Nearly half of patients with positive lung cancer screening findings delay follow-up care
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Key takeaways:
- Delaying follow-up after receipt of positive lung cancer screening findings was relatively common.
- Patients with lung cancer had a high likelihood of clinical upstaging if they delayed follow-up.
Patients with positive lung cancer screening findings frequently delay their first follow-up visit, according to results published in Annals of the American Thoracic Society.
“Overall, we found that nearly half [of patients with positive lung cancer screening findings] experienced delays in care and that the presence and extent of delay were associated with [Lung CT Screening Reporting and Data System; Lung-RADS] findings,” Alwiya Ahmed, MD, MPH, clinical instructor in the division of pulmonary, critical care and sleep medicine at University of Washington, and colleagues wrote.
In a retrospective cohort study, Ahmed and colleagues examined 434 lung cancer screening examinations with positive findings (Lung-RADS category 3, 4A, 4B or 4X) to assess the prevalence of delays in follow-up and how this factor is linked to upstaging in those with non-small cell lung cancer.
Researchers analyzed each Lung-RADS category in multivariable Cox models to compare follow-up rates and odds of delay. Follow-up adherence was defined as those patients who completed a follow-up within 30 days of Lung-RADS recommendations, whereas the researchers defined delayed follow-up as anything exceeding these time frames.
Of the total cohort (n = 369; 66% men; 86% white; 53% current smokers), 59 patients had non-small cell lung cancer, eight patients had neuroendocrine tumors and one patient had an undetermined lung cancer diagnosis.
Most of the assessed examinations fell in Lung-RADS categories 3 (47%) or 4A (32%), with fewer examinations classified into Lung-RADS categories 4B (15%) and 4X (6%).
Lung cancer was found in a greater percentage of Lung-RADS 4B/4X exams than Lung-RADS 4A and Lung-RADS 3 exams (54% vs. 9.4% vs. 2.9%).
A follow-up visit was documented in 384 (87%) examinations.
Researchers observed follow-up delays in almost half (205; 47%) of the total 434 examinations, with a median delay of 104 days.
More than half (59%) of patients with examinations classified as Lung-RADS category 3 delayed follow-up for a median of 210 days, whereas delays occurred less frequently among those with Lung-RADS 4B/4X examinations (40%; median delay, 34 days) and Lung-RADS 4A examinations (35%; median delay, 64 days).
When compared with Lung-RADS 3 examinations, researchers found a heightened follow-up rate in those with screening findings classified as 4A (adjusted HR = 1.88; 95% CI, 1.45-2.44) and 4B/4X (aHR = 2.03; 95% CI, 1.56-2.63).
In alignment with the above finding, the likelihood for delay was reduced among those with Lung-RADS 4A (aOR = 0.34; 95% CI, 0.2-0.57) and 4B/4X (aOR = 0.46; 95% CI, 0.27-0.8) exams vs. those with Lung-RADS 3 exams.
Among patients who delayed follow-up, those with 4A and 4B/4X exams did not delay the visit for as long as those with Lung-RADS 3 exams (Lung-RADS 4A, adjusted percentage difference in median delay, –57.3%; 95% CI, –78.1% to –16.5%; Lung-RADS 4B/4X, –81.3%; 95% CI, –90.6% to –63.2%).
Researchers could make a judgment on cancer staging in 54 of the patients with non-small cell lung cancer. Sixteen of these patients delayed follow-up care, and a majority of those with clinical upstaging had delays (11 out of 14 cases; 79%). The remaining patients fell in the group without upstaging (5 out of 40 cases; 12%; P < .001).
Further, a delayed follow-up report appeared in almost every case of summary stage clinical upstaging (6 out of 7; 86%), according to researchers.
“Future work is needed to develop and evaluate interventions to prevent delays in follow-up for patients after positive findings to ensure that the benefits of early detection through lung cancer screening are translated into clinical practice,” Ahmed and colleagues wrote.
M. Patricia Rivera, MD, professor of medicine in the division of pulmonary diseases and critical care medicine at University of Rochester Medical Center, and colleagues offered similar advice in an accompanying editorial.
“We must aim to develop and implement strategies to improve adherence to the [American College of Radiology]-recommended time to follow-up after a positive examination and standardize recommendations for the timing of diagnostic testing of very suspicious Lung-RADS category 4B or 4X findings to avoid compromising the benefits of [lung cancer screening],” Rivera and colleagues wrote.