Measuring Lung Cancer Screening Volume and Adherence during the COVID-19 Pandemic

ABSTRACT

RATIONALE Although lung cancer screening (LCS) uptake has increased to 5-16% nationally, screening initiation and adherence rates are threatened by the ongoing COVID-19 pandemic. Consistent with guidelines from a CHEST expert panel, our LCS program deferred new and annual low-dose CT (LDCT) screens during the pandemic's spring surge. Upon resuming screening, we pivoted to shared decision-making (SDM) via telemedicine. We characterized how these changes in screening implementation impacted our LCS volume and adherence. METHODS: We measured LCS patient- and LDCT scan-related volumes through our centralized program during pre-COVID (2019), deferral (March 18-May 18, 2020), and follow-up (May 18-November 18, 2020) to measure 3 outcomes: 1). Monthly volume of LDCTs in 2020 compared to 2019, 2). LDCT completion rate for SDM via telemedicine during the follow-up period, and 3). Adherence rates among patients due for LDCT during the deferral period and returned in the subsequent 6 months, compared to adherence among pre-COVID LCS patients. Adherence was defined as a subsequent CT within 11-18 months of a Lung-RADS 1 or 2 result, 4-8 months for Lung-RADS 3, and 2.5-4.5 months for Lung-RADS 4 patients recommended for 3-month follow-up. RESULTS: Monthly scan volume in our LCS program decreased during the COVID-19 first wave but increased following resumption of screening, and by August, the number of LDCTs exceeded 2019 (Figure). The number of patients screened between May-November 2020 and May-November 2019 was comparable (491 and 505 patients, respectively). However, the frequency of patients returning for follow-up was higher in 2020 compared with 2019 (62.1% vs. 46.3%). Following implementation of telemedicine, the screening completion rate decreased during May-November 2020, with 88.6% of patients (435/491) completing SDM but not LDCT, compared with 100% between May-November 2019. During the deferral period March-May 2020, 124 patients were due for a follow-up scan, and 54 (43.5%) received their scan within the study period. In comparison, 60.3% due for follow-up during the same period in 2019 completed their scan. CONCLUSIONS: Maintaining screening adherence has become a focus for many LCS programs. We observed that following the spring surge of the COVID-19 pandemic, the frequency of returning patients was greater than that of new patients initiating screening. Conducting SDM via telemedicine may introduce a barrier to LCS completion. Adherence rates decreased from 2019, with the lowest rates among Lung-RADS 3 patients due for a 6-month follow-up. Additional research should test LCS implementation strategies to improve adherence during the COVID-19 pandemic.