2189. Evaluation of Interventions Intended to Increase Lung Cancer Screening Rates: A Systematic Review and Meta-Analysis
Authors * Denotes Presenting Author
  1. Shina Satoh *; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Staten Island University Hospital
  2. Stuart Cohen ; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; North Shore University Hospital
  3. Manav Shah; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
  4. Mitchell Sungelo; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Staten Island University Hospital
  5. Louise Falzon ; The University of Sheffield
To summarize evidence on the effectiveness of interventions aimed at increasing lung cancer screening (LCS) rates.

Materials and Methods:
Databases including PubMed, Ovid, MEDLINE, EMBASE, The Cochrane Library, ClinicalTrials.gov, and Epistemonikos were searched to identify studies evaluating interventions aimed at increasing LCS rates in a healthcare facility setting. Studies with a prospective intervention and a comparator group, including randomized control trials (RCTs) and observational studies were included. Outcomes of interest were the rates of low-dose computed tomography (LDCT) performed (primary) and ordered (secondary) in the intervention versus the control groups. Two independent reviewers performed abstract/title and full-text screening, data extraction, and quality assessment with a third reviewer adjudicating any discrepancies. An intention-to-treat analysis was used to calculate relative risk (RR) for each study, which was employed as an effect size measure for meta-analyses. Subgroup analyses by intervention type, multistep versus single-step interventions, and decision aids (DA) versus non-DAs were performed. Data was pooled using a random-effects model. Multistep interventions were defined as those addressing multiple barriers throughout the patient’s course of care (e.g., establishing initial care, discussing and scheduling LCS, and ensuring follow-up care). Single-step interventions were those addressing barrier(s) at one point in care (e.g., DA for discussing and deciding to undergo LCS).

There were a total of 13 (n = 2761) studies that met final inclusion criteria for data extraction. Of these, 6 had results available, while 7 were ongoing studies with no results available to date. Interventions aimed at increasing rates of LCS LDCTs included patient navigation (n=1), outreach calls (n = 1), DAs (n = 3), and informational materials addressing psychological barriers to screening (n = 1). Overall, the proportion of screening LDCTs performed in the intervention groups did not improve compared to that of the comparator group (RR [95% CI] of 1.30 [0.74, 2.29]), and meta-analysis indicated high heterogeneity of studies (I^2 = 91%). Relative to control, multistep interventions resulted in higher proportion of LCS LDCTs performed (2.68 [1.77, 4.05]), while single-step interventions did not (0.99 [0.89, 1.10]; p < 0.01 for subgroup differences). Compared to control, DAs did not improve proportion of screening LDCTs performed (0.97 [0.75, 1.26]).

Few trials on LCS interventions exist. Emerging evidence suggests that multistep interventions (patient navigation and outreach calls) may be effective in increasing LDCT LCS.