Barriers to Completing Low Dose Computed Tomography Scan for Lung Cancer Screening

IntroductionAnnual low-dose computed tomography (LDCT) screening has been shown to reduce lung cancer mortality in high-risk individuals by detecting the disease at an earlier stage. This study aims to assess the barriers to completing LDCT in a cohort of patients who were determined eligible for lung cancer screening (LCS).MethodsWe performed a single institution, mixed methods, cross-sectional study of patients who had a LDCT ordered from July-December 2022. We then completed phone surveys with patients who did not complete LDCT to assess knowledge, attitude, and perceptions toward LCS.ResultsWe identified 380 patients who met inclusion criteria, including 331 (87%) who completed LDCT and 49 (13%) who did not. Patients who completed a LDCT and those who did not were similar regarding age, sex, race, primary language, household income, body mass index, median pack years, and quit time. Positive predictors of LDCT completion were: meeting USPSTF guidelines (97.9% vs 81.6%), being married (58.3% vs 44.9%), former versus current smokers (55% vs 41.7%), personal history of emphysema (60.4% vs 42.9%), and family history of lung cancer (13.9% vs 4.1%) (all p<0.05). Of the patients who participated in the phone survey, only 7% of respondents thought they were high risk for developing lung cancer despite attending a shared decision-making visit and only 10% wanted to re-schedule their LDCT.ConclusionThere exist barriers to completing LDCT even after patients are identified as eligible and complete a shared decision-making visit secondary to knowledge barriers, misperceptions, and patient disinterest.MicroabstractAmong those referred for lung cancer screening (LCS), studies show that 15-30% of patients do not complete low-dose computed tomography (LDCT) and therefore lose out on the survival advantage that LCS offers. In our study, we found that the 13% of patients who did not complete LDCT were less likely to be married and more likely to be current smokers.