Patient-Reported Testing Burden of Low-Dose Chest CT Among Lung Cancer Screening Participants.

Abstract

To assess testing-related morbidity associated with low-dose chest CT (LDCT) among lung cancer screening participants across clinical settings and to examine how sociodemographic factors influence patient-reported outcomes. We conducted a prospective study (October 2022 to May 2024) at a university health system and a county safety-net health system. English- and Spanish-speaking individuals scheduled for LDCT within 15 days were eligible. The primary outcome was patient-reported LDCT testing burden measured by the Testing Morbidities Index summated scale score, a validated seven-domain measure of transient testing burden before, during, and after imaging (0 = worst experience; 100 = ideal experience). Secondary outcomes were Patient-Reported Outcomes Measurement Information System-10 physical and mental T-scores. Sociodemographic and clinical characteristics were abstracted from questionnaires and the electronic health record. Multivariable models assessed associations between these factors and testing-related burden. Of 505 enrolled participants, 468 (93%) completed LDCT and both questionnaires and were analyzed (median age, 64 years; range, 50-79). Mean Testing Morbidities Index score was 97.5 (95% confidence interval, 96.8-98.1) at the university site and 96.1 (96% confidence interval, 95.2-96.9) at the safety-net site (P = .01). Safety-net participants more often reported pain or discomfort before LDCT (13% versus 6%, P = .007) and during LDCT (16% versus 8%, P = .006). In multivariable analysis, marital status, employment, and insurance coverage were associated with testing-related morbidity. LDCT screening was associated with minimal short-term testing-related morbidity overall across diverse populations, although specific subgroups experienced greater testing burden. Understanding and addressing these factors may enhance the patient screening experience and improve uptake and adherence, particularly in underserved populations.