UCL Respiratory Lung Cancer 2017 – What’s New! Sam Janes Wellcome Trust Senior Fellow in Clinical Science Professor of Respiratory Medicine Head of UCL Respiratory University College London, UK
UCL Respiratory LDCT for lung cancer screening and the US • 10,000,000 individuals in the US eligible • Could prevent 12,000 deaths annually in the US •‘Final Coverage Decision’ by the Centres of Medicare and Medicaid Services Aberle et al, NEJM, 2011
UCL Respiratory
UCL Respiratory
UCL Respiratory Lung Screen Uptake Trial 2015/16 Jane Wardle Sam Janes Mamta Ruparel Sammantha Quaife Stephen Duffy, Neal Navani, Anand Devaraj, David Baldwin
UCL Respiratory Test Invitational Materials
UCL Respiratory Test Invitational Materials
UCL Respiratory Standard NHS Screening Invitational Materials Made for Lung Screening
UCL Respiratory Standard NHS Screening Invitational Materials
UCL Respiratory Preliminary data: Recruitment via primary care On average: 1.5% of GP population is invited for screening Uptake Recruitment 1% 40 30 Did not attend 20 UCLH 46% Recruited HUH 10 53% Attended but not recruited 0
UCL Respiratory Preliminary data: Outcomes from screening so far Normal Scan Non-malignant pulmonary disease Non-pulmonary incidental finding Self-reported co-morbidity CT detected co-morbidity 80 Indeterminate pulmonary nodule(s) 70 Suspicious thoracic lesion 60 % Frequency 50 4% 40 9% 30 25% 20 10 15% 0 COPD/ Emphysema IHD/ Coronary Calcification>mod 47%
UCL Respiratory Key PRELIMINARY findings 90% of invitees qualify for a CT screen based on age and smoking ‘YES’ 65% are current smokers 56% left school at or before 15 58% live in the lowest IMD quintile neighbourhood
UCL Respiratory The future lung programme • Lung health check and low dose CT scan • Target population o Asymptomatic north central and north east London residents – eligible population c.100,000 o Current and former smokers with 30 pack years o Aged 55-77 years o No previous lung cancer diagnosis o Not on palliative care register • Run as a study in partnership with UCL • 20,000 participants • Launching in November 2017 and run for 3.5 years
Patient Pathway Patient contacts admin team to book appt. Patients triaged over Invitation letter GP data extract (55-77yrs, the phone. Appt confirmation sent sent out to all smokers, ex-smokers) and reminder text 2/3 days prior to patients appt. Smoking cessation DNA Patient ready to quit: Referral to local smoking cessation service Patient attends lung health check appt (spirometry, Patient not ready to quit : height, weight, CO, risk Referral not made profile, VBA smoking) Patient not eligible/declines Meets risk for scan: GP and patient receive profile score letter about the lung health check Scan read and Low dose CT scan provided reported Indeterminate Incidental findings (Lung & Suspected cancer / nodules Normal Scan • GP receives letter with results pulmonary nodule Non-lung) • GP receives letter • Patient receives letter about appt • GP receives a letter with health detected • Patient receives at the hospital • GP receives letter with the check result, result of CT scan letter • Patient booked into 2 ww clinic and management plan results and management • Patient will get with results of health check and • Patient receives a letter asking plan another scan in 1 or scan result OR consultant upgrade • Patient has repeat scan 3 them to make an appt with the 2 years (randomised) to ensure no delay to patient GP mths (BTS guidelines) getting an appt.
UCL Respiratory If we screened 5000 people (based on UKLS data) 1185- repeat scan (may require repeat scans at 3-12 month intervals for up to 4 years or may be discharged sooner) 275 repeat CTs (ie some had 2-4) 5000 screened 50 CT biopsies 160 referrals to 3655 baseline MDT at baseline 5 EBUS scans= normal/ 75 cancers + 105 at repeat <5mm/ 100mm 3 scan 115 PETs nodules = total 265 80 surgical reviews 30 oncology reviews ≤5 cancers
UCL Respiratory Indicative timescales • April 2017 – Agree contract arrangements • April/May 2017 – Finalise study protocol • April 2017 – Begin scoping communications plan • July/August 2017 – Commence engagement with target population, CCGs and primary care • November 2017 – Study launches
UCL Respiratory THANK YOU
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