL, Deffebach M, Pappas M, et al. . Screening for lung cancer with low-dose computed tomography: a systematic review to update the US Preventive Services Task Force recommendation. Ann Intern Med. 2013;159(6):411-420. doi:10.7326/0003-4819-159-6-201309170-00690 - DOI - PubMed
    1. Aberle DR, Adams AM, Berg CD, et al. ; National Lung Screening Trial Research Team . Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. doi:10.1056/NEJMoa1102873 - DOI - PMC - PubMed
    1. de Koning HJ, van der Aalst CM, de Jong PA, et al. . Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med. 2020;382(6):503-513. doi:10.1056/NEJMoa1911793 - DOI - PubMed
    1. Moyer VA; U.S. Preventive Services Task Force . Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(5):330-338. doi:10.7326/M13-2771 - DOI - PubMed
    1. de Koning HJ, Meza R, Plevritis SK, et al. . Benefits and harms of computed tomography lung cancer screening strategies: a comparative modeling study for the U.S. Preventive Services Task Force. Ann Intern Med. 2014;160(5):311-320. doi:10.7326/M13-2316 - DOI - PMC - PubMed

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