Patient Adherence to Lung CT Screening Reporting & Data System-Recommended Screening Intervals in the United States: A Systematic Review and Meta-Analysis

Yannan Lin; Mingzhou Fu; Ruiwen Ding; Kosuke Inoue; Christie Y Jeon; William Hsu; Denise R Aberle; Ashley Elizabeth Prosper

doi:10.1016/j.jtho.2021.09.013

Patient Adherence to Lung CT Screening Reporting & Data System-Recommended Screening Intervals in the United States: A Systematic Review and Meta-Analysis

J Thorac Oncol. 2022 Jan;17(1):38-55. doi: 10.1016/j.jtho.2021.09.013. Epub 2021 Oct 6.

Authors

Yannan Lin¹, Mingzhou Fu², Ruiwen Ding³, Kosuke Inoue⁴, Christie Y Jeon⁵, William Hsu³, Denise R Aberle⁶, Ashley Elizabeth Prosper⁷

Affiliations

¹ Department of Bioengineering, University of California Los Angeles, Los Angeles, California; Medical & Imaging Informatics Group, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California. Electronic address: yannanlin@mednet.ucla.edu.
² Medical Informatics Home Area, Department of Bioinformatics, University of California Los Angeles, Los Angeles, California.
³ Department of Bioengineering, University of California Los Angeles, Los Angeles, California; Medical & Imaging Informatics Group, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California.
⁴ Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Epidemiology, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
⁵ Department of Epidemiology, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, California; Department of Medicine, Samuel Oschin Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.
⁶ Department of Bioengineering, University of California Los Angeles, Los Angeles, California; Medical & Imaging Informatics Group, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California.
⁷ Medical & Imaging Informatics Group, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, California; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California.

Abstract

Lung cancer screening (LCS) is effective in reducing mortality, particularly when patients adhere to follow-up recommendations standardized by the Lung CT Screening Reporting & Data System (Lung-RADS). Nevertheless, patient adherence to recommended intervals varies, potentially diminishing benefit from screening. We conducted a systematic review and meta-analysis of patient adherence to Lung-RADS-recommended screening intervals. We systematically searched MEDLINE, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials, and major radiology and oncology conference archives between April 28, 2014, and December 17, 2020. Eligible studies mentioned patient adherence to the recommendations of Lung-RADS. The review protocol was registered with PROSPERO (CRD42020189326). We identified 24 eligible studies for qualitative summary, of which 21 were suitable for meta-analysis. The pooled adherence rate was 57% (95% confidence interval: 46%-69%) for defined adherence (e.g., an annual incidence screen was performed within 15 mo) among 6689 patients and 65% (95% confidence interval: 55%-75%) for anytime adherence among 5085 patients. Large heterogeneity in adherence rates between studies was observed (I² = 99% for defined adherence, I² = 98% for anytime adherence). Heterogeneous adherence rates were associated with Lung-RADS scores, with significantly higher adherence rates among Lung-RADS 3 to 4 than Lung-RADS 1 to 2 (p < 0.05). Patient adherence to Lung-RADS-recommended screening intervals is suboptimal across clinical LCS programs in the United States, especially among patients with results of Lung-RADS categories 1 to 2. To improve adherence rates, future research may focus on implementing tailored interventions after identifying barriers to LCS. We also propose a minimum standardized set of data elements for future pooled analyses of LCS adherence on the basis of our findings.

Keywords: Lung cancer screening; Lung-RADS (Lung CT Screening Reporting & Data System); Meta-analysis; Patient adherence; Systematic review.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural
Review
Systematic Review

MeSH terms

Early Detection of Cancer*
Humans
Lung
Lung Neoplasms* / diagnostic imaging
Patient Compliance
Tomography, X-Ray Computed
United States

Abstract

Publication types

MeSH terms

Grants and funding