Receipt of Recommended Follow-up Care After a Positive Lung Cancer Screening Examination.
Receipt of Recommended Follow-up Care After a Positive Lung Cancer Screening Examination.
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肺癌筛查阳性后，收到建议的随访护理。
DOI：
10.1001/jamanetworkopen.2022.40403
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发表时间：
2022-11-01
影响因子：
13.8
通讯作者：
Henderson, Louise M.
中科院分区：
文献类型：
--
作者：
Rivera, M. Patricia;Durham, Danielle D.;Long, Jason M.;Perera, Pasangi;Lane, Lindsay;Lamb, Derek;Metwally, Eman;Henderson, Louise M.
在肺癌筛查阳性检查后的较长时间内，坚持推荐的随访和坚持的比率和因素是什么？在这项对685名肺癌筛查呈阳性的成年人进行的队列研究中，总体上对推荐治疗的依从性较低，但在高危结节中和延长随访时间线后有所改善。在黑人个人、男性个人和目前吸烟的个人中，依从性在统计上显著较低。虽然随访率随着时间的延长而提高，但筛查发现的结节的结果与延迟随访时间之间的联系尚不清楚。这项队列研究根据成人的癌症风险调查了肺癌筛查阳性检查后推荐的随访比率和相关因素。要最大限度地提高肺癌筛查的效益，需要在筛查阳性后及时进行随访。美国放射学会(ACR)肺部CT筛查报告和数据系统(LONG-RADS)建议根据筛查结果进行测试和后续时间安排。目的：根据肺RADS分类，确定肺癌筛查阳性后推荐的随访率及相关因素。这项前瞻性队列研究从2015年1月1日至2020年7月31日进行，跟踪调查至2021年7月31日，在北卡罗来纳州的5个学术和社区肺癌筛查地点进行。参与者包括685名筛查呈阳性的成年人，肺-RADS 3、4A、4B或4X类。统计分析时间为2020年12月至2022年3月。个人年龄、种族、性别、吸烟情况、肺癌筛查年限、慢性阻塞性肺疾病、体重指数、转诊临床专科、农村或城市户口。依从性，定义为接受ACR肺部RADS阳性筛查后推荐的后续测试或程序。时间范围：肺部RADS 3个月和肺部RADS 4A分别为6个月和3个月。对于肺-RADS 4B或4X，依从性被定义为4周内的随访护理，因为ACR肺-RADS没有规定时间框架。在接受低剂量CT肺癌筛查的685名受试者中，年龄在65岁以上的有416人(60.7%)，黑人123人(18.0%)，白人562人(82.0%)，男性352人(51.4%)。总的随访率为42.6%(292/685)，按肺RADS分类：肺RADS 3 = 30.0%(109/363)，肺RADS 4A = 49.5%(96/194)，肺RADS 4B或4X = 68.0%(87/128)。随访时间延长，依从性增加：9个月内肺RADS 3 = 占68.6%(249/363)，5个月内肺RADS 4A = 占77.3%(150/194)，62天内肺RADS 4B或4X = 占80.5%(103/128)。对于肺部RADS 3，目前吸烟者与戒烟者相比，推荐的随访可能性较小(调整后的优势比[AOR]，0.48；95%CI，0.29-0.78)。在肺部-RADS 4A中，黑人与白人相比，推荐的随访率较低(AOR，0.35；95%CI，0.15-0.86)。对于肺部-RADS 4B或4X，女性比男性更有可能进行建议的随访(AOR，2.82；95%CI，1.09-7.28)，而在目前吸烟者比戒烟者更不可能(AOR，0.31；95%CI，0.12-0.80)。在这项队列研究中，在阳性筛查检查后，对推荐的随访的坚持程度较低，但在癌症可疑程度较高的结节中，以及在延长随访时间线后，情况有所改善。然而，在临床试验之外，延长筛查发现的结节的随访时间与人群水平的结果之间的关联尚不清楚。这些发现表明，需要进行研究，以了解为什么黑人、男性和目前吸烟的人推荐的随访率较低，以制定策略来提高依从性。
What are the rates and factors associated with adherence to recommended follow-up and adherence after an extended timeline following a positive lung cancer screening examination? In this cohort study of 685 adults with a positive lung cancer screening examination, overall adherence to recommended care was low but improved among higher-risk nodules and after extending the follow-up timeline. Adherence was statistically significantly lower in Black individuals, male individuals, and individuals currently smoking. Although rates of follow-up were improved when the time was extended, the association between outcomes and delaying time to follow-up of screen-detected nodules is unknown. This cohort study examines rates of and factors associated with recommended follow-up after a positive lung cancer screening examination by risk of cancer among adults. Maximizing benefits of lung cancer screening requires timely follow-up after a positive screening test. The American College of Radiology (ACR) Lung CT Screening Reporting and Data System (Lung-RADS) recommends testing and follow-up timing based on the screening result. To determine rates of and factors associated with recommended follow-up after a positive lung cancer screening examination by Lung-RADS category. This prospective cohort study of lung cancer screening examinations performed from January 1, 2015, through July 31, 2020, with follow-up through July 31, 2021, was conducted at 5 academic and community lung cancer screening sites in North Carolina. Participants included 685 adults with a positive screening examination, Lung-RADS categories 3, 4A, 4B, or 4X. Statistical analysis was performed from December 2020 to March 2022. Individual age, race, sex, smoking exposure, year of lung cancer screening examination, chronic obstructive pulmonary disease, body mass index, referring clinician specialty, rural or urban residence. Adherence, defined as receipt of recommended follow-up test or procedure after the positive screen per ACR Lung-RADS timeframes: 6 months for Lung-RADS 3 and 3 months for Lung-RADS 4A. For Lung-RADS 4B or 4X, adherence was defined as follow-up care within 4 weeks, as ACR Lung-RADS does not specify a timeframe. Among the 685 individuals included in this study who underwent lung cancer screening with low-dose computed tomography, 416 (60.7%) were aged at least 65 years, 123 (18.0%) were Black, 562 (82.0%) were White, and 352 (51.4%) were male. Overall adherence to recommended follow-up was 42.6% (292 of 685) and varied by Lung-RADS category: Lung-RADS 3 = 30.0% (109 of 363), Lung-RADS 4A = 49.5% (96 of 194), Lung-RADS 4B or 4X = 68.0% (87 of 128). Extending the follow-up time increased adherence: Lung-RADS 3 = 68.6% (249 of 363) within 9 months, Lung-RADS 4A = 77.3% (150 of 194) within 5 months, and Lung-RADS 4B or 4X = 80.5% (103 of 128) within 62 days. For Lung-RADS 3, recommended follow-up was less likely among those currently smoking vs those who quit (adjusted odds ratio [aOR], 0.48; 95% CI, 0.29-0.78). In Lung-RADS 4A, recommended follow-up was less likely in Black individuals vs White individuals (aOR, 0.35; 95% CI, 0.15-0.86). For Lung-RADS 4B or 4X, recommended follow-up was more likely in female individuals vs male individuals (aOR, 2.82; 95% CI, 1.09-7.28) and less likely in those currently smoking vs those who quit (aOR, 0.31; 95% CI, 0.12-0.80). In this cohort study, adherence to recommended follow-up after a positive screening examination was low but improved among nodules with a higher suspicion of cancer and after extending the follow-up timeline. However, the association of extending the follow-up time of screen-detected nodules with outcomes at the population level, outside of a clinical trial, is unknown. These findings suggest that studies to understand why recommended follow-up is lower in Black individuals, male individuals, and individuals currently smoking are needed to develop strategies to improve adherence.
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影响因子：
20.4
作者：
Goldstraw, Peter;Chansky, Kari;Bolejack, Vanessa
通讯作者：
Bolejack, Vanessa
影响因子：
5
作者：
Barbosa, Eduardo J. Mortani, Jr.;Yang, Rochelle;Hershman, Michelle
通讯作者：
Hershman, Michelle
DOI：
10.1016/j.jtho.2021.09.013
发表时间：
2022-01
期刊：
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
影响因子：
--
作者：
Lin Y;Fu M;Ding R;Inoue K;Jeon CY;Hsu W;Aberle DR;Prosper AE
通讯作者：
Prosper AE
影响因子：
9.6
作者：
Kunitomo, Yukiko;Bade, Brett;Bastian, Lori A.
通讯作者：
Bastian, Lori A.
影响因子：
13.8
作者：
Sakoda LC;Rivera MP;Zhang J;Perera P;Laurent CA;Durham D;Huamani Velasquez R;Lane L;Schwartz A;Quesenberry CP Jr;Minowada G;Henderson LM
通讯作者：
Henderson LM