Frailty was not associated with adherence to repeat LDCT screening (aOR 0.99; 95% CI 0.89-1.10) but was associated with lower adherence to follow-up after positive results (aOR 0.82; 95% CI 0.68-0.99).
Cohort (n=31,795)
Yes
Does frailty reduce adherence to lung cancer screening and follow-up care in adults undergoing LDCT?
Frailty is associated with lower adherence to recommended follow-up after positive lung cancer screening results, suggesting a need for tailored adherence support.
Effect estimate: aOR 0.99 (95% CI 0.89-1.10)
Absolute Event Rate: 17.4% vs 16.6%
Abstract Rationale Frailty may influence adherence to lung cancer screening (LCS) and recommended follow-up, which has implications for optimizing screening strategies and outcomes. We evaluated whether frailty is associated with adherence to repeat screening and to guideline-concordant follow-up. Methods We conducted a retrospective cohort study using the multi-center Personalized Lung Screening (PLuS) study. Adults who completed baseline or repeat low-dose computed tomography (LDCT) between 2016 and 2021 were followed through 2022. Eligibility required at least one primary care visit before baseline LDCT and no lung cancer diagnosis in the prior five years. Frailty was measured using a validated claims-based frailty index and categorized as non-frail (0–0.13), pre-frail (0.13–0.20), or frail (0.20). Primary outcomes were: 1) adherence to annual LDCT within two years among participants with negative Lung Imaging Reporting and Data System (Lung-RADS) scores 1–2, and 2) adherence to recommended follow-up among those with positive scores 3–4X. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results Among 31,795 participants, 18% were frail, 17% pre-frail, and 65% non-frail. Frail participants were more often older, White, male, and former smokers. Repeat LDCT screening: Of 24,962 eligible, overall adherence was 16.9%. Adherence did not differ by frailty status in the primary analysis (frail 17.4% vs non-frail 16.6%; aOR 0.99; 95% CI 0.89–1.10). In a sensitivity analysis excluding individuals who never returned for any screening, frailty was associated with higher adherence (45.4% vs 40.0%; aOR 1.24; 95% CI 1.09–1.42; p for trend across frailty scores = 0.001). Neighborhood education level and smoking status were associated with adherence, whereas age, sex, and race were not. Follow-up after positive Results Among 5,320 with Lung-RADS 3–4X, adherence was 26.8% overall and was lower in frail vs non-frail participants (25.2% vs 27.5%; aOR 0.82; 95% CI 0.68–0.99; p for trend = 0.0378). Older age and current smoking were associated with higher adherence, while never smoking was associated with lower adherence. Findings were consistent in sensitivity analyses with extended follow-up windows. Conclusion Frailty was associated with higher adherence to repeat LDCT among returning patients, but lower adherence to recommended follow-up after positive results. Tailored adherence support and refined referral pathways may be necessary to improve outcomes across different levels of frailty. This abstract is funded by: National Institutes of Health, National Cancer Institute (NIH/NCI)
Shrestha et al. (2026) conducted a cohort in Lung cancer screening (n=31,795). Frailty vs. Non-frail was evaluated on Adherence to annual LDCT within two years among participants with negative Lung-RADS scores 1-2 (aOR 0.99, 95% CI 0.89-1.10). Frailty was not associated with adherence to repeat LDCT screening (aOR 0.99; 95% CI 0.89-1.10) but was associated with lower adherence to follow-up after positive results (aOR 0.82; 95% CI 0.68-0.99).