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Lori C. Sakoda



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    P3.11 - Screening and Early Detection (Not CME Accredited Session) (ID 977)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.11-20 - Patterns and Predictors of Adherence to Recommended Follow-Up After Low-Dose Computed Tomography Screening for Lung Cancer (ID 14357)

      12:00 - 13:30  |  Presenting Author(s): Lori C. Sakoda

      • Abstract
      • Slides

      Background

      Results from the National Lung Screening Trial support current guidelines to screen high-risk smokers annually for lung cancer with low-dose computed tomography (LDCT) in the United States. Monitoring the screening process, including repeat screening and follow-up, is important to ensure the benefits of screening outweigh its harms. We examined early patterns and predictors of adherence to recommended follow-up care after baseline LDCT screening in a large integrated healthcare system.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Our cohort study included patients screened for lung cancer during the first year of LDCT screening at selected Kaiser Permanente Northern California facilities, when referrals for screening came directly from primary care physicians (PCPs, instead of dedicated clinician specialists as now implemented). Using electronic administrative and clinical databases, we identified 145 screening-eligible patients who had a baseline LDCT screening exam from July 2014 to June 2015, with continuous health plan enrollment for at least 14 months post-baseline. Adherence to recommended follow-up after the baseline exam was determined according to Lung-RADS classification. We defined adherence as receipt of imaging within 10 to 14 months after a negative exam (i.e., Lung-RADS category 1 or 2) and receipt of imaging or diagnostic evaluation within ±30 days of the recommended follow-up interval after a positive exam (i.e., Lung-RADS category 3 or 4). Among patients with a negative exam, we further examined whether baseline factors, including age, gender, race/ethnicity, prior healthcare utilization, smoking history, and Charlson comorbidity index (CCI), were associated with adherence, using logistic regression.

      4c3880bb027f159e801041b1021e88e8 Result

      Of the 145 patients, 61% were male, 71% were of white race, 76% were current smokers, and 72% had a CCI of 0-1. The median age was 66 years. Baseline exam results were negative for 122 patients and positive for 23 patients. All five patients subsequently diagnosed with lung cancer were classified as Lung-RADS category 4B at baseline. Adherence to recommended follow-up was higher after a positive than negative exam – 61% vs 23% – although low overall. Among patients with a negative exam, adherence was suggestively associated with gender and race/ethnicity, with greater adherence in women than men [odds ratio, OR (95% confidence interval, CI): 1.8 (0.8–4.1)] and patients of white than non-white race/ethnicity [OR (95% CI): 1.8 (0.7–8.3)].

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our preliminary results suggest adherence to recommended follow-up is low, particularly after a negative baseline exam, due in part to insufficient patient education and shared decision-making about LDCT screening during PCP visits. Further analyses are underway to interpret these results.

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