Approximately two thirds of patients with lung cancer are diagnosed when curative treatment is not possible, due mainly to late stage at presentation to healthcare. International research has focused either on CT screening or community symptom awareness interventions to detect lung cancer earlier. We aimed to test the effect of an individual-level behavioural intervention on consultation rates for respiratory symptoms in people at increased risk of lung cancer.
The CHEST intervention entailed a consultation in general practice to implement a self-help manual, followed by self-monitoring reminders to improve symptom appraisal and encourage help-seeking in patients at increased risk of lung cancer. Eligible participants were long-term smokers with at least 20 pack years, aged 55 and over identified through electronic GP records. They were randomised to the CHEST Intervention plus spirometry or usual care plus spirometry. Primary outcome: consultation rate for respiratory symptoms; secondary outcomes: time to presentation with respiratory symptoms, general and cancer-specific anxiety, depression, views of health and health service utilisation.
We recruited 551 patients (accrual target 550) and the primary outcome obtained on 542. There was a significant increase in respiratory consultation rates in the intervention group (relative rate 1.39 95% CI 1.07 to 1.81 p=0.0145). There were no significant differences in anxiety, depression, views of health or time to first presentation with a respiratory symptom (intervention vs control mean days: 66.4 vs 75.7; HR 0.827 95% CI 0.640 – 1.069 p=0.147). The health economic analyses will be completed by October 2017.
This is the first trial to show a positive effect on help-seeking for symptoms of lung cancer in patients at increased risk of the condition. It could be a low-cost approach to support early diagnosis of lung cancer especially in people who do not meet risk criteria for lung CT screening.