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Goodley P, Crosbie PAJ, Sperrin M, Merchant Z, Booton R, Balata H. When to reinvite initially ineligible populations for targeted lung cancer screening? BMJ Open Respir Res 2024; 11:e002193. [PMID: 38754907 PMCID: PMC11097831 DOI: 10.1136/bmjresp-2023-002193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/19/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Targeted low-dose CT lung cancer screening reduces lung cancer mortality. England's Targeted Lung Health Check programme uses risk prediction tools to determine eligibility for biennial screening among people with a smoking history aged 55-74. Some participants initially ineligible for lung cancer screening will later become eligible with increasing age and ongoing tobacco exposure. It is, therefore, important to understand how many people could qualify for reinvitation, and after how long, to inform implementation of services. METHODS We prospectively predicted future risk (using Prostate, Lung, Colorectal and Ovarian trial's risk model (PLCOm2012) and Liverpool Lung Project version 2 (LLPv2) risk models) and time-to-eligibility of 5345 participants to estimate how many would become eligible through the course of a Lung Health Check screening programme for 55-74 years. RESULTS Approximately a quarter eventually become eligible, with those with the lowest baseline risks unlikely to ever become eligible. Time-to-eligibility is shorter for participants with higher baseline risk, increasing age and ongoing smoking status. At a PLCOm2012 threshold ≥1.51%, 68% of those who continue to smoke become eligible compared with 18% of those who have quit. DISCUSSION Predicting which participants may become eligible, and when, during a screening programme can help inform reinvitation strategies and service planning. Those with risk scores closer to the eligibility threshold, particularly people who continue to smoke, will reach eligibility in subsequent rounds while those at the lowest risk may be discharged from the programme from the outset.
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Affiliation(s)
- Patrick Goodley
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Philip A J Crosbie
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Zoe Merchant
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
| | - Haval Balata
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK
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Goodley P, Balata H, Alonso A, Brockelsby C, Conroy M, Cooper-Moss N, Craig C, Evison M, Hewitt K, Higgins C, Johnson W, Lyons J, Merchant Z, Rowlands A, Sharman A, Sinnott N, Sperrin M, Booton R, Crosbie PAJ. Invitation strategies and participation in a community-based lung cancer screening programme located in areas of high socioeconomic deprivation. Thorax 2023; 79:58-67. [PMID: 37586744 PMCID: PMC10803959 DOI: 10.1136/thorax-2023-220001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Although lung cancer screening is being implemented in the UK, there is uncertainty about the optimal invitation strategy. Here, we report participation in a community screening programme following a population-based invitation approach, examine factors associated with participation, and compare outcomes with hypothetical targeted invitations. METHODS Letters were sent to all individuals (age 55-80) registered with a general practice (n=35 practices) in North and East Manchester, inviting ever-smokers to attend a Lung Health Check (LHC). Attendees at higher risk (PLCOm2012NoRace score≥1.5%) were offered two rounds of annual low-dose CT screening. Primary care recorded smoking codes (live and historical) were used to model hypothetical targeted invitation approaches for comparison. RESULTS Letters were sent to 35 899 individuals, 71% from the most socioeconomically deprived quintile. Estimated response rate in ever-smokers was 49%; a lower response rate was associated with younger age, male sex, and primary care recorded current smoking status (adjOR 0.55 (95% CI 0.52 to 0.58), p<0.001). 83% of eligible respondents attended an LHC (n=8887/10 708). 51% were eligible for screening (n=4540/8887) of whom 98% had a baseline scan (n=4468/4540). Screening adherence was 83% (n=3488/4199) and lung cancer detection 3.2% (n=144) over 2 rounds. Modelled targeted approaches required 32%-48% fewer invitations, identified 94.6%-99.3% individuals eligible for screening, and included 97.1%-98.6% of screen-detected lung cancers. DISCUSSION Using a population-based invitation strategy, in an area of high socioeconomic deprivation, is effective and may increase screening accessibility. Due to limitations in primary care records, targeted approaches should incorporate historical smoking codes and individuals with absent smoking records.
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Affiliation(s)
- Patrick Goodley
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Haval Balata
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Alberto Alonso
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Christopher Brockelsby
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Conroy
- Manchester Integrated Care Partnership (NHS Greater Manchester), Manchester, UK
| | | | - Christopher Craig
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Kath Hewitt
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Coral Higgins
- Manchester Integrated Care Partnership (NHS Greater Manchester), Manchester, UK
| | - William Johnson
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Judith Lyons
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoe Merchant
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Ailsa Rowlands
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Anna Sharman
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicola Sinnott
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Sperrin
- Division of Informatics Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Richard Booton
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
| | - Philip A J Crosbie
- Division of Immunology, Immunity to Infection and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre (MTOC), Manchester University NHS Foundation Trust, Manchester, UK
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King J, Taylor M, Booton R, Crosbie P, Shah D, Evison M, Ng C, Rammohan K, Shah R, Shackcloth M, Grant SW, Sinnott N. Safety of curative-intent lung cancer surgery in older patients (octogenarians): A contemporary multicentre cohort study. J Geriatr Oncol 2023; 14:101635. [PMID: 37812970 DOI: 10.1016/j.jgo.2023.101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Despite octogenarians representing an ever-increasing proportion of patients with lung cancer, there is a paucity of evidence describing outcomes after lung resection for these patients. We aimed to evaluate short and mid-term outcomes for octogenarians after lung resection. MATERIALS AND METHODS A total of 5,470 consecutive patients undergoing lung resection for primary lung cancer from 2012-2019 in two UK centres were included. Primary outcomes were perioperative, 90-day, and one-year mortality in the octogenarian vs. non-octogenarian cohort. Appropriate statistical tests were used to compare outcomes between octogenarian and non-octogenarian patients. Secondary outcomes were post-operative complications and to validate the performance of the Thoracoscore model in the octogenarian cohort. RESULTS Overall, 9.4% (n=513) of patients were aged ≥80. The rates of 90-day mortality, one-year mortality, and post-operative atrial fibrillation were significantly higher for octogenarians. The one-year mortality rate for octogenarians fell significantly over time (2012-2015: 16.5% vs 2016-2019: 10.2%, p=0.034). Subgroup analysis (2016-2019 only) demonstrated no significant difference in peri-operative, 90-day, or one-year mortality between octogenarian and non-octogenarian patients. Validation of the Thoracoscore model demonstrated modest discrimination and acceptable calibration. DISCUSSION Mortality for octogenarians fell significantly over time in this study. Indeed, when confined to the most recent time period, comparable rates of both 90-day and one-year mortality for octogenarian and non-octogenarian patients were seen. Whilst preventative strategies to reduce the incidence of post-operative atrial fibrillation in octogenarians should be considered, these findings demonstrate that following appropriate patient selection, octogenarians can safely undergo lung resection for lung cancer.
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Affiliation(s)
- Jenny King
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
| | - Marcus Taylor
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Richard Booton
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Phil Crosbie
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Dinakshi Shah
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Matthew Evison
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Cassandra Ng
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Kandadai Rammohan
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Rajesh Shah
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester, UK
| | - Nicola Sinnott
- Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
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Bradley C, Alexandris P, Baldwin DR, Booton R, Darby M, Eckert CJ, Gabe R, Hancock N, Janes S, Kennedy M, Lindop J, Neal RD, Rogerson S, Shinkins B, Simmonds I, Upperton S, Vestbo J, Crosbie PA, Callister ME. Measuring spirometry in a lung cancer screening cohort highlights possible underdiagnosis and misdiagnosis of COPD. ERJ Open Res 2023; 9:00203-2023. [PMID: 37609601 PMCID: PMC10440649 DOI: 10.1183/23120541.00203-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/09/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction COPD is underdiagnosed, and measurement of spirometry alongside low-dose computed tomography (LDCT) screening for lung cancer is one strategy to increase earlier diagnosis of this disease. Methods Ever-smokers at high risk of lung cancer were invited to the Yorkshire Lung Screening Trial for a lung health check (LHC) comprising LDCT screening, pre-bronchodilator spirometry and a smoking cessation service. In this cross-sectional study we present data on participant demographics, respiratory symptoms, lung function, emphysema on imaging and both self-reported and primary care diagnoses of COPD. Multivariable logistic regression analysis identified factors associated with possible underdiagnosis and misdiagnosis of COPD in this population, with airflow obstruction defined as forced expiratory volume in 1 s/forced vital capacity ratio <0.70. Results Out of 3920 LHC attendees undergoing spirometry, 17% had undiagnosed airflow obstruction with respiratory symptoms, representing potentially undiagnosed COPD. Compared to those with a primary care COPD code, this population had milder symptoms, better lung function and were more likely to be current smokers (p≤0.001 for all comparisons). Out of 836 attendees with a primary care COPD code who underwent spirometry, 19% did not have airflow obstruction, potentially representing misdiagnosed COPD, although symptom burden was high. Discussion Spirometry offered alongside LDCT screening can potentially identify cases of undiagnosed and misdiagnosed COPD. Future research should assess the downstream impact of these findings to determine whether any meaningful changes to treatment and outcomes occur, and to assess the impact on co-delivering spirometry on other parameters of LDCT screening performance such as participation and adherence. Additionally, work is needed to better understand the aetiology of respiratory symptoms in those with misdiagnosed COPD, to ensure that this highly symptomatic group receive evidence-based interventions.
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Affiliation(s)
- Claire Bradley
- Department Respiratory Medicine, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Panos Alexandris
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - David R. Baldwin
- Department of Respiratory Medicine, City Campus, Nottingham University Hospitals, Nottingham, UK
| | - Richard Booton
- Lung Cancer and Thoracic Surgery Directorate, Heart and Lung Division, Manchester University NHS Foundation Trust, Manchester, UK
| | - Mike Darby
- Department of Radiology, Leeds Teaching Hospitals, Leeds, UK
| | - Claire J. Eckert
- Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rhian Gabe
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Neil Hancock
- Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sam Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Martyn Kennedy
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - Jason Lindop
- Department of Research and Innovation, Leeds Teaching Hospitals, Leeds, UK
| | - Richard D. Neal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Suzanne Rogerson
- Department of Research and Innovation, Leeds Teaching Hospitals, Leeds, UK
| | - Bethany Shinkins
- Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Irene Simmonds
- Leeds Diagnosis and Screening Unit, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Sara Upperton
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - Jorgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Philip A.J. Crosbie
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
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O'Dowd EL, Lee RW, Akram AR, Bartlett EC, Bradley SH, Brain K, Callister MEJ, Chen Y, Devaraj A, Eccles SR, Field JK, Fox J, Grundy S, Janes SM, Ledson M, MacKean M, Mackie A, McManus KG, Murray RL, Nair A, Quaife SL, Rintoul R, Stevenson A, Summers Y, Wilkinson LS, Booton R, Baldwin DR, Crosbie P. Defining the road map to a UK national lung cancer screening programme. Lancet Oncol 2023; 24:e207-e218. [PMID: 37142382 DOI: 10.1016/s1470-2045(23)00104-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 05/06/2023]
Abstract
Lung cancer screening with low-dose CT was recommended by the UK National Screening Committee (UKNSC) in September, 2022, on the basis of data from trials showing a reduction in lung cancer mortality. These trials provide sufficient evidence to show clinical efficacy, but further work is needed to prove deliverability in preparation for a national roll-out of the first major targeted screening programme. The UK has been world leading in addressing logistical issues with lung cancer screening through clinical trials, implementation pilots, and the National Health Service (NHS) England Targeted Lung Health Check Programme. In this Policy Review, we describe the consensus reached by a multiprofessional group of experts in lung cancer screening on the key requirements and priorities for effective implementation of a programme. We summarise the output from a round-table meeting of clinicians, behavioural scientists, stakeholder organisations, and representatives from NHS England, the UKNSC, and the four UK nations. This Policy Review will be an important tool in the ongoing expansion and evolution of an already successful programme, and provides a summary of UK expert opinion for consideration by those organising and delivering lung cancer screenings in other countries.
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Affiliation(s)
- Emma L O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Richard W Lee
- Early Diagnosis and Detection Centre, National Institute for Health and Care Research Biomedical Research Centre at the Royal Marsden and Institute of Cancer Research, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Ahsan R Akram
- Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK; Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Emily C Bartlett
- Royal Brompton and Harefield Hospitals London and National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Kate Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Yan Chen
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Anand Devaraj
- Royal Brompton and Harefield Hospitals London and National Heart and Lung Institute, Imperial College London, London, UK
| | - Sinan R Eccles
- Royal Glamorgan Hospital, Cwm Taf Morgannwg University Health Board, Llantrisant, UK
| | - John K Field
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Jesme Fox
- Roy Castle Lung Cancer Foundation, Liverpool, UK
| | - Seamus Grundy
- Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Sam M Janes
- Lungs for Living Research Centre, Department of Respiratory Medicine, University College London, London, UK
| | - Martin Ledson
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | - Kieran G McManus
- Department of Thoracic Surgery, Royal Victoria Hospital, Belfast, UK
| | - Rachael L Murray
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Samantha L Quaife
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Robert Rintoul
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Anne Stevenson
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, UK
| | - Yvonne Summers
- The Christie Hospital NHS Trust, Manchester University NHS Foundation Trust, Manchester, UK
| | - Louise S Wilkinson
- Oxford Breast Imaging Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Booton
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Philip Crosbie
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Balata H, Punjabi A, Chaudhuri N, Greaves M, Yorke J, Booton R, Crosbie P, Hayton C. The detection, assessment and clinical evolution of interstitial lung abnormalities identified through lung cancer screening. ERJ Open Res 2023; 9:00632-2022. [PMID: 37143833 PMCID: PMC10152255 DOI: 10.1183/23120541.00632-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/11/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionInterstitial lung abnormalities (ILAs) are common incidental findings in lung cancer screening however their clinical evolution and longer-term outcomes are less clear. The aim of this cohort study was to report five-year outcomes of individuals with ILA identified through a lung cancer screening programme. In addition, we compared patient reported outcome measures (PROMs) in patients with screen-detected ILA to newly diagnosed interstitial lung disease (ILD) to assess symptoms and health-related quality of life (HRQOL).MethodsIndividuals with screen-detected ILA were identified and five-year outcomes, including ILD diagnoses, progression-free survival and mortality, were recorded. Risk factors associated with ILD diagnosis were assessed using logistic regression and survival using Cox proportional hazard analysis. PROMs were compared between a subset of patients with ILA and a group of ILD patients.Results1,384 individuals underwent baseline low-dose computed tomography (LDCT) screening with 54 (3.9%) identified as having ILA. 22 (40.7%) were subsequently diagnosed with ILD. 14 individuals (25.9%) died, and 28 (53.8%) suffered disease progression within five years. Fibrotic ILA was an independent risk factor for ILD diagnosis, mortality, and reduced progression-free survival. Patients with ILA had lower symptom burden and better HRQOL in comparison to the ILD group. Breathlessness visual analogue score (VAS) was associated with mortality on multivariate analysis.ConclusionsFibrotic ILA was a significant risk factor for adverse outcomes including subsequent ILD diagnosis. Whilst screen-detected ILA patients were less symptomatic, breathlessness VAS was associated with adverse outcomes. These results could inform risk stratification in ILA.
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Crosbie PAJ, Gabe R, Simmonds I, Hancock N, Alexandris P, Kennedy M, Rogerson S, Baldwin D, Booton R, Bradley C, Darby M, Eckert C, Franks KN, Lindop J, Janes SM, Møller H, Murray RL, Neal RD, Quaife SL, Upperton S, Shinkins B, Tharmanathan P, Callister MEJ. Participation in community-based lung cancer screening: the Yorkshire Lung Screening Trial. Eur Respir J 2022; 60:2200483. [PMID: 35777775 PMCID: PMC9684623 DOI: 10.1183/13993003.00483-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Screening with low-dose computed tomography (LDCT) reduces lung cancer mortality; however, the most effective strategy for optimising participation is unknown. Here we present data from the Yorkshire Lung Screening Trial, including response to invitation, screening eligibility and uptake of community-based LDCT screening. METHODS Individuals aged 55-80 years, identified from primary care records as having ever smoked, were randomised prior to consent to invitation to telephone lung cancer risk assessment or usual care. The invitation strategy included general practitioner endorsement, pre-invitation and two reminder invitations. After telephone triage, those at higher risk were invited to a Lung Health Check (LHC) with immediate access to a mobile CT scanner. RESULTS Of 44 943 individuals invited, 50.8% (n=22 815) responded and underwent telephone-based risk assessment (16.7% and 7.3% following first and second reminders, respectively). A lower response rate was associated with current smoking status (adjusted OR 0.44, 95% CI 0.42-0.46) and socioeconomic deprivation (adjusted OR 0.58, 95% CI 0.54-0.62 for the most versus the least deprived quintile). Of those responding, 34.4% (n=7853) were potentially eligible for screening and offered a LHC, of whom 86.8% (n=6819) attended. Lower uptake was associated with current smoking status (adjusted OR 0.73, 95% CI 0.62-0.87) and socioeconomic deprivation (adjusted OR 0.78, 95% CI 0.62-0.98). In total, 6650 individuals had a baseline LDCT scan, representing 99.7% of eligible LHC attendees. CONCLUSIONS Telephone risk assessment followed by a community-based LHC is an effective strategy for lung cancer screening implementation. However, lower participation associated with current smoking status and socioeconomic deprivation underlines the importance of research to ensure equitable access to screening.
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Affiliation(s)
- Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- These two authors contributed equally
| | - Rhian Gabe
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
- These two authors contributed equally
| | - Irene Simmonds
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Neil Hancock
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Panos Alexandris
- Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | | | | | - David Baldwin
- Dept of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Richard Booton
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Claire Bradley
- Craigavon Area Hospital, Southern Health and Social Care Trust, Portadown, UK
| | - Mike Darby
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Claire Eckert
- Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kevin N Franks
- Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Henrik Møller
- The Danish Clinical Quality Program and Clinical Registries (RKKP), Aarhus, Denmark
| | - Rachael L Murray
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Richard D Neal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | | | | | | | - Matthew E J Callister
- Institute of Health Sciences, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Qudratullah Q, Booton R, Iyer A, Bradley P. EP04.01-009 Performance Indicators of Lung Cancer MDT at a Regional Center: Disagreements Between Trust and NLCA Data. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bradley P, Balata H, Alonso A, Booton R, Crosbie P. P1.04-01 Risk Stratification for Personalised Screening Intervals: Performance of PLCOm2012NoRace at Second Round of Manchester LHC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bradley P, Bola B, Balata H, Sharman A, Booton R, Crosbie P. Incidental findings in low dose CT lung cancer screening of high-risk smokers: results from the Manchester Lung Health Check pilot. Lung Cancer 2022; 173:1-4. [DOI: 10.1016/j.lungcan.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/16/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022]
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Robbins HA, Zahed H, Lebrett MB, Balata H, Johansson M, Sharman A, Evans DG, Crosbie EJ, Booton R, Landy R, Crosbie PAJ. Explaining differences in the frequency of lung cancer detection between the National Lung Screening Trial and community-based screening in Manchester, UK. Lung Cancer 2022; 171:61-64. [PMID: 35917648 PMCID: PMC9790152 DOI: 10.1016/j.lungcan.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/21/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The frequency of lung cancer detection in the Manchester Lung Health Checks (MLHCs), a community-based screening service, was higher than in the National Lung Screening Trial (NLST) over two screening rounds. We aimed to identify the potential reasons for this difference. METHODS We analyzed individual-level data from NLST and MLHCs, restricting to MLHCs participants who met NLST eligibility criteria. We calculated 'detection ratios' comparing the frequency of lung cancer detection in MLHCs vs NLST, first after excluding NLST participants ineligible by MLHC eligibility criteria (6-year lung cancer risk ≥ 1.51 %), and then after standardization to remove the influence of different distributions of baseline lung cancer risk. RESULTS Among the 1,079 MLHCs participants who met NLST eligibility criteria, 4.7% were diagnosed with lung cancer over two screening rounds compared with 1.7% in NLST, giving an initial detection ratio of 2.6 (95%CI 2.2-3.0). This was reduced to 2.2 (95%CI 1.3-2.3) after imposing the MLHCs eligibility criterion on NLST, and further to 1.6 (95%CI 1.2-2.1) after removing the influence of different risk distributions. In stratified analyses, the standardized detection ratio was particularly elevated in individuals who were older, living in areas of high socioeconomic disadvantage, or had an FEV/FVC ratio less than 60. CONCLUSIONS The 2.6-fold higher lung cancer detection in the community-based MLHCs vs NLST is partly explained by differences in eligibility criteria and baseline risk distributions. The residual 60% increase may relate to higher detection in certain risk groups, including older participants, those with more obstructive lung disease, and those living in areas of socioeconomic disadvantage.
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Affiliation(s)
- Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France.
| | - Hana Zahed
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Mikey B Lebrett
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Haval Balata
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Mattias Johansson
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Anna Sharman
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Gareth Evans
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK; Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - Emma J Crosbie
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Philip A J Crosbie
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
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Bradley P, Taylor M, Ugolini S, Crosbie PAJ, Granato F, Balata H, Booton R. Lung cancer screening in 2022: a narrative review. Video-assist Thorac Surg 2022. [DOI: 10.21037/vats-22-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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King J, Shah D, Hewitt K, Punjabi A, Marshall K, Balata H, Brockelsby C, Sinnott N, Lyons J, Martin J, Crosbie P, Booton R, Ng C, Cove-Smith L, Evison M. The diagnostic pathway in lung cancer patients with best supportive care decisions: are there lessons to be learnt? Clin Med (Lond) 2022; 22:246-250. [PMID: 38589084 PMCID: PMC9135074 DOI: 10.7861/clinmed.2021-0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION A proportion of patients with lung cancer will not be suitable for anti-cancer treatment and are managed with best supportive care (BSC). The aim of this retrospective case series analysis was to critically review the use of diagnostic and staging investigations in patients who were ultimately managed with BSC. METHODS A retrospective review of all lung cancer patients with a multidisciplinary team outcome of BSC from 01 June 2018 to 01 June 2019 was performed. Patients were categorised into those with an early BSC decision and those that underwent further investigations prior to a BSC decision (investigations beyond initial computed tomography (CT)). Patient demographics, clinical characteristics and outcomes were collated and analysed. RESULTS Seventy-seven lung cancer patients managed with BSC were identified. Patients were elderly (average age 79 years), functionally limited (80% World Health Organization performance status ≥3), frail (70% clinical frailty score ≥6) and had advanced stage disease (90% stage III/IV). Thirty-one (40%) underwent further investigations beyond the initial CT prior to the BSC decision. The most common types of further investigations were endobronchial ultrasound-guided transbronchial needle aspiration (27/31; 74%), positron emission tomography - CT (18/31; 45%) and CT-guided lung biopsy (7/31; 23%). This is despite high levels of consultant chest physician review at first assessment (71%), cancer nurse specialist involvement (97%), specialist palliative care involvement (65%), a high pathological confirmation rate of sampling procedures (89%) and adequacy of molecular testing. The most common reason for a BSC recommendation was a lack of fitness for systemic therapy (17/31; 55%). Six out of thirty-one (19%) patients deteriorated rapidly and died on the cancer pathway and 5/31 (16%) patients had inadequate renal function for systemic anti-cancer treatment. There was low utilisation of serum epidermal growth factor receptor mutation testing across the study cohort (2/77; 3%). DISCUSSION In an older, functionally limited and frail patient with lung cancer, there is a risk of over-investigation. Impaired renal function is an important clinical factor to identify early to support discussions in this cohort. There will always be an unavoidable proportion of patients that undergo further investigations (often in search of rare targetable mutations) and are then ultimately recommended for best supportive care; such cases could form the basis of specific review and learning for lung cancer services.
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Affiliation(s)
| | | | | | | | | | | | - Chris Brockelsby
- Wythenshawe Hospital, Manchester, UK and Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK
| | | | | | | | - Philip Crosbie
- University of Manchester, Manchester, UK and lung cancer physician, Wythenshawe Hospital, Manchester, UK
| | - Richard Booton
- Wythenshawe Hospital, Manchester, UK and honourary chair in respiratory medicine, University of Manchester, Manchester, UK
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Taylor M, Whittaker G, Grant SW, Booton R, Shah R. Risk prediction for lung cancer surgery in the current era. Video-assist Thorac Surg 2022. [DOI: 10.21037/vats-21-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Taylor M, Hashmi SF, Martin GP, Granato F, Abah U, Smith M, Shackcloth M, Booton R, Grant SW. External validation of a clinical prediction model for mid-term mortality after video-assisted thoracoscopic surgery lobectomy for non-small cell lung cancer. Video-assist Thorac Surg 2022. [DOI: 10.21037/vats-22-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Balata H, Ruparel M, O'Dowd E, Ledson M, Field JK, Duffy SW, Quaife SL, Sharman A, Janes S, Baldwin D, Booton R, Crosbie PAJ. Analysis of the baseline performance of five UK lung cancer screening programmes. Lung Cancer 2021; 161:136-140. [PMID: 34583222 DOI: 10.1016/j.lungcan.2021.09.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/26/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Low-dose CT (LDCT) screening reduces lung cancer specific mortality. Several countries, including the UK, are evaluating the clinical impact and cost-effectiveness of LDCT screening using the latest evidence. In this paper we report baseline screening performance from five UK-based lung cancer screening programmes. METHODS Data was collected at baseline from each screening programme. Measures of performance included prevalence of screen detected lung cancer, rate of surveillance imaging for indeterminate findings and surgical resection rates. Screening related harms were assessed by measuring false positive rates, number of invasive tests with associated complications in individuals without lung cancer and benign surgical resection rates. RESULTS A total of 11,148 individuals had a baseline LDCT scan during the period of analysis (2011 to 2020). Overall, 84.7% (n = 9,440) of baseline LDCT scans were categorised as negative, 11.1% (n = 1,239) as indeterminate and 4.2% (n = 469) as positive. The prevalence of screen detected lung cancer was 2.2%, ranging between 1.8% and 4.4% for individual programmes. The surgical resection rate was 66% (range 46% to 83%) and post-surgical 90-day mortality for those with lung cancer 1.2% (n = 2/165). The false positive rate was 2% (n = 219/10,898) and of those with a positive result, one in two had lung cancer diagnosed (53.3%). An invasive test was required in 0.6% (n = 61/10,898) of screening attendees without lung cancer; there were no associated major complications or deaths. The benign surgical resection rate was 4.6% (n = 8/173), equating to 0.07% of the screened population. DISCUSSION The performance of UK-based lung cancer screening programmes, delivered within or aligned to the National Health Service, compares favourably to published clinical trial data. Reported harms, including false positive and benign surgical resection rates are low. Ongoing monitoring of screening performance is vital to ensure standards are maintained and harms minimised.
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Affiliation(s)
- Haval Balata
- Manchester Thoracic Oncology Centre (MTOC), Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Emma O'Dowd
- Department of Respiratory Medicine, Nottingham City Hospital, Nottingham, UK
| | - Martin Ledson
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - John K Field
- Molecular and Clinical Cancer Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Samantha L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Anna Sharman
- Manchester Thoracic Oncology Centre (MTOC), Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sam Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - David Baldwin
- Department of Respiratory Medicine, Nottingham City Hospital, Nottingham, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre (MTOC), Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Philip A J Crosbie
- Manchester Thoracic Oncology Centre (MTOC), Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Bradley P, Ryan D, Craig C, Booton R, Crosbie P, Balata H. P61.02 The Use of PLCOm2012 vs PLCOm2012noRace Risk Prediction Models in a UK Lung Cancer Screening Programme. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Taylor M, Abah U, Hayes T, Eadington T, Smith M, Shackcloth M, Granato F, Shah R, Booton R, Grant SW. Preoperative Anemia is Associated With Worse Long-Term Survival After Lung Cancer Resection: A Multicenter Cohort Study of 5,029 Patients. J Cardiothorac Vasc Anesth 2021; 36:1373-1379. [PMID: 34538557 DOI: 10.1053/j.jvca.2021.08.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/28/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Although some evidence to suggest an association between preoperative anemia and reduced overall survival exists, contemporary studies investigating the impact of preoperative anemia on outcomes after resection for primary lung cancer are lacking. DESIGN A multicenter retrospective review. SETTING Two tertiary cardiothoracic surgery centers in the Northwest of England. PARTICIPANTS A total of 5,029 patients between 2012 and 2018. INTERVENTIONS All patients underwent lung resection for primary lung cancer. Patients were classified as anemic based on the World Health Organization definition. Men with hemoglobin <130 g/L and women with hemoglobin <120 g/L were considered to be anemic. MEASUREMENTS AND MAIN RESULTS Outcomes assessed included perioperative mortality, 90-day mortality, and overall survival. Multivariate logistic and Cox regression analyses were used to assess the impact of preoperative anemia on 90-day mortality and overall survival, respectively. Overall, preoperatively, 24.0% (n = 1207) of patients were anemic. The 90-day mortality for anemic and nonanemic patients was 5.6% and 3.1%, respectively (p < 0.001). After multivariate adjustment, preoperative anemia was not associated with increased 90-day mortality. However, a log-rank analysis demonstrated reduced overall survival for anemic patients (p < 0.001). After multivariate adjustment, preoperative anemia was found to be independently associated with reduced overall survival (hazard ratio 1.287, 95% confidence interval 1.141-1.451, p < 0.001). CONCLUSIONS Although anemia was not an independent predictor of short-term outcomes, it was independently associated with significantly reduced survival for patients undergoing resection for lung cancer. Further work is required to understand why anemia reduces long-term survival and whether pathways for anemic patients can be adapted to improve long-term outcomes.
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Affiliation(s)
- Marcus Taylor
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom.
| | - Udo Abah
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Tim Hayes
- Department of Cardiothoracic Anaesthesia, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Thomas Eadington
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Matthew Smith
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Felice Granato
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Richard Booton
- Department of Respiratory Medicine, Manchester University Hospital NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospital NHS Foundation Trust, Manchester, United Kingdom
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Taylor M, Hashmi SF, Martin GP, Shackcloth M, Shah R, Booton R, Grant SW. A systematic review of risk prediction models for perioperative mortality after thoracic surgery. Interact Cardiovasc Thorac Surg 2021; 32:333-342. [PMID: 33257987 DOI: 10.1093/icvts/ivaa273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Guidelines advocate that patients being considered for thoracic surgery should undergo a comprehensive preoperative risk assessment. Multiple risk prediction models to estimate the risk of mortality after thoracic surgery have been developed, but their quality and performance has not been reviewed in a systematic way. The objective was to systematically review these models and critically appraise their performance. METHODS The Cochrane Library and the MEDLINE database were searched for articles published between 1990 and 2019. Studies that developed or validated a model predicting perioperative mortality after thoracic surgery were included. Data were extracted based on the checklist for critical appraisal and data extraction for systematic reviews of prediction modelling studies. RESULTS A total of 31 studies describing 22 different risk prediction models were identified. There were 20 models developed specifically for thoracic surgery with two developed in other surgical specialties. A total of 57 different predictors were included across the identified models. Age, sex and pneumonectomy were the most frequently included predictors in 19, 13 and 11 models, respectively. Model performance based on either discrimination or calibration was inadequate for all externally validated models. The most recent data included in validation studies were from 2018. Risk of bias (assessed using Prediction model Risk Of Bias ASsessment Tool) was high for all except two models. CONCLUSIONS Despite multiple risk prediction models being developed to predict perioperative mortality after thoracic surgery, none could be described as appropriate for contemporary thoracic surgery. Contemporary validation of available models or new model development is required to ensure that appropriate estimates of operative risk are available for contemporary thoracic surgical practice.
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Affiliation(s)
- Marcus Taylor
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Syed F Hashmi
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Manchester Academic Heath Science Centre, University of Manchester, Manchester, UK
| | - Michael Shackcloth
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Rajesh Shah
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Richard Booton
- Department of Respiratory Medicine, Wythenshawe Hospital, Manchester University Hospital Foundation Trust, Manchester, UK
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospitals Foundation Trust, Manchester, UK
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Punjabi A, Al-Najjar H, Teng B, Borrill Z, Brown L, Nagarajan T, Gallagher J, Grundy S, Sundar R, Higgins C, Shackley D, Sinnott N, Balata H, Lyons J, Martin J, Brocklesby C, Crosbie P, Booton R, Evison M. Performance monitoring of EBUS for the staging and diagnosis of lung cancer: auditing the Greater Manchester EBUS service against new national standards. BMJ Open Respir Res 2021; 8:8/1/e000777. [PMID: 34172527 PMCID: PMC8237730 DOI: 10.1136/bmjresp-2020-000777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/16/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a pivotal test in lung cancer staging and diagnosis, mandating robust audit and performance monitoring of EBUS services. We present the first regional cancer alliance EBUS performance audit against the new National EBUS specification. Methods Across the five EBUS centres in the Greater Manchester Cancer Alliance, data are recorded at the point of procedure, when pathological results are available and at 6 months postprocedure to review any further pathological sampling (eg, at surgical resection) and the outcome of clinical–radiological follow-up. Outcomes across all five centres were compared with national standards for all lung cancer EBUS procedures from 01 January 2017 to 31 December 2018. Results 1899 lung cancer staging or diagnostic EBUS procedures were performed across the five centres during the study period; 1309 staging EBUS procedures and 590 diagnostic EBUS procedures. Major complications were seen in six cases (<1%). All five trusts demonstrated performance above that set national standards in key metrics for both staging and diagnostic EBUS, however the provision of adequate tissue for predictive marker testing was below national standards at one trust. Across Greater Manchester, 72% and 64% of patients had their EBUS procedure performed within 7 days of referral in 2017 and 2018, respectively. Only one out of five trusts met the national targets of >85% of procedures performed within 7 days of referral. Conclusion The National EBUS service specification is an important framework to drive the quality of EBUS services across the UK. Our data provide assurance of appropriate performance and safety while also highlighting specific areas for attention that can be addressed with the support of the cancer alliance.
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Affiliation(s)
| | - Haider Al-Najjar
- Respiratory, Manchester University NHS Foundation Trust, Manchester, UK
| | - Benjamin Teng
- Respiratory Medicine, Manchester Royal Infirmary, Manchester, UK
| | - Zoe Borrill
- Respiratory Medicine, North Manchester General Hospital, Manchester, UK
| | - Louise Brown
- Respiratory Medicine, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Thapas Nagarajan
- Respiratory Medicine, Macclesfield Hospital, East Cheshire NHS Trust, Macclesfield, UK
| | - Joanna Gallagher
- Respiratory Medicine, Macclesfield Hospital, East Cheshire NHS Trust, Macclesfield, UK
| | - Seamus Grundy
- Respiratory Medicine, Royal Albert Edward Infirmary, Wrightington, Wigan & Leigh NHS Foundation Trust, Wigan, UK
| | - Ram Sundar
- Department of Respiratory Medicine, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Coral Higgins
- Manchester Health & Care Commisioning, South Manchester Clinical Commissiong Group & Macmillan Cancer Improvement Partnership, Manchester, UK
| | | | - Nicola Sinnott
- Respiratory Medicine, Wythenshawe Hospital, Manchester Foundation Trust, Mnachester, UK
| | - Haval Balata
- Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Judith Lyons
- Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Julie Martin
- Respiratory Medicine, Wythenshawe Hospital, Manchester Foundation Trust, Mnachester, UK
| | | | - Phil Crosbie
- Respiratory Medicine, Wythenshawe Hospital, Manchester, Greater Manchester, UK
| | - Richard Booton
- Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
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King J, Shah D, Hewitt K, Punjabi A, Marshall K, Balata H, Brocklesby C, Sinnott N, Lyons J, Martin J, Crosbie P, Booton R, Ng C, Cove-Smith L, Evison M. Reviewing the diagnostic pathway in lung cancer patients with best supportive care decisions – are there lessons to be learnt? Lung Cancer 2021. [DOI: 10.1016/s0169-5002(21)00358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Craig C, Evison M, Punjabi A, Al-Najjar H, Teng B, Borrill Z, Brown L, Nagarajan T, Gallagher J, Grundy S, Sundar R, Brockelsby C, Barrett E, Crosbie P, Booton R, Lyons J, Sinnott N, Martin J. What proportion of patients staged as single station N2 with pre-operative EBUS-TBNA have multi-station N2 from intra-operative lymph node staging? Lung Cancer 2021. [DOI: 10.1016/s0169-5002(21)00254-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Bradley P, Ryan D, Craig C, Booton R, Crosbie P, Balata H. The use of PLCOm2012 vs PLCOm2012noRace risk prediction models in a UK lung cancer screening programme. Lung Cancer 2021. [DOI: 10.1016/s0169-5002(21)00260-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ricciardi S, Booton R, Petersen RH, Infante M, Scarci M, Veronesi G, Cardillo G. Managing of screening-detected sub-solid nodules-a European perspective. Transl Lung Cancer Res 2021; 10:2368-2377. [PMID: 34164284 PMCID: PMC8182699 DOI: 10.21037/tlcr.2020.03.37] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since the National Lung Screening Trial in 2011 showed a 20% reduction in lung cancer mortality using annual low-dose computed tomography (LDCT), several randomised controlled trials and studies have been started in Europe. These include the Italian lung study (ITALUNG), the Dutch-Belgian lung cancer screening trial (NELSON), the UK lung cancer screening trial (UKLS), the Detection and screening of early lung cancer with novel imaging technology (DANTE), the Danish lung cancer screening trial (DLCST), the German lung cancer screening intervention trial (LUSI), the Multicentric Italian lung detection trial (MILD) and the CT screening for lung cancer study (COSMOS). As a result of the increasing number of screening trials and the growing utilization of LDCT, the high detection of subsolid nodules is an increasingly important clinical problem. In the last few years, several guidelines have been published and providing guidance on the optimal management of subsolid nodules, but many controversies still exist. Follow-up imaging plays an important role in clinical assessment and subsequent management of this particular type of lung nodules, since they can be transient inflammatory lesions, and if persistent they can be both benign lesions or lung cancers of variable clinical behaviour. However, the vast majority of subsolid nodules retain an indolent course over many years. The aim of this review is to present a European perspective in management of screening detected subsolid nodules.
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Affiliation(s)
- Sara Ricciardi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, Pathology and Critical Care, University Hospital of Pisa, Pisa, Italy
| | - Richard Booton
- North West Lung Centre, Wythenshawe Hospital, Manchester University Foundation Trust & School of Biological Sciences, The University of Manchester, Manchester UK
| | - Renè Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
| | - Maurizio Infante
- Department of Thoracic Surgery, University and Hospital Trust, Verona, Italy
| | - Marco Scarci
- Department of Thoracic Surgery, S. Gerardo Hospital, Monza, Italy
| | - Giulia Veronesi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University Milan, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
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Franks KN, McParland L, Webster J, Baldwin DR, Sebag-Montefiore D, Evison M, Booton R, Faivre-Finn C, Naidu B, Ferguson J, Peedell C, Callister MEJ, Kennedy M, Hewison J, Bestall J, Gregory WM, Hall P, Collinson F, Olivier C, Naylor R, Bell S, Allen P, Sloss A, Snee M. SABRTooth: a randomised controlled feasibility study of stereotactic ablative radiotherapy (SABR) with surgery in patients with peripheral stage I nonsmall cell lung cancer considered to be at higher risk of complications from surgical resection. Eur Respir J 2020; 56:2000118. [PMID: 32616595 DOI: 10.1183/13993003.00118-2020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/28/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Stereotactic ablative radiotherapy (SABR) is a well-established treatment for medically inoperable peripheral stage I nonsmall cell lung cancer (NSCLC). Previous nonrandomised evidence supports SABR as an alternative to surgery, but high-quality randomised controlled trial (RCT) evidence is lacking. The SABRTooth study aimed to establish whether a UK phase III RCT was feasible. DESIGN AND METHODS SABRTooth was a UK multicentre randomised controlled feasibility study targeting patients with peripheral stage I NSCLC considered to be at higher risk of surgical complications. 54 patients were planned to be randomised 1:1 to SABR or surgery. The primary outcome was monthly average recruitment rates. RESULTS Between July 2015 and January 2017, 318 patients were considered for the study and 205 (64.5%) were deemed ineligible. Out of 106 (33.3%) assessed as eligible, 24 (22.6%) patients were randomised to SABR (n=14) or surgery (n=10). A key theme for nonparticipation was treatment preference, with 43 (41%) preferring nonsurgical treatment and 19 (18%) preferring surgery. The average monthly recruitment rate was 1.7 patients against a target of three. 15 patients underwent their allocated treatment: SABR n=12, surgery n=3. CONCLUSIONS We conclude that a phase III RCT randomising higher risk patients between SABR and surgery is not feasible in the National Health Service. Patients have pre-existing treatment preferences, which was a barrier to recruitment. A significant proportion of patients randomised to the surgical group declined and chose SABR. SABR remains an alternative to surgery and novel study approaches are needed to define which patients benefit from a nonsurgical approach.
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Affiliation(s)
- Kevin N Franks
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Joint first authors
| | - Lucy McParland
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
- Joint first authors
| | - Joanne Webster
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - David Sebag-Montefiore
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Matthew Evison
- Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Richard Booton
- Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Corinne Faivre-Finn
- University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - Babu Naidu
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Clive Peedell
- The James Cook University Hospital, Middlesbrough, UK
| | | | - Martyn Kennedy
- Dept of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Janine Bestall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Walter M Gregory
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Peter Hall
- Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Fiona Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Catherine Olivier
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Rachel Naylor
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sue Bell
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Peter Allen
- Patient and Public Involvement Representative, Leeds, UK
| | - Andrew Sloss
- Patient and Public Involvement Representative, Leeds, UK
| | - Michael Snee
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
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Crosbie PA, Gabe R, Simmonds I, Kennedy M, Rogerson S, Ahmed N, Baldwin DR, Booton R, Cochrane A, Darby M, Franks K, Hinde S, Janes SM, Macleod U, Messenger M, Moller H, Murray RL, Neal RD, Quaife SL, Sculpher M, Tharmanathan P, Torgerson D, Callister ME. Yorkshire Lung Screening Trial (YLST): protocol for a randomised controlled trial to evaluate invitation to community-based low-dose CT screening for lung cancer versus usual care in a targeted population at risk. BMJ Open 2020; 10:e037075. [PMID: 32912947 PMCID: PMC7485242 DOI: 10.1136/bmjopen-2020-037075] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/24/2020] [Accepted: 07/08/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Lung cancer is the world's leading cause of cancer death. Low-dose computed tomography (LDCT) screening reduced lung cancer mortality by 20% in the US National Lung Screening Trial. Here, we present the Yorkshire Lung Screening Trial (YLST), which will address key questions of relevance for screening implementation. METHODS AND ANALYSIS Using a single-consent Zelen's design, ever-smokers aged 55-80 years registered with a general practice in Leeds will be randomised (1:1) to invitation to a telephone-based risk-assessment for a Lung Health Check or to usual care. The anticipated number randomised by household is 62 980 individuals. Responders at high risk will be invited for LDCT scanning for lung cancer on a mobile van in the community. There will be two rounds of screening at an interval of 2 years. Primary objectives are (1) measure participation rates, (2) compare the performance of PLCOM2012 (threshold ≥1.51%), Liverpool Lung Project (V.2) (threshold ≥5%) and US Preventive Services Task Force eligibility criteria for screening population selection and (3) assess lung cancer outcomes in the intervention and usual care arms. Secondary evaluations include health economics, quality of life, smoking rates according to intervention arm, screening programme performance with ancillary biomarker and smoking cessation studies. ETHICS AND DISSEMINATION The study has been approved by the Greater Manchester West research ethics committee (18-NW-0012) and the Health Research Authority following review by the Confidentiality Advisory Group. The results will be disseminated through publication in peer-reviewed scientific journals, presentation at conferences and on the YLST website. TRIAL REGISTRATION NUMBERS ISRCTN42704678 and NCT03750110.
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Affiliation(s)
- Philip Aj Crosbie
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Rhian Gabe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Irene Simmonds
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Martyn Kennedy
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Suzanne Rogerson
- Department of Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nazia Ahmed
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David R Baldwin
- Department of Respiratory Medicine, City Campus, Nottingham University Hospitals, Nottingham, UK
| | - Richard Booton
- Lung Cancer and Thoracic Surgery Directorate, Heart and Lung Division, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ann Cochrane
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Michael Darby
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kevin Franks
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Sam M Janes
- Department of Respiratory Medicine, University College London, London, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
| | - Mike Messenger
- Leeds Centre for Personalised Medicine and Health, University of Leeds, Leeds, UK
| | - Henrik Moller
- Thames Cancer Registry, Kings College London, London, UK
| | - Rachael L Murray
- Division of Epidemiology and Public Health, Faculty of Medicine, University of Nottingham, Nottingham, UK
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Samantha L Quaife
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | | | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Matthew Ej Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Lebrett MB, Balata H, Evison M, Colligan D, Duerden R, Elton P, Greaves M, Howells J, Irion K, Karunaratne D, Lyons J, Mellor S, Myerscough A, Newton T, Sharman A, Smith E, Taylor B, Taylor S, Walsham A, Whittaker J, Barber PV, Tonge J, Robbins HA, Booton R, Crosbie PAJ. Analysis of lung cancer risk model (PLCO M2012 and LLP v2) performance in a community-based lung cancer screening programme. Thorax 2020; 75:661-668. [PMID: 32631933 PMCID: PMC7402560 DOI: 10.1136/thoraxjnl-2020-214626] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/08/2020] [Accepted: 04/20/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Low-dose CT (LDCT) screening of high-risk smokers reduces lung cancer (LC) specific mortality. Determining screening eligibility using individualised risk may improve screening effectiveness and reduce harm. Here, we compare the performance of two risk prediction models (PLCOM2012 and Liverpool Lung Project model (LLPv2)) and National Lung Screening Trial (NLST) eligibility criteria in a community-based screening programme. METHODS Ever-smokers aged 55-74, from deprived areas of Manchester, were invited to a Lung Health Check (LHC). Individuals at higher risk (PLCOM2012 score ≥1.51%) were offered annual LDCT screening over two rounds. LLPv2 score was calculated but not used for screening selection; ≥2.5% and ≥5% thresholds were used for analysis. RESULTS PLCOM2012 ≥1.51% selected 56% (n=1429) of LHC attendees for screening. LLPv2 ≥2.5% also selected 56% (n=1430) whereas NLST (47%, n=1188) and LLPv2 ≥5% (33%, n=826) selected fewer. Over two screening rounds 62 individuals were diagnosed with LC; representing 87% (n=62/71) of 6-year incidence predicted by mean PLCOM2012 score (5.0%). 26% (n=16/62) of individuals with LC were not eligible for screening using LLPv2 ≥5%, 18% (n=11/62) with NLST criteria and 7% (n=5/62) with LLPv2 ≥2.5%. NLST eligible Manchester attendees had 2.5 times the LC detection rate than NLST participants after two annual screens (≈4.3% (n=51/1188) vs 1.7% (n=438/26 309); p<0.0001). Adverse measures of health, including airflow obstruction, respiratory symptoms and cardiovascular disease, were positively correlated with LC risk. Coronary artery calcification was predictive of LC (adjOR 2.50, 95% CI 1.11 to 5.64; p=0.028). CONCLUSION Prospective comparisons of risk prediction tools are required to optimise screening selection in different settings. The PLCOM2012 model may underestimate risk in deprived UK populations; further research focused on model calibration is required.
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Affiliation(s)
- Mikey B Lebrett
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Haval Balata
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Denis Colligan
- South Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, Manchester, UK
| | - Rebecca Duerden
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter Elton
- Greater Manchester and Eastern Cheshire Strategic Clinical Networks, Manchester, Manchester, UK
| | - Melanie Greaves
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - John Howells
- Department of Radiology, Royal Preston Hospital, Preston, Lancashire, UK
| | - Klaus Irion
- Department of Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Devinda Karunaratne
- Department of Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Judith Lyons
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stuart Mellor
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | - Amanda Myerscough
- South Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Tom Newton
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | - Anna Sharman
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Elaine Smith
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ben Taylor
- Department of Radiology, Christie NHS Foundation Trust, Manchester, Manchester, UK
| | - Sarah Taylor
- South Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anna Walsham
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, Salford, UK
| | - James Whittaker
- Department of Radiology, Stockport NHS Foundation Trust, Stockport, Stockport, UK
| | - Phil V Barber
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Janet Tonge
- Academic Unit of Primary Care, University of Leeds Leeds Institute of Health Sciences, Leeds, Manchester, UK
| | - Hilary A Robbins
- International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Richard Booton
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, Manchester, UK
| | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
- Prevention and Early Detection Theme, NIHR Manchester Biomedical Research Centre, Manchester, UK
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Balata H, Harvey J, Barber PV, Colligan D, Duerden R, Elton P, Evison M, Greaves M, Howells J, Irion K, Karunaratne D, Mellor S, Newton T, Sawyer R, Sharman A, Smith E, Taylor B, Taylor S, Tonge J, Walsham A, Whittaker J, Vestbo J, Booton R, Crosbie PA. Spirometry performed as part of the Manchester community-based lung cancer screening programme detects a high prevalence of airflow obstruction in individuals without a prior diagnosis of COPD. Thorax 2020; 75:655-660. [DOI: 10.1136/thoraxjnl-2019-213584] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022]
Abstract
BackgroundCOPD is a major cause of morbidity and mortality in populations eligible for lung cancer screening. We investigated the role of spirometry in a community-based lung cancer screening programme.MethodsEver smokers, age 55–74, resident in three deprived areas of Manchester were invited to a ‘Lung Health Check’ (LHC) based in convenient community locations. Spirometry was incorporated into the LHCs alongside lung cancer risk estimation (Prostate, Lung, Colorectal and Ovarian Study Risk Prediction Model, 2012 version (PLCOM2012)), symptom assessment and smoking cessation advice. Those at high risk of lung cancer (PLCOM2012 ≥1.51%) were eligible for annual low-dose CT screening over two screening rounds. Airflow obstruction was defined as FEV1/FVC<0.7. Primary care databases were searched for any prior diagnosis of COPD.Results99.4% (n=2525) of LHC attendees successfully performed spirometry; mean age was 64.1±5.5, 51% were women, 35% were current smokers. 37.4% (n=944) had airflow obstruction of which 49.7% (n=469) had no previous diagnosis of COPD. 53.3% of those without a prior diagnosis were symptomatic (n=250/469). After multivariate analysis, the detection of airflow obstruction without a prior COPD diagnosis was associated with male sex (adjOR 1.84, 95% CI 1.37 to 2.47; p<0.0001), younger age (p=0.015), lower smoking duration (p<0.0001), fewer cigarettes per day (p=0.035), higher FEV1/FVC ratio (<0.0001) and being asymptomatic (adjOR 4.19, 95% CI 2.95 to 5.95; p<0.0001). The likelihood of screen detected lung cancer was significantly greater in those with evidence of airflow obstruction who had a previous diagnosis of COPD (adjOR 2.80, 95% CI 1.60 to 8.42; p=0.002).ConclusionsIncorporating spirometry into a community-based targeted lung cancer screening programme is feasible and identifies a significant number of individuals with airflow obstruction who do not have a prior diagnosis of COPD.
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Evison M, Pearse C, Howle F, Baugh M, Huddart H, Ashton E, Rutherford M, Kearney C, Elsey L, Staniforth D, Hoyle K, Raja M, Jerram J, Regan D, Booton R, Britton J, O'Rourke C, Shackley D, Benbow L, Crossfield A, Pilkington J, Bailey M, Preece R. Feasibility, uptake and impact of a hospital-wide tobacco addiction treatment pathway: Results from the CURE project pilot. Clin Med (Lond) 2020; 20:196-202. [PMID: 32188658 PMCID: PMC7081814 DOI: 10.7861/clinmed.2019-0336] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Providing comprehensive tobacco addiction treatment to smokers admitted to acute care settings represents an opportunity to realise major health resource savings and population health improvements. METHODS The CURE project is a hospital-wide tobacco addiction treatment service piloted in Wythenshawe Hospital, Manchester, UK. The core components of the project are electronic screening of all patients to identify smokers; the provision of brief advice and pharmacotherapy by frontline staff; opt-out referral of smokers to a specialist team for inpatient behavioural interventions; and continued support after discharge. RESULTS From 01 October 2018 to 31 March 2019, 92% (13,515/14,690) of adult admissions were screened for smoking status, identifying 2,393 current smokers. Of these, 96% were given brief advice to quit by the admitting team. Through the automated 'opt-out' referral process, 61% patients completed inpatient behavioural interventions with a specialist cessation practitioner (69% within the first 48 hours of admission). Overall, 66% of smokers were prescribed pharmacotherapy. Over one in five of all smokers admitted during this pilot reported that they were abstinent from smoking 12 weeks after discharge (22%) at a cost £183 per quit. DISCUSSION National implementation of this cost-effective programme would be likely to generate substantial benefits to public health.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lyn Elsey
- Wythenshawe Hospital, Manchester, UK
| | | | - Kathryn Hoyle
- Manchester Health & Care Commissioning, Manchester, UK
| | | | - Julie Jerram
- Manchester Health & Care Commissioning, Manchester, UK
| | - David Regan
- Manchester Health & Care Commissioning, Manchester, UK
| | | | | | | | | | - Liz Benbow
- Greater Manchester Health and Social Care Partnership, Manchester, UK
| | - Andrea Crossfield
- Greater Manchester Health and Social Care Partnership, Manchester, UK
| | - Jayne Pilkington
- Greater Manchester Health and Social Care Partnership, Manchester, UK
| | | | - Richard Preece
- Greater Manchester Health and Social Care Partnership, Manchester, UK
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Dildar B, Balata H, Evison M, Alonso A, Duerden R, Gerova N, Lyons J, Sharman A, Sinnott N, Booton R, Crosbie P. Outcome of pure ground glass and part-solid nodules in the Manchester ‘Lung Health Check’ screening pilot. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30040-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Punjabi A, Hewitt K, Balata H, Sinnott N, Lyons J, Crosbie P, Gee C, Duerden R, Greaves M, Booton R, Sharman A, Evison M. Implementation and outcomes of the RAPID programme: addressing the front end of the lung cancer pathway in Manchester. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kalinke L, Thakrar R, Daniels H, Rintoul R, Booton R, Hackshaw A, Janes S. EARL: a multicentre phase III randomised trial to evaluate the efficacy of endobronchial electrocautery with autofluorescence bronchoscopy (AFB) surveillance versus AFB surveillance alone in high-grade bronchial dysplasia. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Balata H, Tonge J, Barber PV, Colligan D, Elton P, Evison M, Kirwan M, Novasio J, Sharman A, Slevin K, Taylor S, Waplington S, Booton R, Crosbie PA. Attendees of Manchester's Lung Health Check pilot express a preference for community-based lung cancer screening. Thorax 2019; 74:1176-1178. [PMID: 31481631 DOI: 10.1136/thoraxjnl-2018-212601] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 07/04/2019] [Accepted: 08/19/2019] [Indexed: 12/11/2022]
Abstract
Manchester's 'Lung Health Check' pilot utilised mobile CT scanners in convenient retail locations to deliver lung cancer screening to socioeconomically disadvantaged communities. We assessed whether screening location was an important factor for those attending the service. Location was important for 74.7% (n=701/938) and 23% (n=216/938) reported being less likely to attend an equivalent hospital-based programme. This preference was most common in current smokers (27% current smokers vs 19% former smokers; AdjOR 1.46, 95% CI 1.03 to 2.08, p=0.036) and those in the lowest deprivation quartile (25% lowest quartile vs 17.6% highest quartile; AdjOR 2.0, 95% CI 1.24 to 3.24, p=0.005). Practical issues related to travel were most important in those less willing to attend a hospital-based service, with 83.3% citing at least one travel related barrier to non-attendance. A convenient community-based screening programme may reduce inequalities in screening adherence especially in those at high risk of lung cancer in deprived areas.
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Affiliation(s)
- Haval Balata
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Janet Tonge
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, Manchester, UK
| | - Phil V Barber
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Denis Colligan
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, Manchester, UK
| | - Peter Elton
- Greater Manchester Health and Social Care Partnership, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Marie Kirwan
- Thoracic Oncology Research Hub, Manchester University NHS Foundation Trust, Manchester, UK
| | - Juliette Novasio
- Thoracic Oncology Research Hub, Manchester University NHS Foundation Trust, Manchester, UK
| | - Anna Sharman
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kathryn Slevin
- Thoracic Oncology Research Hub, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sarah Taylor
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, Manchester, UK
| | - Sara Waplington
- Thoracic Oncology Research Hub, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Phil A Crosbie
- Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
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Spiro SG, Shah PL, Rintoul RC, George J, Janes S, Callister M, Novelli M, Shaw P, Kocjan G, Griffiths C, Falzon M, Booton R, Magee N, Peake M, Dhillon P, Sridharan K, Nicholson AG, Padley S, Taylor MN, Ahmed A, Allen J, Ngai Y, Chinyanganya N, Ashford-Turner V, Lewis S, Oukrif D, Rabbitts P, Counsell N, Hackshaw A. Sequential screening for lung cancer in a high-risk group: randomised controlled trial: LungSEARCH: a randomised controlled trial of Surveillance using sputum and imaging for the EARly detection of lung Cancer in a High-risk group. Eur Respir J 2019; 54:13993003.00581-2019. [PMID: 31537697 PMCID: PMC6796151 DOI: 10.1183/13993003.00581-2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Low-dose computed tomography (LDCT) screening detects early-stage lung cancer and reduces mortality. We proposed a sequential approach targeted to a high-risk group as a potentially efficient screening strategy. METHODS LungSEARCH was a national multicentre randomised trial. Current/ex-smokers with mild/moderate chronic obstructive pulmonary disease (COPD) were allocated (1:1) to have 5 years surveillance or not. Screened participants provided annual sputum samples for cytology and cytometry, and if abnormal were offered annual LDCT and autofluorescence bronchoscopy (AFB). Those with normal sputum provided annual samples. The primary end-point was the percentage of lung cancers diagnosed at stage I/II (nonsmall cell) or limited disease (small cell). RESULTS 1568 participants were randomised during 2007-2011 from 10 UK centres. 85.2% of those screened provided an adequate baseline sputum sample. There were 42 lung cancers among 785 screened individuals and 36 lung cancers among 783 controls. 54.8% (23 out of 42) of screened individuals versus 45.2% (14 out of 31) of controls with known staging were diagnosed with early-stage disease (one-sided p=0.24). Relative risk was 1.21 (95% CI 0.75-1.95) or 0.82 (95% CI 0.52-1.31) for early-stage or advanced cancers, respectively. Overall sensitivity for sputum (in those randomised to surveillance) was low (40.5%) with a cumulative false-positive rate (FPR) of 32.8%. 55% of cancers had normal sputum results throughout. Among sputum-positive individuals who had AFB, sensitivity was 45.5% and cumulative FPR was 39.5%; the corresponding measures for those who had LDCT were 100% and 16.1%, respectively. CONCLUSIONS Our sequential strategy, using sputum cytology/cytometry to select high-risk individuals for AFB and LDCT, did not lead to a clear stage shift and did not improve the efficiency of lung cancer screening.
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Affiliation(s)
- Stephen G Spiro
- Dept of Respiratory Medicine, University College Hospital, London, UK.,These authors are joint lead authors
| | - Pallav L Shah
- Dept of Respiratory Medicine, Royal Brompton Hospital, Chelsea and Westminster Hospital and Imperial College London, London, UK
| | - Robert C Rintoul
- Dept of Oncology, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
| | - Jeremy George
- UCL Respiratory, Dept of Medicine, University College London, London, UK
| | - Samuel Janes
- UCL Respiratory, Dept of Medicine, University College London, London, UK
| | - Matthew Callister
- Dept of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marco Novelli
- Cellular Pathology, University College Hospital, London, UK
| | - Penny Shaw
- Radiology (Imaging), University College Hospital, London, UK
| | | | - Chris Griffiths
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mary Falzon
- Cellular Pathology, University College Hospital, London, UK
| | - Richard Booton
- Lung Cancer and Thoracic Surgery Directorate, Manchester University NHS Trust and University of Manchester, Manchester, UK
| | - Nicholas Magee
- Respiratory Medicine, Belfast City Hospital, Belfast, UK
| | - Michael Peake
- Dept of Immunity, Infection and Inflammation, University of Leicester, Leicester, UK.,Centre for Cancer Outcomes, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul Dhillon
- Respiratory Medicine, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Kishore Sridharan
- Dept of Thoracic Medicine, Sunderland Royal Hospital, Sunderland, UK
| | - Andrew G Nicholson
- Dept of Histopathology, Royal Brompton Hospital and Harefield NHS Foundation Trust and National Heart and Lung Institute, London, UK
| | - Simon Padley
- Radiology, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Magali N Taylor
- Radiology (Imaging), University College Hospital, London, UK
| | - Asia Ahmed
- Radiology (Imaging), University College Hospital, London, UK
| | - Jack Allen
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - Yenting Ngai
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | | | | | - Sarah Lewis
- Research and Development, Royal Papworth Hospital, Cambridge, UK
| | - Dahmane Oukrif
- Dept of Pathology, University College Hospital, London, UK
| | - Pamela Rabbitts
- Leeds Institute of Cancer and Pathology (LICAP), University of Leeds, Leeds, UK
| | | | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, London, UK.,These authors are joint lead authors
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Barclay E, Sharman A, Duerden B, Booton R, Evison M. CT staging for suspected lung cancer: should we routinely image the pelvis? Clin Radiol 2019. [DOI: 10.1016/j.crad.2019.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Barclay E, Sharman A, Booton R, Duerden R, Evison M. P2.13-07 CT Staging for Suspected Lung Cancer; Should We Routinely Image the Pelvis? J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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37
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Barclay E, Sharman A, Duerden B, Booton R, Evison M. Percutaneous CT-guided biopsies in patients with suspected lung cancer. Clin Radiol 2019. [DOI: 10.1016/j.crad.2019.09.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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38
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Geary B, Walker MJ, Snow JT, Lee DCH, Pernemalm M, Maleki-Dizaji S, Azadbakht N, Apostolidou S, Barnes J, Krysiak P, Shah R, Booton R, Dive C, Crosbie PA, Whetton AD. Identification of a Biomarker Panel for Early Detection of Lung Cancer Patients. J Proteome Res 2019; 18:3369-3382. [PMID: 31408348 DOI: 10.1021/acs.jproteome.9b00287] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lung cancer is the most common cause of cancer-related mortality worldwide, characterized by late clinical presentation (49-53% of patients are diagnosed at stage IV) and consequently poor outcomes. One challenge in identifying biomarkers of early disease is the collection of samples from patients prior to symptomatic presentation. We used blood collected during surgical resection of lung tumors in an iTRAQ isobaric tagging experiment to identify proteins effluxing from tumors into pulmonary veins. Forty proteins were identified as having an increased abundance in the vein draining from the tumor compared to "healthy" pulmonary veins. These protein markers were then assessed in a second cohort that utilized the mass spectrometry (MS) technique: Sequential window acquisition of all theoretical fragment ion spectra (SWATH) MS. SWATH-MS was used to measure proteins in serum samples taken from 25 patients <50 months prior to and at lung cancer diagnosis and 25 matched controls. The SWATH-MS analysis alone produced an 11 protein marker panel. A machine learning classification model was generated that could discriminate patient samples from patients within 12 months of lung cancer diagnosis and control samples. The model was evaluated as having a mean AUC of 0.89, with an accuracy of 0.89. This panel was combined with the SWATH-MS data from one of the markers from the first cohort to create a 12 protein panel. The proteome signature developed for lung cancer risk can now be developed on further cohorts.
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Affiliation(s)
- Bethany Geary
- Stoller Biomarker Discovery Centre, Institute of Cancer Sciences, Faculty of Medical and Human Sciences , University of Manchester , Manchester M13 9PL , United Kingdom
- Stem Cell and Leukaemia Proteomics Laboratory, Institute of Cancer Sciences, Faculty of Medical and Human Sciences , University of Manchester , Manchester M13 9PL , United Kingdom
| | - Michael J Walker
- Stem Cell and Leukaemia Proteomics Laboratory, Institute of Cancer Sciences, Faculty of Medical and Human Sciences , University of Manchester , Manchester M13 9PL , United Kingdom
| | - Joseph T Snow
- Stem Cell and Leukaemia Proteomics Laboratory, Institute of Cancer Sciences, Faculty of Medical and Human Sciences , University of Manchester , Manchester M13 9PL , United Kingdom
- Department of Earth Sciences , University of Oxford , Oxford OX1 2JD , United Kingdom
| | - David C H Lee
- Stoller Biomarker Discovery Centre, Institute of Cancer Sciences, Faculty of Medical and Human Sciences , University of Manchester , Manchester M13 9PL , United Kingdom
| | - Maria Pernemalm
- Science for Life Laboratory, Department of Oncology and Pathology , Karolinska Institutet , 171 77 Solna , Sweden
| | - Saeedeh Maleki-Dizaji
- Stem Cell and Leukaemia Proteomics Laboratory, Institute of Cancer Sciences, Faculty of Medical and Human Sciences , University of Manchester , Manchester M13 9PL , United Kingdom
| | - Narges Azadbakht
- Stem Cell and Leukaemia Proteomics Laboratory, Institute of Cancer Sciences, Faculty of Medical and Human Sciences , University of Manchester , Manchester M13 9PL , United Kingdom
| | - Sophia Apostolidou
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health , University College London , London WC1E 6BT , United Kingdom
| | - Julie Barnes
- Abcodia , Cambourne , Cambridge CB23 6EB , United Kingdom
| | - Piotr Krysiak
- Department of Thoracic Surgery , Wythenshawe Hospital, Manchester University NHS Foundation Trust , Manchester M23 9LT , United Kingdom
| | - Rajesh Shah
- Department of Thoracic Surgery , Wythenshawe Hospital, Manchester University NHS Foundation Trust , Manchester M23 9LT , United Kingdom
| | - Richard Booton
- North West Lung Centre , Wythenshawe Hospital, Manchester University NHS Foundation Trust , Manchester M23 9LT , United Kingdom
| | - Caroline Dive
- Clinical and Experimental Pharmacology Group , Cancer Research UK Manchester Institute, University of Manchester , Manchester M13 9PL , United Kingdom
- Cancer Research UK Lung Cancer Centre of Excellence , Manchester M13 9PL , United Kingdom
| | - Philip A Crosbie
- Stoller Biomarker Discovery Centre, Institute of Cancer Sciences, Faculty of Medical and Human Sciences , University of Manchester , Manchester M13 9PL , United Kingdom
- Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health , University College London , London WC1E 6BT , United Kingdom
- North West Lung Centre , Wythenshawe Hospital, Manchester University NHS Foundation Trust , Manchester M23 9LT , United Kingdom
| | - Anthony D Whetton
- Stoller Biomarker Discovery Centre, Institute of Cancer Sciences, Faculty of Medical and Human Sciences , University of Manchester , Manchester M13 9PL , United Kingdom
- Department of Earth Sciences , University of Oxford , Oxford OX1 2JD , United Kingdom
- Cancer Research UK Lung Cancer Centre of Excellence , Manchester M13 9PL , United Kingdom
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Crosbie PA, Balata H, Evison M, Atack M, Bayliss-Brideaux V, Colligan D, Duerden R, Eaglesfield J, Edwards T, Elton P, Foster J, Greaves M, Hayler G, Higgins C, Howells J, Irion K, Karunaratne D, Kelly J, King Z, Lyons J, Manson S, Mellor S, Miller D, Myerscough A, Newton T, O'Leary M, Pearson R, Pickford J, Sawyer R, Screaton NJ, Sharman A, Simmons M, Smith E, Taylor B, Taylor S, Walsham A, Watts A, Whittaker J, Yarnell L, Threlfall A, Barber PV, Tonge J, Booton R. Second round results from the Manchester 'Lung Health Check' community-based targeted lung cancer screening pilot. Thorax 2019; 74:700-704. [PMID: 30420406 PMCID: PMC6585285 DOI: 10.1136/thoraxjnl-2018-212547] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/12/2018] [Accepted: 10/22/2018] [Indexed: 12/02/2022]
Abstract
We report results from the second annual screening round (T1) of Manchester's 'Lung Health Check' pilot of community-based lung cancer screening in deprived areas (undertaken June to August 2017). Screening adherence was 90% (n=1194/1323): 92% of CT scans were classified negative, 6% indeterminate and 2.5% positive; there were no interval cancers. Lung cancer incidence was 1.6% (n=19), 79% stage I, treatments included surgery (42%, n=9), stereotactic ablative radiotherapy (26%, n=5) and radical radiotherapy (5%, n=1). False-positive rate was 34.5% (n=10/29), representing 0.8% of T1 participants (n=10/1194). Targeted community-based lung cancer screening promotes high screening adherence and detects high rates of early stage lung cancer.
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Affiliation(s)
- Phil A Crosbie
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Haval Balata
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Melanie Atack
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Val Bayliss-Brideaux
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Denis Colligan
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Rebecca Duerden
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Josephine Eaglesfield
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Timothy Edwards
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter Elton
- Greater Manchester, Lancashire, South Cumbria Strategic Clinical Network, Manchester, UK
| | | | - Melanie Greaves
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Graham Hayler
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Coral Higgins
- Manchester Health and Care Commissioning, Manchester, UK
| | - John Howells
- Department of Radiology, Royal Preston Hospital, Preston, UK
| | - Klaus Irion
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Devinda Karunaratne
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jodie Kelly
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoe King
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Judith Lyons
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sarah Manson
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stuart Mellor
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Amanda Myerscough
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Tom Newton
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Rachel Pearson
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | | | - Richard Sawyer
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Anna Sharman
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maggi Simmons
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Elaine Smith
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ben Taylor
- Department of Radiology, Christie NHS Foundation Trust, Manchester, UK
| | - Sarah Taylor
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anna Walsham
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Angela Watts
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - James Whittaker
- Department of Radiology, Stockport NHS Foundation Trust, Stockport, UK
| | - Laura Yarnell
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anthony Threlfall
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Phil V Barber
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Janet Tonge
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Balata H, Evison M, Sharman A, Crosbie P, Booton R. CT screening for lung cancer: Are we ready to implement in Europe? Lung Cancer 2019; 134:25-33. [PMID: 31319989 DOI: 10.1016/j.lungcan.2019.05.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/12/2019] [Accepted: 05/26/2019] [Indexed: 12/23/2022]
Abstract
Lung cancer screening with low-dose CT (LDCT) is already available in certain parts of the world, such as the United States, but not yet in Europe. The recently published European position statement on lung cancer screening has recommended planning for implementation of screening to start within 18-months [1]. Pilot European programmes are already underway, primarily in the United Kingdom (UK), delivering lung cancer screening to their local populations. This review article acknowledges the evidence base for LDCT screening and will discuss the challenges that still need to be overcome in an attempt to answer the question: are we ready to implement in Europe?
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Affiliation(s)
- Haval Balata
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health University of Manchester, Manchester, UK.
| | - Matthew Evison
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - Anna Sharman
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
| | - Philip Crosbie
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre (MTOC), North West Lung Centre, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, UK
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41
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Crosbie PA, Balata H, Evison M, Atack M, Bayliss-Brideaux V, Colligan D, Duerden R, Eaglesfield J, Edwards T, Elton P, Foster J, Greaves M, Hayler G, Higgins C, Howells J, Irion K, Karunaratne D, Kelly J, King Z, Manson S, Mellor S, Miller D, Myerscough A, Newton T, O'Leary M, Pearson R, Pickford J, Sawyer R, Screaton NJ, Sharman A, Simmons M, Smith E, Taylor B, Taylor S, Walsham A, Watts A, Whittaker J, Yarnell L, Threlfall A, Barber PV, Tonge J, Booton R. Implementing lung cancer screening: baseline results from a community-based 'Lung Health Check' pilot in deprived areas of Manchester. Thorax 2019; 74:405-409. [PMID: 29440588 DOI: 10.1136/thoraxjnl-2017-211377] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 11/03/2022]
Abstract
We report baseline results of a community-based, targeted, low-dose CT (LDCT) lung cancer screening pilot in deprived areas of Manchester. Ever smokers, aged 55-74 years, were invited to 'lung health checks' (LHCs) next to local shopping centres, with immediate access to LDCT for those at high risk (6-year risk ≥1.51%, PLCOM2012 calculator). 75% of attendees (n=1893/2541) were ranked in the lowest deprivation quintile; 56% were high risk and of 1384 individuals screened, 3% (95% CI 2.3% to 4.1%) had lung cancer (80% early stage) of whom 65% had surgical resection. Taking lung cancer screening into communities, with an LHC approach, is effective and engages populations in deprived areas.
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Affiliation(s)
- Phil A Crosbie
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Haval Balata
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Melanie Atack
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Val Bayliss-Brideaux
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Denis Colligan
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Rebecca Duerden
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Josephine Eaglesfield
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Timothy Edwards
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter Elton
- Greater Manchester, Lancashire, South Cumbria Strategic Clinical Network, Manchester, UK
| | | | - Melanie Greaves
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Graham Hayler
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Coral Higgins
- Manchester Health and Care Commissioning, Manchester, UK
| | - John Howells
- Department of Radiology, Royal Preston Hospital, Preston, UK
| | - Klaus Irion
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Devinda Karunaratne
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jodie Kelly
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoe King
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Sarah Manson
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stuart Mellor
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Amanda Myerscough
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Tom Newton
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Rachel Pearson
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | | | - Richard Sawyer
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Anna Sharman
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maggi Simmons
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Elaine Smith
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ben Taylor
- Department of Radiology, Christie NHS Foundation Trust, Manchester, UK
| | - Sarah Taylor
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anna Walsham
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Angela Watts
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - James Whittaker
- Department of Radiology, Stockport NHS Foundation Trust, Stockport, UK
| | - Laura Yarnell
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anthony Threlfall
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
| | - Phil V Barber
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Janet Tonge
- Macmillan Cancer Improvement Partnership, Manchester Clinical Commissioning Group, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Balata H, Hayton C, Barber P, Duerden R, Evison M, Greaves M, Howells J, Irion K, Karunaratne D, Leonard C, Mellor S, Newton T, Sawyer R, Sharman A, Smith E, Taylor B, Walsham A, Whittaker J, Chaudhuri N, Booton R, Crosbie P. Prevalence of incidental interstitial lung disease in the Manchester lung cancer screening pilot. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30103-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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43
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Traverse-Healy L, Balata H, Blandin Knight S, Armitage C, Barber P, Colligan D, Elton P, Kirwan M, Lyons J, Mcwilliams L, Novasio J, Sharman A, Slevin K, Taylor S, Tonge J, Waplington S, Yorke J, Evison M, Booton R, Crosbie P. The impact of community-based lung cancer screening on smoking behaviour in a deprived population. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30215-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mulla A, Al-Najjar H, Bailey S, Brown L, Martin J, Lyons J, Crosbie P, Booton R, Evison M. EBUS in lung cancer staging and diagnosis: service performance across a cancer alliance. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30085-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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45
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Perrotta F, Nankivell M, Adizie J, Elshafi M, Jafri S, Maqsood U, Munavvar M, Woolhouse I, Lerner A, Evison M, Booton R, Baldwin D, Janes S, Yarmus L, Bianco A, Navani N. Performance of endobronchial ultrasound-guided transbronchial needle aspiration in PD-L1 testing in patients with NSCLC. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30095-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Cheng A, Craig C, Summers Y, Taylor P, Califano R, Cove-Smith L, Woolf D, Duerden R, Sharman A, Lyons J, Crosbie P, Booton R, Evison M. Metachronous oligometastatic non-small cell lung cancer: are we selecting the appropriate patients for radical treatment? Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30128-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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47
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Tonge JE, Atack M, Crosbie PA, Barber PV, Booton R, Colligan D. "To know or not to know…?" Push and pull in ever smokers lung screening uptake decision-making intentions. Health Expect 2018; 22:162-172. [PMID: 30289583 PMCID: PMC6433322 DOI: 10.1111/hex.12838] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the United States, lung cancer screening aims to detect cancer early in nonsymptomatic current and former smokers. A lung screening pilot service in an area of high lung cancer incidence in the United Kingdom has been designed based on United States trial evidence. However, our understanding of acceptability and reasons for lung screening uptake or decline in a United Kingdom nontrial context are currently limited. OBJECTIVE To explore with ever smokers the acceptability of targeted lung screening and uptake decision-making intentions. DESIGN Qualitative study using semistructured focus groups and inductive thematic analysis to explore acceptability and uptake decision-making intentions with people of similar characteristics to lung screening eligible individuals. SETTING AND PARTICIPANTS Thirty-three participants (22 ex-smokers; 11 smokers) men and women, smokers and ex-smokers, aged 50-80 were recruited purposively from community and health settings in Manchester, England. RESULTS Lung screening was widely acceptable to participants. It was seen as offering reassurance about lung health or opportunity for early detection and treatment. Participant's desire to know about their lung health via screening was impacted by perceived benefits; emotions such as worry about a diagnosis and screening tests; practicalities such as accessibility; and smoking-related issues including perceptions of individual risk and smoking stigma. DISCUSSION Decision making was multifaceted with indications that current smokers faced higher participation barriers than ex-smokers. Reducing participation barriers through careful service design and provision of decision support information will be important in lung screening programmes to support informed consent and equitable uptake.
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Affiliation(s)
- Janet E Tonge
- Macmillan Cancer Improvement Partnership, Parkway Business Centre, Manchester Health and Care Commissioning, Manchester, UK
| | - Melanie Atack
- Macmillan Cancer Improvement Partnership, Parkway Business Centre, Manchester Health and Care Commissioning, Manchester, UK
| | - Phil A Crosbie
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Phil V Barber
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Booton
- North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Denis Colligan
- Macmillan Cancer Improvement Partnership, Parkway Business Centre, Manchester Health and Care Commissioning, Manchester, UK
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Tonge J, Atack M, Crosbie P, Barber P, Booton R, Colligan D. P3.11-24 “To Know or Not to Know ...?” Push and Pull in Ever Smokers Lung Screening Uptake Decision Making Intentions. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Franks K, Mcparland L, Webster J, Baldwin D, Sebag-Montefiore D, Evison M, Booton R, Faivre-Finn C, Naidu B, Ferguson J, Peedell C, Callister M, Kennedy M, Gregory W, Hewison J, Bestall J, Bell S, Hall P, Snee M. P2.16-16 SABRTOOTH: A Fasibility Study of SABR Versus Surgery in Patients with Peripheral Stage I NSCLC Considered to be at Higher Risk for Surgery. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Balata H, Crosbie P, Evison M, Booton R. MA03.01 Manchester Lung Cancer Screening: Results of the First Incidence Screening Round. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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