Low Receipt of ACR-Recommended Follow-Care Discovered Among Patients With Lung Cancer

M. Patricia Rivera, MD

Adherence to follow-up screening in patients with lung cancer was found to be low, showing that many do not follow the American College of Radiology (ACR) Lung CT Screening Reporting and Data System (Lung-RADS) recommendations.¹

The findings, which were reported in in JAMA Network Open, also showed that the association of extending the follow-up time of screen-detected nodules with outcomes for individuals who are Black, male, or smokers remains unknown.

The study included individuals who had lung cancer screening examinations between January 1, 2015, and July 31, 2020, with a follow-up through July 31, 2021, from 5 academic and community lung cancer screening sites in North Carolina. Investigators led by M. Patricia Rivera, MD of Rochester University Medical Center in Rochester, New York collected data from the North Carolina Lung Screening Registry, which is a National Cancer Institute-funded registry that prospectively collects data on individuals who undergo lung cancer screening at participating locations in the state.

The registry has data on individual risk factor and sociodemographic information, screening exam and follow-up information, and outcome data from data exports, electronic health records, radiology reports, and state cancer registry data.

There were 685 adults with a positive screening exam, Lung-RADS, in categories 3, 4A, 4B, and 4X. Study participants were required to have at least 1 year of follow-up after their low-dose computed tomography examination.

Rivera et al performed the statistical analysis between December 2020 and March 2022.

Among the 685 individuals, 60.7% were aged at least 65 years or older, 18% were Black, 51.5% were male, and 82% were White.

Overall adherence to the recommend follow-up was 42.5% but varied by Lung-RADS category. The follow-up was 30% for Lung-RADS 3, 49.5% for Lung-RADS 4A, 68% for Lung-RADS 4B or 4X. When the follow-up time was extended, the adherence increased to 68.6% within 9 months, 77.3% within 5 months, and 80.5% within 62 days, respectively.

For Lung-RADS 3, the recommended follow-up was less likely for those who are smokers compared with those who had quit. Additionally, in Lung-RADS 4A, individuals who were Black were less likely to adhere to the recommended follow-up compared with white individuals.

For Lung-RADS 4B or 4X, individuals who were female were more likely to adhere to the follow-up compared with individuals who were male. Furthermore, individuals who are smokers were less likely to follow up for these categories than those who quit smoking.

Some limitations of the study included it being conducted in just 1 geographic area.

Additionally, individuals may have received follow-up care outside the locations where they were screened, which would not be evident in these data, according to Rivera et al.

The investigators also added that the impact of delays in follow-up care is not well-known, so it is unclear what the impact of increased follow-up would cause for individuals.

“Strategies to improve follow-up after a positive screening examination should focus on improving adherence to ACR-recommended follow-up for Lung-RADS 3 and 4A nodules with special attention on Black individuals, men, and those currently smoking to obtain timely follow-up. In addition, because there is no clear recommendation for the appropriate time to follow-up of Lung-RADS 4B and 4X nodules, consensus is needed on the appropriate follow-up timeline for these high-risk nodules. This is crucial given data from other studies suggesting delays in early-stage lung cancer care are associated with worse survival,” wrote Rivera et al.

REFERENCE:

_{Rivera MP, Durham DD, Long JM, et al. Receipt of recommended follow-up care after a positive lung cancer screening examination. JAMA Netw Open. 2022;5(11):e2240403. doi:10.1001/jamanetworkopen.2022.40403}