Abstract Background Pulmonary nodules are frequently detected in routine imaging, yet ensuring timely evaluation and continuity of care remains a persistent challenge, particularly in underserved, high-burden settings. Failure to complete diagnostic follow-up contributes to delayed cancer detection, preventable morbidity, and increased health-system inefficiency. Despite national guideline frameworks, real-world data describing where and why patients disengage within the lung nodule care pathway are limited. Quantifying attrition and its predictors is essential to inform targeted quality-improvement strategies and reduce missed opportunities for early intervention. Methods A cross-sectional study was conducted at a Bronx safety-net hospital between July 2022 and June 2024. Patients with pulmonary nodules were retrospectively identified, and the care cascade was mapped from index detection through Pulmonology consultation, retention in follow-up, treatment initiation, and remission. Logistic regression identified independent predictors of loss to follow-up among patients seen by Pulmonology. Results The study included 132 patients (76 males 57.6%, 56 females 42.4%). Of these, 104 patients (81%) were evaluated by Pulmonology, yet only 64 (62% of those evaluated) remained in active follow-up after the initial visit. Among those retained, 24 patients (38%) initiated treatment, and 5 patients (8%) achieved remission. The median interval from nodule detection to Pulmonology evaluation was six weeks. In multivariable analysis, incidental detection (adjusted OR ≈ 2.1; 95% CI, 1.1–4.7; p = 0.04) and longer delay to Pulmonology (per week; adjusted OR ≈ 1.08; 95% CI, 1.01–1.16; p = 0.03) were independently associated with loss to follow-up, whereas nodule characteristics, comorbidities, age, and sex were not significant predictors. Conclusions Our findings reveal that the most critical gap in pulmonary nodule management occurs after the initial Pulmonology evaluation, when nearly four in ten patients disengage from follow-up. This pattern reflects a breakdown in the continuity of care that bridges detection to treatment. Strengthening communication between referring teams and specialists, ensuring structured follow-up protocols, and incorporating patient navigation or reminder systems may help close this loop. Addressing this vulnerable transition, especially for incidentally detected nodules, can promote timely diagnosis, prevent avoidable delays, and advance equitable, closed-loop cancer care This abstract is funded by: None
Nada et al. (2026) studied this question.