How to improve patient adherence to annual lung cancer screening recommendations

Hiring a full-time program coordinator can help health systems bring in more patients for annual lung cancer screening, according to new research published in the Journal of the American College of Radiology.

“Although screening with baseline low-dose CT (LDCT) can identify a small number of early-stage lung cancers, detection improves during subsequent follow-up annual screening,” wrote Lucy B. Spalluto MD, MPH, department of radiology and radiological sciences at Vanderbilt University Medical Center in Nashville, and colleagues. “Therefore, annual adherence to annual lung screening is important to decrease lung cancer deaths.”

Annual lung cancer screening with LDCT is recommended for high-risk patients by both the American Cancer Society and the U.S. Preventive Services Task Force. Spalluto and colleagues tracked adherence at their own academic institution’s lung cancer screening program before and after hiring a full-time program coordinator.

“Before hiring of the program coordinator (a full-time nurse practitioner) in October 2015, shared decision making and tobacco treatment counseling were performed by three thoracic radiologists and two nurse practitioners,” the authors wrote. “After hiring, the program coordinator performed shared decision making, tobacco treatment counseling, and tracking of program participants.”

Overall, 319 patients completed baseline lung cancer screening with LCDT between Jan. 1, 2014, and Sept. 30, 2016, with normal results. Fifty-nine percent of those patients were adherence to annual follow-up recommendations, and 41% were not. Patient adherence was 21.7% before the program coordinator was hired and 65.6% after.

“Our study provides important results on the impact of resources for lung screening programs on program outcomes and the impact of a lung screening program coordinator on retaining patients with normal studies for annual lung screening,” Spalluto et al. wrote.

The team noted that tracking barriers to annual screening is a key part of improving patient adherence across the board. When patients were asked why they did not adhere to annual lung screening recommendations, they listed “lack of transportation, financial cost, lack of communication by physicians and lack of current symptoms” as some of their reasons.

“If I had symptoms that I was concerned about then I would definitely go for a follow-up. As of now, I feel fine, so I don’t feel there is a need to go back for another follow-up,” one patient said when speaking with researchers. “It all depends on the cost,” another patient said.

The researchers also examined some resources—including appropriate patient education materials and shared decision-making tools—that could potentially help address these barriers and make a positive impact on lung cancer screening programs.

“Appropriation of resources is likely necessary to achieve high-quality, evidence-based lung screening,” the authors concluded.