More support needed to minimize attrition in community-based lung cancer screening programs

CHICAGO — More education and follow-up is needed to support high-risk populations undergoing lung cancer screening in community settings to prevent them from being lost to follow-up, according to a study presented at International Association for the Study of Lung Cancer Multidisciplinary Symposium in Thoracic Oncology.

Swedish Cancer Institute reported an 11% attrition rate for their lung cancer screening program.

“Lung cancer screening programs have become more prevalent following results of the National Lung Screening Trial,” Alexander S. Carlson, BA, from the division of interventional pulmonology at Swedish Cancer Institute, said during the presentation. “Lung cancer screening is a continuum of care, [whereas] shared decision-making assists in forming a relationship to provide this continuum.”

However, little is known about attrition rates in these programs, Carlson said.

Carlson and colleagues evaluated data of 520 individuals enrolled in their lung cancer screening program from 2012 to 2016. Researchers identified patients who left the program, closure dates and reasons for exiting the program.

Reasons for leaving included attrition, defined as loss to follow-up or declining further screening. Researchers documented attrition as exit from the program after a patient failed to respond to written communication, a minimum of three attempts were made to contact the patient and a clinical note was sent to the referring provider.

Most patients remained in the program (n = 398), and 23% (n = 122) were officially closed out. Thirteen percent (n = 67) of the cases closed out for clinical, geographic or other reasons.

The rate of attrition from the program was 11% (n = 55). Of these patients, 69% had been smokers at enrollment (n = 38), compared with 52% (n = 205) of those who remained in the program (P = .014).

Other characteristics did not significantly differ between patients who dropped and remained in the program, including the proportion with nodules at the first scan (67.3% vs. 71.6%), the largest nodule size (8.4 ± 13 vs. 6.3 ± 5.8) and median distance traveled (9.2 miles vs. 9 miles).

The median time to attrition was 14 months (interquartile range, 13-17).

In 78% of attrition cases, 43 patients had only one CT scan before attrition.

“Future work needs to focus on promoting continuum of care within lung cancer screening and identify high risk populations to minimize attrition as we move forward,” Carlson said. – by Melinda Stevens

Reference:

Carlson AS, et al. Abstract OA01.03. Presented at International Association for the Study of Lung Cancer Multidisciplinary Symposium in Thoracic Oncology; Sept. 14-16, 2017; Chicago.

Disclosure: Carlson reports no relevant financial disclosures.