In the UK, lung cancer kills more people than any other type of cancer. This is because it is common – the third most common cancer – and very often has no signs or symptoms so is diagnosed at a late stage, when treatment has a limited impact on survival. Late diagnosis of lung cancer is a leading cause of poor cancer survival outcomes in the UK.
This NHS England funded initiative, which offers patients access to a mobile CT, is the first of its kind in London, and means people who have been identified as being at increased risk of lung cancer will be invited for a lung health check. If appropriate, they will then be offered a CT scan in a convenient place on the same day.
The project builds on several landmark studies, including the recently announced NELSON study which has reported a 26% reduction in lung cancer deaths when high-risk patients had a CT scan.
Piloting low dose CT projects was identified as a priority in the 2018/19 NHS England Planning Guidance refresh and we aim to work collaboratively to share knowledge and build the evidence base with pilots across the NHS.
Our project involves a detailed evaluation drawing on the collection of significant data around the benefits and costs of asymptomatic low dose CT lung cancer scanning. The aim is to provide a strong evidence base across a large population to understand how to implement low dose CT scanning in an NHS setting.
In collaboration with the Royal Brompton and Harefield NHS Foundation Trust (RBHT), we are targeting people in Hammersmith and Fulham (which has the highest lung cancer incidence and mortality across west London), and in Hillingdon (which has the lowest one-year survival for lung cancer) to hopefully diagnose lung cancer earlier.
The pilot compares a fixed scanner at RBHT for the Hammersmith and Fulham population against a mobile CT scanner, placed in a supermarket car park in Hillingdon. This will add to our understanding of acceptability in terms of where the scanning takes place (community vs hospital venue) and when appointments are available (working hours vs extending opening).
Twenty GP practices across both boroughs are taking part in the project. People aged between 60 and 75 who are current or ex-smokers have been identified via their GP records and invited to attend a lung health check.
The health check, led by a respiratory nurse, consists of various tests including lung function, checking respiratory symptoms and BMI. In addition, a risk assessment tool, in the form of a questionnaire, is used to determine whether the person is at high risk of lung cancer. If so, patients are offered an appointment for a low dose CT scan, ideally on the same day. The scans are reviewed and reported back to the patients and their GP within 2-3 weeks. Where appropriate, patients can be referred to a local stop smoking service.
The pilot is running until March 2019, and the results will allow us to share recommendations and provide support to other cancer alliances implementing similar pilots. We will also be adding to the evidence base and learning sought by the National Screening Committee, which is considering the introduction of a lung cancer screening programme.
For more information please contact Katie Morris, senior project lead.