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

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.