1. Implementation of a lung health clinic in high-risk individuals in South East London: a prospective feasibility cohort study
Background
In 2013, lung cancer was the third most common cancer after breast cancer and prostate cancer. There were over 45,000 new cases of lung cancer in the UK
Lung cancer is the most common cause of cancer death in the UK, with over 35,000 deaths from the condition in England in 2014, more than from breast and colorectal cancers combined. This accounts for 22% of all cancer deaths in both males and females combined.
The clinical challenge:
Lung cancer continues to be diagnosed at a late stage. In 2013, 77% of cases were stages IIIB or IV at the time of diagnosis
28% of cases were referred through the two-week urgent referral pathway
35% of cases are diagnosed via A&E admission. Outcomes are significantly worse for those diagnosed following an A&E presentation
The pick up rate of early cancer in high risk patients is not ideal, as chest X-rays - the preferred imaging test – presents significant limitations
Lung cancer tends to be diagnosed at a late stage and mainly via A&E which results in poorer clinical outcomes.
Aims
TOHETI aims to investigate uptake of low dose CT scans when offered as part of a lung health clinic assessment in patients aged who are current or formers smokers (smoking cessation <15 years)
Proposed pathway 1 2 3 4 5 6
Community
pharmacy
GP database
search
Smoking cessation clinics
Secondary care: respiratory clinic
Non- recruitment questionnaire
Patient invitation
+ risk score questionnaire
Low risk score or Symptoms of lung cancer
Excluded
Methods
The current clinical pathway for lung cancer diagnosis relies on patients visiting their GP once symptoms suggestive of lung cancer have developed. Patients symptomatic for lung cancer at diagnosis tend to have more advanced stages of lung cancer and are less likely to be eligible for treatment of curative intent.
A successful lung cancer screening strategy must correctly identify patients with lung cancer, where the benefits of early chest low dose CT outweigh the possible risks, while simultaneously minimising the risks arising from the investigation of false-positive results.
Non- acceptance
High risk score
Lung health clinic
Chest x-ray
Same day
Invite eligible patients to complete a risk questionnaire
GP EMIS Search
Community pharmacy
Secondary care
Smoking cessation
Patients with high risk invited to the lung health clinic
Patients with a ≥5% risk of lung cancer over 5 years will be invited to attend the clinic
Lung health clinic: Nurse led clinic
Lung function tests (spirometry and CO test)
Chest radiology and low dose chest CT
Patients will be notified of the result of their scans
No lung cancer or nodules
Suspicion of lung cancer
Lung nodules
No lung nodule or lung cancer
Low dose chest CT
Suspected lung cancer
Lung nodule
UKLS lung nodule pathway
Lung cancer pathway
GP refers patient with respiratory disease
Very high risk
Low risk
Localised spirometry service
No scan
Discharge to GP
Intermediate and high risk
Refer to Chest Clinic
Low-dose CT scan
Low to intermediate risk nodule
Normal scan
High risk nodule
Interval low-dose CT scan
Patient follow up
Patient information leaflet
Outcomes
Expected impact
Patient experience and satisfaction
Improved patient experience and satisfaction due to a streamlined clinical pathway
Quality of care
Better patient outcomes by reducing late lung cancer diagnosis and ultimately improving patient prognosis
Efficiency
Improved cost-effectiveness by decreasing the cost per QALY (quality-adjusted life year) both from NHS and societal perspective
CONTACT US: Project Manager: Ms Yvonne Akande
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