Almatrafi Anas, Gabe Rhian, Beeken Rebecca J, Neal Richard D, Clegg Andrew, Best Kate E, Relton Samuel, Brown Martel, Tam Hui Zhen, Hancock Neil, Crosbie Philip A J, Callister Matthew E J
Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK.
Department of Epidemiology, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia.
J Med Screen. 2025 Sep;32(3):161-171. doi: 10.1177/09691413251315087. Epub 2025 Jan 27.
BackgroundLow-dose computed tomography screening reduces lung cancer-specific mortality in high-risk individuals. Lung cancer risk factors overlap with comorbid diseases, highlighting the significance of frailty and comorbidities for lung cancer screening (LCS). Here, we describe the prevalence of frailty and comorbidity in those invited for LCS and evaluate their associations with response to telephone risk assessment invitation and subsequent uptake of LCS.MethodsAnalysis was based on the intervention arm of the Yorkshire Lung Screening Trial, where ever-smoked individuals aged 55-80 were invited to telephone risk assessment followed by community-based LCS if at higher risk. The electronic frailty index (eFI) was used to compute individual frailty scores (categorised as fit, mild, moderate and severe) and derive comorbidity data.ResultsOf 27,761 individuals invited, 24.1% ( = 6702), 8.5% ( = 2353) and 1.7% ( = 459) had mild, moderate and severe frailty, respectively. Over half responded to the invitation to telephone risk assessment ( = 14,523, 52.5%) with frailty associated with a higher response rate compared to fit individuals: adjusted odds ratio (OR) 1.34, 95% confidence interval (CI) 1.26-1.42 for mild frailty; OR 1.28, 95%CI 1.16-1.40 for moderate frailty; and OR 1.32, 95%CI 1.08-1.61 for severe frailty. Similar patterns were seen with comorbidity counts. After assessment, moderate (OR 0.75, 95%CI 0.59-0.96) and severe (OR 0.67, 95%CI 0.43-1.04) frailty were associated with reduced screening uptake.ConclusionThe presence of frailty was associated with increased response to LCS invitation. Given the strong association between frailty and reduced life expectancy, these results suggest that people with potentially more life years to be gained from LCS may be less inclined to take part. Further research is needed to explore the interactions between frailty and LCS decision-making to inform future invitation strategies.
低剂量计算机断层扫描筛查可降低高危人群的肺癌特异性死亡率。肺癌风险因素与合并症重叠，凸显了虚弱和合并症对肺癌筛查（LCS）的重要性。在此，我们描述了受邀参加LCS者的虚弱和合并症患病率，并评估它们与电话风险评估邀请的反应以及随后LCS接受情况之间的关联。
分析基于约克郡肺癌筛查试验的干预组，其中邀请年龄在55 - 80岁的曾经吸烟者进行电话风险评估，如果风险较高则随后进行基于社区的LCS。使用电子虚弱指数（eFI）计算个体虚弱评分（分为健康、轻度、中度和重度）并得出合并症数据。
在27761名受邀者中，分别有24.1%（n = 6702）、8.5%（n = 2353）和1.7%（n = 459）有轻度、中度和重度虚弱。超过一半的人回应了电话风险评估邀请（n = 14523，52.5%），与健康个体相比，虚弱与更高的回应率相关：轻度虚弱的调整优势比（OR）为1.34，95%置信区间（CI）为1.26 - 1.42；中度虚弱的OR为1.28，95%CI为1.16 - 1.40；重度虚弱的OR为1.32，95%CI为1.08 - 1.61。合并症计数也呈现类似模式。评估后，中度（OR 0.75，95%CI 0.59 - 0.96）和重度（OR 0.67，95%CI 0.43 - 1.04）虚弱与筛查接受率降低相关。
虚弱的存在与对LCS邀请的反应增加相关。鉴于虚弱与预期寿命缩短之间的紧密关联。这些结果表明，可能从LCS中获得更多生存年限的人可能不太愿意参与。需要进一步研究来探索虚弱与LCS决策之间的相互作用，以为未来的邀请策略提供信息。
