Factors Associated With Nonadherence to Lung Cancer Screening Across Multiple Screening Time Points.
Factors Associated With Nonadherence to Lung Cancer Screening Across Multiple Screening Time Points.
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DOI：
10.1001/jamanetworkopen.2023.15250
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发表时间：
2023-05-01
影响因子：
13.8
通讯作者：
Hsu, William
中科院分区：
文献类型：
--
作者：
Lin, Yannan;Liang, Li-Jung;Ding, Ruiwen;Prosper, Ashley Elizabeth;Aberle, Denise R.;Hsu, William
这项队列研究调查了多个时间点与患者不遵守肺癌筛查建议相关的因素。在多个筛查时间点，哪些因素和纵向模式与患者不依从肺癌筛查相关？在这项1979例患者的队列研究中，发现6个因素（包括基线肺部计算机断层扫描筛查报告和数据系统（Lung-RADS）评分）与患者不遵守推荐的随访检查相关。连续肺RADS评分为1或2的患者，不依从性随时间增加。研究结果表明，连续阴性筛查结果（Lung-RADS评分，1或2）的患者更有可能随着时间的推移而不依从筛查，并可能从外展和教育中受益。在随机临床试验中，低剂量计算机断层扫描（CT）筛查已被证明可降低肺癌死亡率，其中随访建议的依从率超过90%;然而，在实践中，肺计算机断层扫描筛查报告和数据系统（Lung-RADS）建议的依从性较低。识别有不遵守筛查建议风险的患者可能有助于个性化外展，以提高总体筛查依从性。确定多个筛选时间点患者不依从Lung-RADS建议的相关因素。这项队列研究在一个美国学术医疗中心进行，分布在10个提供肺癌筛查的地理位置。该研究招募了在2013年7月31日至2021年11月30日期间接受低剂量CT筛查的肺癌患者。肺癌的低剂量CT筛查主要结果是不遵守肺癌筛查的随访建议，定义为未能完成推荐的或更具侵入性的随访检查15个月内（即诊断剂量CT、正电子发射断层扫描-CT或组织采样vs低剂量CT）在一个实施方案中，患者可以接受3个月（肺-RADS评分，1或2）、9个月（肺-RADS评分，3）、5个月（肺-RADS评分，4A）或3个月（肺-RADS评分，4 B/X）。采用多变量逻辑回归分析确定与患者不依从基线Lung-RADS建议相关的因素。广义估计方程模型用于评估纵向肺RADS评分模式是否与患者随时间的不依从性相关。在纳入的1979例患者中，1111例（56.1%）在基线筛选时年龄≥ 65岁（平均[SD]年龄为65.3 [6.6]岁），1176例（59.4%）为男性。基线肺RADS评分为1或2分的患者与3分的患者相比，（校正比值比[AOR]，0.35; 95% CI，0.25-0.50），4A（AOR，0.21; 95% CI，0.13-0.33）或4B/X，（AOR，0.10; 95% CI，0.05-0.19）;研究生vs大学学历（AOR，0.70; 95% CI，0.53-0.92）;有肺癌家族史vs无家族史（AOR，0.74; 95% CI，0.59-0.93）;年龄校正的Charlson Comorbid Index评分较高（≥4）vs较低（0或1）（AOR，0.67; 95% CI，0.46-0.98）;高收入与低收入类别（AOR，0.79; 95% CI，0.65-0.98）;以及由肺或胸相关科室的医生与其他科室的医生转诊（AOR，0.56; 95% CI，0.44-0.73）。在830例完成至少2次筛选检查的合格患者中，连续肺RADS评分为1 - 2分的患者在随后筛选时不遵守肺RADS建议的校正比值增加（AOR，1.38; 95% CI，1.12-1.69）。在这项回顾性队列研究中，肺癌筛查结果连续阴性的患者更有可能不遵守随访建议。这些人是定制外展的潜在候选人，以提高对推荐的年度肺癌筛查的依从性。
This cohort study investigates factors associated with patient nonadherence to lung cancer screening recommendations across multiple time points. What factors and longitudinal patterns are associated with patient nonadherence to lung cancer screening across multiple screening time points? In this cohort study of 1979 patients, 6 factors, including baseline Lung Computed Tomography Screening Reporting & Data System (Lung-RADS) score, were found to be associated with patient nonadherence to recommended follow-up examination. Nonadherence increased over time for patients who received consecutive Lung-RADS scores of 1 or 2. The findings suggest that patients with consecutive negative screening results (Lung-RADS score, 1 or 2) are more likely to become nonadherent to screening over time and may benefit from outreach and education. Screening with low-dose computed tomography (CT) has been shown to reduce mortality from lung cancer in randomized clinical trials in which the rate of adherence to follow-up recommendations was over 90%; however, adherence to Lung Computed Tomography Screening Reporting & Data System (Lung-RADS) recommendations has been low in practice. Identifying patients who are at risk of being nonadherent to screening recommendations may enable personalized outreach to improve overall screening adherence. To identify factors associated with patient nonadherence to Lung-RADS recommendations across multiple screening time points. This cohort study was conducted at a single US academic medical center across 10 geographically distributed sites where lung cancer screening is offered. The study enrolled individuals who underwent low-dose CT screening for lung cancer between July 31, 2013, and November 30, 2021. Low-dose CT screening for lung cancer. The main outcome was nonadherence to follow-up recommendations for lung cancer screening, defined as failing to complete a recommended or more invasive follow-up examination (ie, diagnostic dose CT, positron emission tomography–CT, or tissue sampling vs low-dose CT) within 15 months (Lung-RADS score, 1 or 2), 9 months (Lung-RADS score, 3), 5 months (Lung-RADS score, 4A), or 3 months (Lung-RADS score, 4B/X). Multivariable logistic regression was used to identify factors associated with patient nonadherence to baseline Lung-RADS recommendations. A generalized estimating equations model was used to assess whether the pattern of longitudinal Lung-RADS scores was associated with patient nonadherence over time. Among 1979 included patients, 1111 (56.1%) were aged 65 years or older at baseline screening (mean [SD] age, 65.3 [6.6] years), and 1176 (59.4%) were male. The odds of being nonadherent were lower among patients with a baseline Lung-RADS score of 1 or 2 vs 3 (adjusted odds ratio [AOR], 0.35; 95% CI, 0.25-0.50), 4A (AOR, 0.21; 95% CI, 0.13-0.33), or 4B/X, (AOR, 0.10; 95% CI, 0.05-0.19); with a postgraduate vs college degree (AOR, 0.70; 95% CI, 0.53-0.92); with a family history of lung cancer vs no family history (AOR, 0.74; 95% CI, 0.59-0.93); with a high age-adjusted Charlson Comorbidity Index score (≥4) vs a low score (0 or 1) (AOR, 0.67; 95% CI, 0.46-0.98); in the high vs low income category (AOR, 0.79; 95% CI, 0.65-0.98); and referred by physicians from pulmonary or thoracic-related departments vs another department (AOR, 0.56; 95% CI, 0.44-0.73). Among 830 eligible patients who had completed at least 2 screening examinations, the adjusted odds of being nonadherent to Lung-RADS recommendations at the following screening were increased in patients with consecutive Lung-RADS scores of 1 to 2 (AOR, 1.38; 95% CI, 1.12-1.69). In this retrospective cohort study, patients with consecutive negative lung cancer screening results were more likely to be nonadherent with follow-up recommendations. These individuals are potential candidates for tailored outreach to improve adherence to recommended annual lung cancer screening.
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作者：
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DOI：
10.1016/j.jtho.2021.09.013
发表时间：
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Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
影响因子：
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