ADHERENCE TO ANNUAL LUNG CANCER SCREENING WITHIN THE VETERANS HEALTH ADMINISTRATION LUNG CANCER SCREENING DEMONSTRATION PROJECT

Abstract

SESSION TITLE: Lung Cancer Screening: New Questions and New Answers SESSION TYPE: Original Investigations PRESENTED ON: 10/09/2018 08:45 AM - 09:45 AM PURPOSE: The National Lung Screening Trial (NLST) demonstrated a lung cancer mortality reduction from screening high risk individuals with low-dose computed tomography (LDCT) annually for three years. Mortality benefit and cost-efficacy of LDCT screening is dependent on adherence with screening and in the NLST the adherence rate was 95%. This is high compared to adherence rates from colon cancer, breast cancer, and cervical cancer in the community which have reportedly averaged 40-65%. We aimed to examine the adherence to annual LDCT screening after baseline LDCT within the Veterans Health Administration (VHA) Lung Cancer Screening Demonstration Project (LCSDP). METHODS: This is a retrospective observational cohort study of Veterans screened for lung cancer within the VHA LCSDP. The original project was conducted from July 1, 2013, and June 30, 2015 at eight geographically diverse Veterans Affairs hospitals. Screening was performed in current or former smokers (quit within the past 15 years) ages 55-80 with at least a 30-pack year smoking history. We utilized data generated from the LCSDP and 18 months following its completion stored in the VHA Corporate Data Warehouse. Adherence to screening was defined as it was in the NLST as having undergone a follow-up LDCT within 15 months from baseline scan. RESULTS: A total 2,106 Veterans underwent a baseline LDCT across all sites. Sixty percent (n=1269) had scans negative for nodules ≥ 4mm in size and repeat annual LDCT was recommended. In this group with a negative baseline scan, 149 were considered no longer eligible for screening because they had been diagnosed with lung cancer, were undergoing evaluation for cancer, no longer met the target age or years of cessation, were considered to have other life-limiting disease or were no longer interested in participating. Of the 1120 remaining eligible for repeat annual LDCT, 870 went on to undergo the follow-up scan yielding a 77.6% adherence rate for annual screening in those with a normal baseline scan. CONCLUSIONS: The American College of Chest Physicians (ACCP) and the American Thoracic Society (ATS) have outlined the components necessary for high-quality screening programs. One highlighted component is adherence with annual repeat LDCT. This study demonstrates that even within the context of a well-designed, implemented and guideline adherent LDCT screening program, adherence is not optimal and does not reach the reported 95% of the NLST when the baseline scan is negative. Both mortality benefit and cost-efficacy are likely to suffer without better adherence. Future research is needed to identify mechanisms and interventions to improve adherence. CLINICAL IMPLICATIONS: This study demonstrates that adherence with annual LDCT following a negative baseline scan is not optimal and highlights the need for measures to improve adherence to ensure that lung cancer screening achieves the most benefit possible. DISCLOSURES: No relevant relationships by Paul Brasher, source=Web Response research grant relationship with auris Please note: $5001 - $20000 Added 05/24/2018 by Gerard Silvestri, source=Web Response, value=Grant/Research Support Research grant relationship with Exact Sciences Please note: $20001 - $100000 Added 11/21/2017 by Nichole Tanner, source=Web Response, value=Grant/Research Consultant relationship with Exact Sciences Please note: $1001 - $5000 Added 11/21/2017 by Nichole Tanner, source=Web Response, value=Honoraria Grant/Research relationship with Oncimmune Please note: $5001 - $20000 Added 11/21/2017 by Nichole Tanner, source=Web Response, value=Grant/Research Support Speaker/Speaker's Bureau relationship with Oncocyte Please note: $1-$1000 Added 11/21/2017 by Nichole Tanner, source=Web Response, value=Honoraria Consultant relationship with Cook Medical Please note: $1001 - $5000 Added 11/21/2017 by Nichole Tanner, source=Web Response, value=Consulting fee Consultant relationship with Olympus America Please note: $1-$1000 Added 11/21/2017 by Nichole Tanner, source=Web Response, value=Consulting fee Grant relationship with Cook Medical Please note: >$100000 Added 11/21/2017 by Nichole Tanner, source=Web Response, value=Grant/Research Support Research relationship with Olympus Medical Please note: >$100000 Added 11/21/2017 by Nichole Tanner, source=Web Response, value=Grant/Research Support No relevant relationships by Derik Yeager, source=Web Response