Impact of frailty and comorbidity on initial response to lung cancer screening invitation and low-dose CT screening uptake: Findings from the Yorkshire Lung Screening Trial.

IF 2.6 4区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Journal of Medical Screening Pub Date : 2025-01-27 DOI:10.1177/09691413251315087

Anas Almatrafi, Rhian Gabe, Rebecca J Beeken, Richard D Neal, Andrew Clegg, Kate E Best, Samuel Relton, Martel Brown, Hui Zhen Tam, Neil Hancock, Philip A J Crosbie, Matthew E J Callister

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引用次数: 0

Abstract

Background: Low-dose computed tomography screening reduces lung cancer-specific mortality in high-risk individuals. Lung cancer risk factors overlap with comorbid diseases, highlighting the significance of frailty and comorbidities for lung cancer screening (LCS). Here, we describe the prevalence of frailty and comorbidity in those invited for LCS and evaluate their associations with response to telephone risk assessment invitation and subsequent uptake of LCS.

Methods: Analysis was based on the intervention arm of the Yorkshire Lung Screening Trial, where ever-smoked individuals aged 55-80 were invited to telephone risk assessment followed by community-based LCS if at higher risk. The electronic frailty index (eFI) was used to compute individual frailty scores (categorised as fit, mild, moderate and severe) and derive comorbidity data.

Results: Of 27,761 individuals invited, 24.1% (n = 6702), 8.5% (n = 2353) and 1.7% (n = 459) had mild, moderate and severe frailty, respectively. Over half responded to the invitation to telephone risk assessment (n = 14,523, 52.5%) with frailty associated with a higher response rate compared to fit individuals: adjusted odds ratio (OR_adj) 1.34, 95% confidence interval (CI) 1.26-1.42 for mild frailty; OR_adj 1.28, 95%CI 1.16-1.40 for moderate frailty; and OR_adj 1.32, 95%CI 1.08-1.61 for severe frailty. Similar patterns were seen with comorbidity counts. After assessment, moderate (OR_adj 0.75, 95%CI 0.59-0.96) and severe (OR_adj 0.67, 95%CI 0.43-1.04) frailty were associated with reduced screening uptake.

Conclusion: The presence of frailty was associated with increased response to LCS invitation. Given the strong association between frailty and reduced life expectancy, these results suggest that people with potentially more life years to be gained from LCS may be less inclined to take part. Further research is needed to explore the interactions between frailty and LCS decision-making to inform future invitation strategies.

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背景：低剂量计算机断层扫描筛查可降低高危人群的肺癌特异性死亡率。肺癌的风险因素与合并症重叠，这突出了虚弱和合并症对肺癌筛查（LCS）的重要性。在此，我们描述了应邀参加肺癌筛查者中体弱和合并症的发生率，并评估了它们与对电话风险评估邀请的反应及随后接受肺癌筛查的相关性：分析基于约克郡肺筛查试验的干预组，该试验邀请 55-80 岁的吸烟者接受电话风险评估，如果风险较高，则接受社区肺筛查。电子虚弱指数（eFI）用于计算个人虚弱分数（分为适合、轻度、中度和重度）并得出合并症数据：在 27761 名受邀者中，分别有 24.1%（n = 6702）、8.5%（n = 2353）和 1.7%（n = 459）的人患有轻度、中度和重度虚弱。超过一半的人回复了电话风险评估邀请（n = 14,523, 52.5%），与体格健壮的人相比，体弱者的回复率更高：轻度体弱者的调整赔率比 (ORadj) 为 1.34，95% 置信区间 (CI) 为 1.26-1.42；中度体弱者的调整赔率比为 1.28，95% 置信区间 (CI) 为 1.16-1.40；重度体弱者的调整赔率比为 1.32，95% 置信区间 (CI) 为 1.08-1.61。合并症计数也有类似的模式。经过评估，中度（ORadj 0.75，95%CI 0.59-0.96）和重度（ORadj 0.67，95%CI 0.43-1.04）虚弱与筛查率降低有关：结论：体弱与对 LCS 邀请的响应增加有关。考虑到体弱与预期寿命缩短之间的密切联系，这些结果表明，可能会从 LCS 中获得更多寿命的人可能不太愿意参加 LCS。还需要进一步的研究来探索体弱与LCS决策之间的相互作用，为未来的邀请策略提供参考。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Medical Screening 医学-公共卫生、环境卫生与职业卫生

CiteScore

4.90

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Medical Screening, a fully peer reviewed journal, is concerned with all aspects of medical screening, particularly the publication of research that advances screening theory and practice. The journal aims to increase awareness of the principles of screening (quantitative and statistical aspects), screening techniques and procedures and methodologies from all specialties. An essential subscription for physicians, clinicians and academics with an interest in screening, epidemiology and public health.