Patient motivations for non-adherence to lung cancer screening in a military population

Kenneth P Seastedt; Michael J Luca; Jared L Antevil; Robert F Browning; Philip S Mullenix; Junewai L Reoma; Sean A McKay

doi:10.21037/jtd-20-1841

Patient motivations for non-adherence to lung cancer screening in a military population

J Thorac Dis. 2020 Oct;12(10):5916-5924. doi: 10.21037/jtd-20-1841.

Authors

Kenneth P Seastedt¹, Michael J Luca², Jared L Antevil³, Robert F Browning⁴, Philip S Mullenix⁵, Junewai L Reoma⁵, Sean A McKay²

Affiliations

¹ Department of Surgery, USUHS F. Edward Hébert School of Medicine, Bethesda, MD, USA.
² Department of Pulmonology, USUHS F. Edward Hébert School of Medicine, Bethesda, MD, USA.
³ Department of Cardiothoracic Surgery, Veterans Affairs Medical Center, Washington, DC, USA.
⁴ Department of Pulmonology, Division of Interventional Pulmonology, USUHS F. Edward Hébert School of Medicine, Bethesda, MD, USA.
⁵ Department of Cardiothoracic Surgery, USUHS F. Edward Hébert School of Medicine, Bethesda, MD, USA.

Abstract

Background: Lung cancer remains the leading cause of cancer deaths in the United States, and lung cancer screening has been shown to decrease this mortality. Adherence to lung cancer screening is paramount to realize the mortality benefit, and reported adherence rates vary widely. Few reports address non-adherence to screening, and our study sought to understand the non-compliant patients in our military population.

Methods: This Institutional Review Board approved retrospective review of patients enrolled in our screening program from 2013-2019 identified patients who failed to obtain a subsequent Low Dose CT scan (LDCT) within 15 months of their prior scan. Attempts were made to contact these patients and elucidate motivations for non-adherence via telephone.

Results: Of the 242 patients enrolled, 183 (76%) patients were adherent to the protocol. Significant predictors of non-adherence versus adherence were younger age (P=0.008), female sex (P=0.005), and enlisted officer rank (P=0.03). There was no difference with regards to race, smoking status, pack-years, negative screens, lung-RADS level, or nodule size. 31 (52%) non-adherent patients were contacted, and 24 (77%) reported their reason for non-adherence was lack of follow-up for a LDCT. Twenty (64%) were interested in re-enrollment. Of the total screening cohort, 15 interventions were performed, with lung cancer identified in 5 (2%)-a 67% false positive rate. One stage IV lung cancer was found in a non-adherent patient who re-enrolled.

Conclusions: Lack of perceived contact for follow-up was expressed as the primary reason for non-compliance in our screening program. Compliance is critical to the efficacy of any screening modality, and adherence rates to lung cancer screening may be increased through improved contact with patients via multiple avenues (i.e., phone, email, and letter). There is benefit in contacting non-adherent patients as high rates of re-enrollment are possible.

Keywords: Lung cancer screening; adherence; enrollment; low dose CT scan (LDCT); smoking.