Barriers to Completing Low Dose Computed Tomography Scan for Lung Cancer Screening

Lye-Yeng Wong; Sania Choudhary; Ntemena Kapula; Margaret Lin; Irmina A Elliott; Brandon A Guenthart; Douglas Z Liou; Leah M Backhus; Mark F Berry; Joseph B Shrager; Natalie S Lui

doi:10.1016/j.cllc.2024.04.014

Barriers to Completing Low Dose Computed Tomography Scan for Lung Cancer Screening

Clin Lung Cancer. 2024 Apr 27:S1525-7304(24)00070-6. doi: 10.1016/j.cllc.2024.04.014. Online ahead of print.

Affiliations

¹ Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Falk Building, Stanford, CA 94305.
² Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305.
³ Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Falk Building, Stanford, CA 94305; VA Palo Alto Health Care System, Palo Alto CA.
⁴ Department of Cardiothoracic Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Falk Building, Stanford, CA 94305. Electronic address: natalielui@stanford.edu.

PMID: 38749902
DOI: 10.1016/j.cllc.2024.04.014

Abstract

Introduction: Annual low-dose computed tomography (LDCT) screening has been shown to reduce lung cancer mortality in high-risk individuals by detecting the disease at an earlier stage. This study aims to assess the barriers to completing LDCT in a cohort of patients who were determined eligible for lung cancer screening (LCS).

Methods: We performed a single institution, mixed methods, cross-sectional study of patients who had a LDCT ordered from July to December 2022. We then completed phone surveys with patients who did not complete LDCT to assess knowledge, attitude, and perceptions toward LCS.

Results: We identified 380 patients who met inclusion criteria, including 331 (87%) who completed LDCT and 49 (13%) who did not. Patients who completed a LDCT and those who did not were similar regarding age, sex, race, primary language, household income, body mass index, median pack years, and quit time. Positive predictors of LDCT completion were: meeting USPSTF guidelines (97.9% vs 81.6%), being married (58.3% vs 44.9%), former versus current smokers (55% vs 41.7%), personal history of emphysema (60.4% vs 42.9%), and family history of lung cancer (13.9% vs 4.1%) (all P < .05). Of the patients who participated in the phone survey, only 7% of respondents thought they were high risk for developing lung cancer despite attending a shared decision-making visit and only 10% wanted to re-schedule their LDCT.

Conclusion: There exist barriers to completing LDCT even after patients are identified as eligible and complete a shared decision-making visit secondary to knowledge barriers, misperceptions, and patient disinterest.

Keywords: Barriers to screening; Screening scan; Shared decision-making.