Less than two-thirds of patients receive timely follow-up care after a low-dose CT lung cancer screening, according to a new large-scale analysis published Thursday in JAMA Network Open.
Delays or lack of follow-through were more pronounced among Black, low-income, or patients with mental health disorders. Lung disease is the leading cancer killer worldwide and CT screening has been proven to reduce mortality. However, providers must stick to the recommendations spelled out in the American College of Radiology’s Lung-RADS recommendations to achieve such success, authors advised.
“To optimize the mortality benefit of [lung cancer screening], it is clear that further work must be done to improve adherence overall and especially among marginalized populations,” Eduardo Núñez, MD, with the Department of Veterans Affairs’ Center for Healthcare Organization & Implementation Research, and co-authors concluded.
For their study, Núñez et al. retrospectively analyzed lung cancer screenings provided across Veterans Health Administration facilities between 2015-2019. Researchers looked for patients’ receipt of receiving the next step after screening, as spelled out by ACR’s Lung CT Screening Reporting and Data System.
All told, 28,294 veterans met the study’s inclusion criteria, nearly 95% of whom were men while 77% were white at an average age of 65. More than 63% underwent recommended follow-up within the anticipated timeframe, while 13% experienced a late evaluation, and nearly 16% had no apparent follow-up, according to VHA records. Differences at the facility level accounted for roughly 9% of observed variation.
Veterans who are Black, suffering from PTSD or substance use disorders, earning a lower income, and living a greater distance from a facility all had higher odds of delayed or missed care after their CT scan. Meanwhile, those with high-risk findings (Lung-RADS category 4 vs. 1), screened in high-volume facilities, or academic centers were less likely to experience such delays.
“Future work should focus on learning effective strategies from LCS centers with high adherence to extend successful program features to the people and locations with greater barriers to care,” Núñez and colleagues urged.
You can read more about their conclusions in the Journal of the American Medical Association here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.