Uptake of Lung Cancer Screening CT After a Provider Order for Screening in the PROSPR-Lung Consortium

• DOI: 10.1007/s11606-023-08408-9
• Publication Date: 2023-10-02T17:01:46Z
• Authors: Christine Neslund...; Amy Tang; Elizabeth Alleman; Katie R. Zarins; Pin Li; Michael J. Simoff; Jennifer Elston L...; Katharine A. Rendle; Andrea N. Burnett...; Stacey A. Honda; Caryn Oshiro; Oluwatosin Olaiya; Robert T. Greenlee; Anil Vachani; Debra P. Ritzwoller
• Keywords: Male; Cohort Studies; Lung Neoplasms; Humans; Mass Screening; Tomography, X-Ray Computed; Lung; Early Detection of Cancer

Uptake of lung cancer screening (LCS) has been slow with less than 20% of eligible people who currently or formerly smoked reported to have undergone a screening CT.To determine individual-, health system-, and neighborhood-level factors associated with LCS uptake after a provider order for screening.We conducted an observational cohort study of screening-eligible patients within the Population-based Research to Optimize the Screening Process (PROSPR)-Lung Consortium who received a radiology referral/order for a baseline low-dose screening CT (LDCT) from a healthcare provider between January 1, 2015, and June 30, 2019.The primary outcome is screening uptake, defined as LCS-LDCT completion within 90 days of the screening order date.During the study period, 18,294 patients received their first order for LCS-LDCT. Orders more than doubled from the beginning to the end of the study period. Overall, 60% of patients completed screening after receiving their first LCS-LDCT order. Across health systems, uptake varied from 41 to 87%. In both univariate and multivariable analyses, older age, male sex, former smoking status, COPD, and receiving care in a centralized LCS program were positively associated with completing LCS-LDCT. Unknown insurance status, other or unknown race, and lower neighborhood socioeconomic status, as measured by the Yost Index, were negatively associated with screening uptake.Overall, 40% of patients referred for LCS did not complete a LDCT within 90 days, highlighting a substantial gap in the lung screening care pathway, particularly in decentralized screening programs.