Evaluation of a service adopting a proactive approach to high risk of lung cancer: The Liverpool Healthy Lung Programme


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Bhagabati Ghimire1,Roberta Maroni2,Daniel Vulkan2,Zoheb Shah2,Michelle Timoney3,Lisa Jones3,Rachel Arvanitis3,Martin Ledson4,Katy Gardner4,Michael Marcus5,Sarah Hill5,Darcy Fideo5,Sabrina Mason5,Samuel G. Smith6,Linda Lukehirst4,Faye Clarke4,Samantha Quaife7,Veronique Poirier8,Karen Fitzgerald8,Stephen W. Duffy9,John K. Field10
1,2Wolfson institute of Preventive Medicine, Queen Mary University of London,3NHS Liverpool Clinical Commissioning Group,4Liverpool Heart and Chest Hospital,5Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre,6Leeds Institute of Health Sciences, University of Leeds,7Institute of Epidemiology and Health, University College London,8Accelerate, Coordinate, Evaluate (ACE) team, Cancer Research UK,9Wolfson Institute of Preventive Medicine, Queen Mary University of London,105 Roy Castle Lung Cancer Research Programme, University of Liverpool Cancer Research Centre

Abstract

Background

Lung cancer is the leading cause of cancer death in the United Kingdom with lower survival rates in patients of lower socioeconomic status than their more affluent counterparts. Community based health services addressing subjects at high risk of lung cancer may be effective in reducing lung disease morbidity and mortality. The Liverpool Healthy Lung Programme is such an initiative.

Method

Patients aged 58-75 years, with a history of smoking or a diagnosis of chronic obstructive pulmonary disease (COPD) according to general practice records, were invited for a lung health check in a community health hub setting. A detailed risk assessment, a spirometry test and a low-dose computed tomography (CT) scan were performed when patients were judged to be above a specific threshold of lung cancer risk. Consent was requested from the participants to share their data for evaluation purposes. During analysis, demographics, risk factors and clinical attributes of patients were compared between the most deprived IMD quintile and the four remaining IMD quintiles using logistic regression. The stage distribution of lung cancers diagnosed was compared to the national stage distribution using the chi-squared test.

Results

A total of 4,566 patients attended the appointment between April 2016 and January 2018 and 3,591 (79%) consented to data sharing. More than 80% of the patients were in the most deprived category. Of those attending, 63% underwent spirometry and 43% were recommended for a CT scan. The 5-year risk of lung cancer was found to be greater in the most deprived group (p=0.0005). A total of 25 cancers were diagnosed during this study, of which 16 (64%) were stage I.

Conclusion

Community based proactive approaches to early diagnosis of lung cancer in health deprived regions are likely to be effective in early detection of lung cancer and possibly COPD.