Lost to Follow-up: Social Determinants and Patient Perceptions in Lung Cancer Screening Adherence

BACKGROUND: Lung cancer screening (LCS) with Low-Dose Computed Tomography (LDCT) significantly reduces cancer mortality but remains substantially underutilized. This study examines how social determinants of health (SDOH), including financial concerns, transportation barriers, and patient-provider trust, influence adherence to annual LCS.

METHODS: A prospective cohort study was conducted at an urban, safety-net academic health system. Participants who initially underwent LDCT but failed to adhere to annual follow-up were surveyed, assessing demographics, financial and transportation concerns, patient-provider relationships, and experiences of racial discrimination. Data was analyzed using descriptive statistics, chi-square tests, and Spearman correlations.

RESULTS: Among surveyors (n = 236), cost concerns (54.4%) and access to transportation (13.3%) were significant barriers to LCS adherence. Access to transportation was more limited for non-White (22.2%) and female (18.4%) populations, compared to White (6.5%, P < .01) and male (7.1%, P = .02) populations. However, there was no difference in cost concerns (P = .50, P = .89). Additionally, non-White (4.51/5 vs. 4.26/5, P < .01) and female (4.44/5 vs. 4.31/5, P = .04) patients reported higher levels of trust and comfort with providers comparing to their counter cohorts. Perceived racial discrimination in healthcare remained higher in non-White participants (1.53/5 vs. 1.25/5, P < .01) without effect in gender cohorts (P = .24).

CONCLUSIONS: LCS can decrease the chance of lung cancer death among eligible individuals but is drastically underutilized. Most people not adhering to LCS cited cost concerns, despite coverage by insurers. Patient-provider trust can be leveraged to assess and address individual barriers to LCS.