Browse ATS 2021 Abstracts

HomeProgram ▶ Browse ATS 2021 Abstracts

ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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"Lost to Follow-Up?" Barriers to Lung Cancer Screening Adherence in US Veterans

Session Title
A4775 - "Lost to Follow-Up?" Barriers to Lung Cancer Screening Adherence in US Veterans
Author Block: B. Bade1, E. DeRycke2, Y. Kunitomo2, K. Lerz3, M. Skanderson3, M. Rose3, P. DiDomenico3, M. Conti3, C. Taylor3, K. A. Crothers4, D. Federman3, S. Haskell3, B. Bean-Mayberry5, C. Brandt3, L. Bastian2, K. M. Akgun2, H. C. Cain6; 1Yale University, New Haven, CT, United States, 2VA Connecticut Healthcare System, West Haven, CT, United States, 3VA Connecticut Healthcare System, WEST HAVEN, CT, United States, 4Division of Pulmonary, Critical Care and Sleep, University of Washington, Seattle, WA, United States, 5VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States, 6Medicine/PCCSM, Yale School of Medicine, West Haven, CT, United States.
Introduction Because most cancers identified through lung cancer screening (LCS) are found after a baseline low dose CT (LDCT) scan, preventing non-adherence (i.e., being “lost to follow-up”) is critical. Non-adherence in the National Lung Screening Trial (NLST) was <10%. Yet, non-adherence outside clinical trials is widely variable (22-49%). We identified factors associated with non-adherence to first LCS follow-up in a cohort of United States (US) veterans. Methods We retrospectively analyzed veterans participating in VA Connecticut Healthcare System’s (VACHS) LCS program. VACHS utilizes an electronic clinical reminder to identify eligible patients. We defined adherence to follow-up as at least one LDCT within 15 months of the baseline LDCT. To account for interruption due to the coronavirus pandemic, we restricted observations to those participating in LCS between 6/1/2013-12/1/2018 (last date of follow-up 03/01/2020). We compared groups by adherence. Exposures of interest were based on prior work identifying sex, race, health behaviors (i.e., smoking, drug use), and mental health (MH) conditions as contributors to disparate care in US veterans with chronic lung disease. Comorbidities were identified by >2 outpatient or >1 inpatient International Classification of Diseases (ICD-9 and -10) codes. We used logistic regression to identify factors associated with non-adherence; due to co-linearity, we included drug use disorder alone (rather than drug and alcohol use disorders). Results Among 5,446 veterans participating in LCS, a minority (31%) were non-adherent to one-year follow-up. Compared to adherent, non-adherent veterans were younger (64.7 vs. 65.1 years) and more likely to be female (5% vs. 3%), non-white (23% vs. 20%), and current smokers (78% vs. 73%). Rates of MH comorbidity were high overall: alcohol use 23%, post-traumatic stress 17%, depression 14%, drug use 14%, bipolar 8%, and schizophrenia 4%. Veterans who were non-adherent were more likely to suffer from bipolar (9 vs. 7%), drug use (17% vs. 13%), and alcohol use disorders (25% vs. 22%; all p<0.05). After adjusting for age, sex, race, tobacco use, and MH conditions, significant associations with non-adherence to LCS follow-up included: female sex, non-white race, current smoking, and drug use disorder (Figure). Conclusions In a large VA cohort, non-adherence to LCS follow-up at 1-year is higher than that obtained in NLST but comparable to other non-trial settings. We identified sex, race, smoking status, and drug use disorder as risk factors for being “lost to follow-up.” Quality improvement should prioritize these groups into efforts to optimize LCS adherence.