ABSTRACT
Objective: Screening with low-dose CT (LDCT) effectively reduces mortality from lung cancer. Elective imaging procedures, including lung cancer screening (LCS) LDCT exams, were paused during the height of the COVID-19 pandemic at our institution to conserve healthcare resources and minimize risk as we learned how to mitigate the spread of COVID-19. We aimed to investigate the short-term impact of this COVID-related screening pause on patient participation and adherence to LCS. Methods: We analyzed data of 5133 LDCT screening exams performed at our institution from 2961 patients who were aged 50-80 at each screen between July 31, 2013 and Dec 30, 2020. Independent t-test, Pearson's chi-square and Fisher's exact tests were used to compare monthly average number of LDCTs, on-time adherence rates (i.e., completion of recommended or more invasive follow-up within 15, 9, 5, and 3 months for Lung-RADS 1/2, 3, 4A, and 4B/4X, respectively), percentages of positive screens (Lung-RADS 3 and 4), and lung cancer diagnoses across pre- (July 31, 2013 ∼ Mar 18, 2020), during (Mar 19, 2020 ∼ May 19, 2020), and post-COVID screening pause (May 20, 2020 and after) periods. Results: As expected, compared with the pre-COVID screening pause, there was a significant decrease in monthly average number of LDCTs during the COVID screening pause period (total monthly mean ± sd: pre 55±28 vs during 17±1, p<0.05;new patient monthly mean ± sd: pre 34±16 vs during 6±2, p<0.05). However, a surge in LCS activities was observed after the COVID screening pause period (total: during 17±1 vs post 89±10, p<0.05;new: during 6±2 vs post 42±8, p<0.05), surpassing monthly means in the pre-COVID period (total: pre 55±28 vs post 89±10, p<0.05;new: pre 34±16 vs post 42±8, p<0.05). Overall on-time adherence decreased in the post-COVID period as opposed to the pre-COVID period (p<0.05). There were no significant changes in the percent of positive screens across the three periods (p>0.05). Among the 88 patients diagnosed with lung cancers, 76 diagnoses were made before COVID, 12 diagnoses were made after the COVID pause, and no lung cancer diagnoses were made during the COVID screening pause period. There were no significant differences in terms of the rate of lung cancer (pre 2.9% vs post 1.9%, p>0.05) and the percent of advanced lung cancers (pre 20% vs post 0%, p>0.05) during the two periods. Conclusion: The rate of LCS exams performed at our institution declined during the early days of the COVID-19 pandemic, as elective exams were paused. Once screening resumed, we experienced a surge in the rate of LCS that surpassed pre-COVID rates. Although there were no significant changes in the percentages of positive screens and lung cancer diagnoses shortly after the COVID screening pause period, long-term follow-up is needed to monitor these trends. Additionally, interventions may be needed to improve rates of patients' timely adherence to LCS follow-up recommendations, which decreased in the post-COVID period.