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Guideline-Recommended Lung Cancer Screening Adherence Is Superior With a Centralized Approach
Chest ( IF 9.6 ) Pub Date : 2021-09-15 , DOI: 10.1016/j.chest.2021.09.002
Harrison B Smith 1 , Ralph Ward 2 , Cassie Frazier 3 , Jonathan Angotti 1 , Nichole T Tanner 4
Affiliation  

Background

To recognize fully the benefit of lung cancer screening (LCS), annual adherence must approach the high levels seen in the National Lung Screening Trial. Emerging data suggest that annual adherence is poor and that a centralized approach to screening improves adherence.

Research Questions

Do differences in adherence exist between a centralized and decentralized approach to LCS within a hybrid program and what are predictors of adherence?

Study Design and Methods

A retrospective evaluation of a single-center hybrid LCS program was conducted to compare outcomes including patient eligibility and adherence between the centralized and decentralized approaches. Patient demographics and outcomes were compared between those screened with a centralized and decentralized approach and between adherent and nonadherent patients using two-sample t tests, χ 2 tests, or analyses of variance, as appropriate. Annual adherence analysis was conducted using data from patients who remained eligible for screening with a baseline Lung CT Screening Reporting and Data System (Lung-RADS) score of 1 or 2. Logistic regression was used to estimate the association between adherence and the primary exposure, adjusting for potential confounders.

Results

A cohort of 1,117 patients underwent baseline low-dose CT imaging. Two hundred eleven patients (19%) were ineligible by United States Preventative Services Task Force criteria and most (90%) were screened with the decentralized approach. After exclusions, 765 patients with Lung-RADS score of 1 or 2 remained eligible for annual screening. Overall adherence was 56%; however, adherence in the centralized program was 70%, compared with 41% with the decentralized approach (P < .001). Individuals screened in a decentralized approach were 73% less likely to be adherent (OR, 0.27; 95% CI, 0.19-0.37). A greater proportion of patients with three or more comorbidities were screened outside the centralized program.

Interpretation

Those screened using a centralized approach were more likely to meet eligibility criteria for LCS and more likely to return for annual screening than those screened using a decentralized approach.



中文翻译:

指南推荐的肺癌筛查依从性优于集中方法

背景

为了充分认识到肺癌筛查 (LCS) 的益处,每年的依从性必须接近国家肺筛查试验中的高水平。新出现的数据表明,每年的依从性很差,而集中的筛查方法可以提高依从性。

研究问题

混合项目中 LCS 的集中式和分散式方法之间是否存在依从性差异?依从性的预测因素是什么?

研究设计和方法

对单中心混合 LCS 计划进行了回顾性评估,以比较集中式和分散式方法之间的结果,包括患者资格和依从性。使用双样本t检验、χ2检验或方差分析,酌情比较采用集中式和分散式方法筛查的患者以及依从性和非依从性患者之间的患者人口统计和结果。年度依从性分析使用来自仍符合筛查条件且基线肺 CT 筛查报告和数据系统 (Lung-RADS) 评分为 1 或 2 的患者的数据进行。逻辑回归用于估计依从性与主要暴露之间的关联,调整潜在的混杂因素。

结果

一组 1,117 名患者接受了基线低剂量 CT 成像。211 名患者 (19%) 不符合美国预防服务工作组的标准,大多数 (90%) 使用分散方法进行筛查。排除后,765 名 Lung-RADS 评分为 1 或 2 的患者仍有资格进行年度筛查。总体依从性为 56%;然而,集中式方案的依从率为 70%,而分散式方案的依从率为 41% ( P  < .001)。采用分散方法筛查的个体依从性降低 73%(OR,0.27;95% CI,0.19-0.37)。更大比例的患有三种或更多合并症的患者在集中计划之外进行了筛查。

解释

与使用分散方法筛选的人相比,使用集中方法筛选的人更有可能满足 LCS 的资格标准,并且更有可能返回进行年度筛选。

更新日期:2021-09-15
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