Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston.
Department of Internal Medicine, The Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City.
JAMA Netw Open. 2020 Nov 2;3(11):e2025102. doi: 10.1001/jamanetworkopen.2020.25102.
To be effective in reducing deaths from lung cancer among high-risk current and former smokers, screening with low-dose computed tomography must be performed periodically.
To examine lung cancer screening (LCS) adherence rates reported in the US, patient characteristics associated with adherence, and diagnostic testing rates after screening.
Five electronic databases (MEDLINE, Embase, Scopus, CINAHL, and Web of Science) were searched for articles published in the English language from January 1, 2011, through February 28, 2020.
Two reviewers independently selected prospective and retrospective cohort studies from 95 potentially relevant studies reporting patient LCS adherence.
Quality appraisal and data extraction were performed independently by 2 reviewers using the Newcastle-Ottawa Scale for quality assessment. A random-effects model meta-analysis was conducted when at least 2 studies reported on the same outcome. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guideline.
The primary outcome was LCS adherence after a baseline screening. Secondary measures were the patient characteristics associated with adherence and the rate of diagnostic testing after screening.
Fifteen studies with a total of 16 863 individuals were included in this systematic review and meta-analysis. The pooled LCS adherence rate across all follow-up periods (range, 12-36 months) was 55% (95% CI, 44%-66%). Regarding patient characteristics associated with adherence rates, current smokers were less likely to adhere to LCS than former smokers (odds ratio [OR], 0.70; 95% CI, 0.62-0.80); White patients were more likely to adhere to LCS than patients of races other than White (OR, 2.0; 95% CI, 1.6-2.6); people 65 to 73 years of age were more likely to adhere to LCS than people 50 to 64 years of age (OR, 1.4; 95% CI, 1.0-1.9); and completion of 4 or more years of college was also associated with increased adherence compared with people not completing college (OR, 1.5; 95% CI, 1.1-2.1). Evidence was insufficient to evaluate diagnostic testing rates after abnormal screening scan results. The main source of variation was attributable to the eligibility criteria for screening used across studies.
In this study, the pooled LCS adherence rate after a baseline screening was far lower than those observed in large randomized clinical trials of screening. Interventions to promote adherence to screening should prioritize current smokers and smokers from minority populations.
为了有效降低高危现吸烟者和前吸烟者的肺癌死亡率，必须定期进行低剂量计算机断层扫描筛查。
本研究旨在检查美国报告的肺癌筛查（LCS）依从率、与依从性相关的患者特征，以及筛查后的诊断检测率。
从 2011 年 1 月 1 日至 2020 年 2 月 28 日，5 个电子数据库（MEDLINE、Embase、Scopus、CINAHL 和 Web of Science）检索了以英文发表的文章。
两位评审员独立从 95 项可能相关的研究中筛选出报告患者 LCS 依从性的前瞻性和回顾性队列研究。
两位评审员使用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）独立进行质量评估和数据提取。当至少有 2 项研究报告了相同的结果时，进行了随机效应模型荟萃分析。报告遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。
主要结果是基线筛查后的 LCS 依从率。次要措施包括与依从性相关的患者特征，以及筛查后的诊断检测率。
本系统评价和荟萃分析共纳入了 15 项研究，总计 16863 名个体。所有随访期（12-36 个月）的 LCS 依从率为 55%（95%CI，44%-66%）。关于与依从率相关的患者特征，与曾经吸烟者相比，当前吸烟者更不可能遵循 LCS（比值比[OR]，0.70；95%CI，0.62-0.80）；与非白种人患者相比，白人患者更有可能遵循 LCS（OR，2.0；95%CI，1.6-2.6）；65 岁至 73 岁的患者比 50 岁至 64 岁的患者更有可能遵循 LCS（OR，1.4；95%CI，1.0-1.9）；与未完成大学学业的患者相比，完成 4 年或以上大学学业的患者也更有可能增加依从性（OR，1.5；95%CI，1.1-2.1）。证据不足以评估异常筛查扫描结果后的诊断检测率。主要的变异来源归因于研究中使用的筛查纳入标准。
在这项研究中，基线筛查后的 LCS 总体依从率远低于大规模随机临床试验中观察到的水平。促进筛查依从性的干预措施应优先考虑当前吸烟者和少数族裔人群中的吸烟者。
