Tracking the non-enrolled: lung cancer screening patterns among individuals not accrued to a clinical trial

Abstract Introduction For lung cancer screening, available data are often derived from patients enrolled prospectively on clinical trials. We therefore investigated lung cancer screening patterns among individuals eligible for but not enrolled in a screening trial. Patients and Methods From February 2017 through February 2019, we enrolled subjects to a trial examining telephone-based navigation during low-dose computed tomography (LDCT) for lung cancer screening. We identified patients for whom LDCT was ordered, and who were approached but not enrolled in the trial. We categorized non-enrollment as patient declined or unable to contact. We compared characteristics and LDCT completion rates among these groups and the enrolled population using two-sample t-test and Chi-squared test. Results Among 900 individuals approached for participation (mean age 62 years, 45 percent female, 53 percent black), 447 patients were enrolled to the screening clinical trial. There were no significant demographic differences between the enrolled and non-enrolled cohorts. Among the 453 individuals not enrolled, 251 (55 percent) declined participation, and 202 (45 percent) were unable to be contacted despite up to six attempts. LDCT completion was significantly associated with enrollment status: 81% among enrolled individuals, 73% among individuals who declined participation, and 49% among individuals unable to be contacted (P Conclusion In this single-center study, demographic factors did not predict participation in a lung cancer screening trial. Lung cancer screening adherence rates were substantially lower among individuals not enrolled in a screening trial, particularly among individuals unable to be contacted. These findings may inform the broader implementation of screening programs.