Factors determining early adherence to a lung cancer screening protocol

¹ Dept of Pulmonary Medicine, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain
² Dept of Radiology, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain

^* To whom correspondence should be addressed. E-mail: lmseijo{at}unav.es.

	Abstract

Lung cancer screening using CT is effective in detecting early stage disease. However, concerns regarding adherence have been raised.

We conducted a retrospective observational study of 641 asymptomatic smokers enrolled in our lung cancer screening program between 2000 and 2003. Adherent subjects were compared with non-adherent subjects with regard to lung function, gender, age, motivation for enrollment, smoking status, distance to the referral center, family history of lung cancer, asbestos exposure, education, the presence and type of nodule(s) seen on initial CT, and exposure to a nursing intervention designed to improve adherence.

Overall early adherence to the study protocol was 65%. Multivariate analysis confirmed the importance of gender, proximity to the referral center, the presence of non-calcified nodules, and the nursing intervention as factors conditioning adherence to the study protocol. Patients encouraged to participate in the study were more adherent, as were former smokers. Gender interactions were observed in multivariate analysis. The nursing intervention was significant for women, while abnormal lung function improved male adherence.

Adherence to lung cancer screening is particularly good among women and subjects living near the referral center. Our study suggests the need to develop new strategies, especially those targeting men and subjects with low-risk perception, in order to improve adherence.