Immediate chest X-ray for patients at risk of lung cancer presenting in primary care: randomised controlled feasibility trial.
British Journal of Cancer
Cancer Research UK
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BACKGROUND: Achieving earlier stage diagnosis is one option for improving lung cancer outcomes in the United Kingdom. Patients with lung cancer typically present with symptoms to general practitioners several times before referral or investigation. METHODS: We undertook a mixed methods feasibility individually randomised controlled trial (the ELCID trial) to assess the feasibility and inform the design of a definitive, fully powered, UK-wide, Phase III trial of lowering the threshold for urgent investigation of suspected lung cancer. Patients over 60, with a smoking history, presenting with new chest symptoms to primary care, were eligible to be randomised to intervention (urgent chest X-ray) or usual care. RESULTS: The trial design and materials were acceptable to GPs and patients. We randomised 255 patients from 22 practices, although the proportion of eligible patients who participated was lower than expected. Survey responses (89%), and the fidelity of the intervention (82% patients X-rayed within 3 weeks) were good. There was slightly higher anxiety and depression in the control arm in participants aged >75. Three patients (1.2%) were diagnosed with lung cancer. CONCLUSIONS: We have demonstrated the feasibility of individually randomising patients at higher risk of lung cancer, to a trial offering urgent investigation or usual care.British Journal of Cancer advance online publication 10 January 2017; doi:10.1038/bjc.2016.414 www.bjcancer.com.
This trial was funded by the National Awareness and Early Diagnosis Initiative (NAEDI) Research Call Funding Partners (in alphabetical order): Cancer Research UK (trial reference: C8350/A12199); Department of Health, England; Economic and Social Research Council; Health and Social Care Research and Development Division, Public Health Agency, Northern Ireland; National Institute for Social Care and Health Research, Wales; and the Scottish Government (http://www.naedi.org.uk). The trial was developed on behalf of the NCRI Primary Care and Lung Clinical Studies Groups. It was sponsored by Bangor University. The Wales Cancer Trials Unit is funded by Cancer Research UK. The South East Wales Trials Unit is funded by Health and Care Research Wales. We would like to thank all the patients who participated in the trial; all the practices who participated in the trial; members of the Independent Trial Steering Committee; the Bristol Randomised Trials Collaboration; the Health and Care Research Wales Workforce; the Marie Curie Palliative Care Research Centre, and the Primary Care Research Network Workforce.
This is the author accepted manuscript. The final version is available from Cancer Research UK via the DOI in this record.
Vol. 116, pp. 293–302.
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