Compared to adherence in large randomized clinical trials, researchers have found that adherence to lung cancer screening (LCS) outside of trials is much lower overall and lower for current smokers and smokers from minority populations (JAMA Netw Open. 2020;3[11]:e2025102. doi:10.1001/jamanetworkopen.2020.25102).
Maria A Lopez-Olivo, MD, PhD, Department of Health Services Research, The University of Texas MD Anderson Cancer Center (Houston, TX), and colleagues conducted a systematic review and meta-analysis to examine “the rate of adherence to [LCS] among high-risk individuals outside randomized clinical trials” and to explore how adherence compares across subgroups of patients.
They noted that “screening with low-dose computed tomography must be performed periodically in order to be effective in reducing death from lung cancer among high-risk current and former smokers.”
Dr Lopez-Olivo colleagues found 95 potentially relevant US studies reporting patient LCS adherence that were published between January 2011, and February 28, 2020, in one of the five electronic databases they used (MEDLINE, Embase, Scopus, CINAHL, and Web of Science).
From those 95 relevant studies, two reviewers selected prospective and retrospective cohort studies reporting patient LCS adherence.
Using the Newcastle-Ottawa Scale for quality assessment, quality appraisal and data extraction were done independently by 2 reviewers. When at least 2 studies reported on the same outcome, a random effects model meta-analysis was conducted and followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines for reporting.
Findings ultimately included data from 15 studies and showed that the pooled rate across all follow-up periods (ranging between 12 and 36 months) for LCS adherence was 55% among 16,863 individuals included.
Regarding patient characteristics associated with adherence rates, current smokers were less likely to adhere to LCS than former smokers; White patients were more likely to adhere to LCS than patients of races other than White; people 65 to 73 years of age were more likely to adhere to LCS than people 50 to 64 years of age; and completion of 4 or more years of college was associated with increased adherence compared with those who had not completed college
Dr Lopez-Olivo and team concluded that “the pooled LCS adherence rate after a baseline screening was far lower than those observed in large randomized clinical trials of screening. Interventions to promote adherence to screening should prioritize current smokers and smokers from minority populations."—Marta Rybczynski
