Study Shows Less Than 50 Percent Adherence to Follow-Up After Positive CT Findings for Lung Cancer

A new study of people who had positive findings for lung cancer on low-dose computed tomography (CT) revealed that only 42 percent received timely, recommended follow-up care.

The authors of the prospective, multicenter study, which was recently published in JAMA Network Open, examined rates of follow-up care among 685 patients who were screened for lung cancer via low-dose CT. The researchers noted that 363 patients had Lung-RADS 3 findings, 194 people had Lung-RADS 4A findings and 128 study participants had Lung-RADS 4B or 4X findings.

While the overall rate of adherence with follow-up care was 42.6 percent, the study authors said adherence increased with an increased level of suspicion for lung cancer. The researchers reported a 30 percent adherence rate in the Lung-RADS 3 group; a 49.5 percent adherence rate in the Lung-RADS 4A group; and a 68 percent adherence rate for those with Lung-RADS 4B or 4x findings.

The study authors also noted lower rates of follow-up care adherence for men, Black individuals, and smokers. In the Lung-RADS 4B or 4X group, females were nearly three times more likely than men to have recommended follow-up care. The study authors noted that Black individuals in the Lung-RADS 4A group were 65 percent less likely than White individuals to have recommended follow-up care. In the Lung-RADS 4A group, current smokers were 27 percent less likely than former smokers to have recommended follow-up care, according to the study.

“Our results highlight gaps in recommended follow-up according to level of suspicion for lung cancer per Lung-RADS and suggest an area of future research focused on the consequences of decreased adherence to recommended follow-up on lung cancer mortality at the population level,” wrote lead study author M. Patricia Rivera, M.D., a professor and chief of the Division of Pulmonary and Critical Care Medicine at the University of Rochester Medical Center, and colleagues.

(Editor’s note: For related content, see “Study Looks at Potential Impact of Expanded Eligibility for Low-Dose CT Lung Cancer Screening” and “Lung Cancer Screening Study Says Significant Disparities Persist Despite Expanded Eligibility.”)

The study authors noted that expanding the recommended follow-up timeframes in the Lung-RADS 3 group (from six months to nine months) and the Lung-RADS 4A group (from three months to five months) increased respective adherence rates by 38.6 percent and 27.8 percent. Expanding the Lung-RADS 4B or 4X group from a four-week follow-up period to 62 days increased the adherence rate by 12.5 percent, according to the researchers.

While the researchers noted that an extended follow-up period is unlikely to have a substantial impact on outcomes in people with Lung-RADS 3 findings, they said there is insufficient evidence to determine the impact of delayed follow-up care for people with Lung-RADS 4A, 4B or 4X nodules. Rivera and colleagues also pointed out there is a strong need to determine clear consensus guidance on the recommended follow-up time for patients who have Lung-RADS 4B and 4X findings on CT.

“This is crucial given data from other studies suggesting delays in early-stage lung cancer care are associated with worse survival,” emphasized Rivera and colleagues.

In regard to study limitations, the researchers acknowledged the prospective, multicenter study was performed in one geographic area in North Carolina and may not reflect differences in lung cancer screening follow-up across the United States. The study authors also noted that follow-up care performed outside of the initial screening location was not reflected in the study findings.