Almatrafi, A. orcid.org/0000-0002-7893-0123, Gabe, R., Beeken, R.J. orcid.org/0000-0001-8287-9351 et al. (9 more authors) (2025) 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. Journal of Medical Screening. ISSN 0969-1413
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 (ORadj) 1.34, 95% confidence interval (CI) 1.26–1.42 for mild frailty; ORadj 1.28, 95%CI 1.16–1.40 for moderate frailty; and ORadj 1.32, 95%CI 1.08–1.61 for severe frailty. Similar patterns were seen with comorbidity counts. After assessment, moderate (ORadj 0.75, 95%CI 0.59–0.96) and severe (ORadj 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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Author(s) 2025. This is an open access article under the terms of the Creative Commons Attribution License (CC-BY-NC 4.0), which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. |
Keywords: | Lung cancer screening, frailty, comorbidity, low-dose computed tomography, lung cancer |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Elderly Care and Rehabilitation (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Health Sciences (Leeds) > Academic Unit of Primary Care (Leeds) The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 13 Feb 2025 14:09 |
Last Modified: | 13 Feb 2025 14:09 |
Status: | Published |
Publisher: | SAGE Publications |
Identification Number: | 10.1177/09691413251315087 |
Related URLs: | |
Sustainable Development Goals: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:223086 |