Project ACTS (Adherence to CT Screening)

Project ACTS logoThe goal of Project ACTS is to increase the proportion of high-risk individuals who adhere to screening recommendations in order to have earlier intervention and reduce lung cancer mortality.

Currently the Centers for Medicare & Medicaid Services (CMS) mandates coverage for screening by computed tomography (CT) for individuals at high risk for lung cancer. However, there are systemic barriers that may make it difficult for those who require follow-up scans (such as those with abnormal findings in the first scan) to comply with recommendations for additional low-dose CT screening and annual follow-up.

The long-term goal of Project ACTS (Adherence to CT Screening) — a unique collaboration among clinicians, researchers, and advocates— is to increase the proportion of high-risk individuals who comply with these recommendations. The more people who adhere to screening recommendations, the more likely that lung cancers will be diagnosed at an early stage, leading to early treatment and reduced lung cancer mortality.

A high-risk individual, as defined by National Lung Screening Trial (NLST) criteria, is a current or former smoker with a 30 or more pack-year smoking history (former smokers had quit up to 15 years before enrollment in the study), 55 to 74 years of age, with no evidence of lung cancer.

The Project ACTS investigative team will develop a patient-vetted (shared decision-making) engagement tool to support increased adherence to the lung cancer screening algorithm among individuals at high risk. As illustrated in the following figure, the tool (indicated in the orange bar) will be separate from current engagement tools used to increase participant engagement before or at the first CT scan (as per CMS mandate – indicated in the green bar).

screening algorithm comparison

The main objectives of Project ACTS are:

  1. To identify participant- and clinician-specific barriers that impede adherence to follow-up scans in high-risk individuals
  2. To develop a patient-vetted, clinician-approved (shared decision-making) engagement tool to support increased adherence to lung cancer screening follow-up recommendations in high-risk individuals
  3. To conduct usability, feasibility, and acceptability testing of the engagement tool in multiple screening centers
  4. To conduct a cluster randomized trial of the engagement tool in multiple screening centers

Results to Date

  1. Byrne MM, Hirsch EA, Hoover K, et al. Developing a conceptual framework for a person-centered approach to improving adherence and outcomes in lung cancer screening: the engaged approach to lung cancer screening (a brief report). JTO Clin Res Rep. Published online September 17, 2024. www.jtocrr.org/article/S2666-3643(24)00098-5/fulltext
  2. Basu Roy U, Byrne M, McCoy J, et al. Project ACTS (Adherence to CT Screening): Development and Usability of Patient Engagement Tools to Support Lung Cancer Screening Adherence. Poster, World Conference on Lung Cancer, 2019.
  3. Basu Roy U, Blair C, Byrne M, et al. BMS Foundation Grantee Summit 2019 Changemaker Chat. April 16, 2019.