This section gives a brief overview of issues that may involve healthcare professionals in primary and secondary care. UKLS has been opened at an optimistic time for lung cancer screening. In late 2010 the US-based National Lung Cancer Screening Trial was stopped early as the criteria for discontinuation had been met – a 20% reduction in mortality from lung cancer. However, before screening can be adopted in the UK, several questions need to be answered, not least whether screening can be cost effective. There are many other issues that include the design of the screen, the population at risk, the method of work-up of subjects with nodules and whether results from the US can be applied in Europe. Two consensus statements have been produced on the subject that conclude that trials that are currently underway should continue to the links to IASLC and UKLS statements:
UKLS website - Information for primary care
The UKLS Trial is being conducted on the basis of close collaboration with the GPs and primary care practices of patients recruited to the trial.
As you will see on this website, enrolment involves the identification of patients from age/sex registers of health authorities ensuring that patients in correct age groups are invited. This method of approach has been discussed extensively with participating primary care trusts. We are seeking further details from health authorities including details of invitees and primary care practices.
Your patient will receive an information pack comprising a letter, information sheet, questionnaires and pre-paid reply envelope. As described on this website the questionnaire will allow the calculation of a risk score based on the LLP risk model and patients with the highest scores who are willing to participate will received a second information pack again comprising an information booklet, questionnaires and a pre-paid reply envelope. If your patient responds positively to this second approach the team will invite them to a recruitment centre for a clinic visit at which they will be shown an information DVD, and a discussion with a research nurse.
Each participant will meet individually with the UKLS research nurse to confirm eligibility and the opportunity will be taken at this visit to obtain fully informed written consent. The nurse will perform lung function and blood tests, buckle swabs, nasal brushings and sputum samples. The results of the spirometry will be forwarded to general practitioners. Participants will also fill in a lifestyle, medical history, psychosocial and health economics questionnaire and about 2 weeks after this visit they will be informed as to which arm they have been randomised. All smokers will be provided with smoking cessation advice sheets, designed to complement the smoking cessation advice provided by their primary care practices.
Communication with you
The UKLS team will inform participant’s primary care practices at a number of stages throughout the recruitment, randomisation intervention and follow up process. We will provide you with the results of spirometry and CT scans throughout the course of your patient’s participation in the study.
You will be advised of which arm your patient has been randomised to and the results of spiral CT scanning in the intervention group. You will be further advised of any subsequent treatments and investigations. Throughout this time you will be welcome to call the UKLS team over any matter relating to your patients.
Communication with your patient
Patients may come to you with queries about why they have been contacted, what the potential benefits of lung cancer screening may be and whether there are any harmful effects. Whilst we are providing as much information as possible, through this website and the various patient information materials, we appreciate that many invitees to screening trials turn to their GP for further explanation and advice.
What to say to your patients
We’d be most grateful if you could encourage your patients to read the extensive patient information we have developed for the trial. It’s important to emphasise to patients that screening has both potentially beneficial and harmful effects. We recognise that an invitation to screening will cause anxiety in some people and that you may be required to help your patient(s) deal with this anxiety.
It’s our expectation that through the provision of accurate and balanced information, the vast majority of invitees to the UKLS trial will not suffer long term psychological effects.
Your patients may also ask about why we are collecting fairly detailed information in the questionnaires about other aspects of their health; as you will appreciate this information is necessary to build up an accurate profile of screening participants.
Finally you may be asked about some of the technical aspects of low dose CT and/or follow up investigations. If there is any aspect for which you would like information from the study team, please do not hesitate to get in touch with us.
What to do if symptoms develop
Our expectation is that patients participating in the UKLS trial should continue to attend their primary care doctors in the usual way. Our information materials will emphasise the importance of continuing to respond to symptoms as they would otherwise do, and seek appropriate medical help. As you’ll be aware there are some preconceptions about screening and some participants can wrongly believe that, through taking a screening test, they do not need to be as vigilant about seeking help in relation to symptoms. We are hopeful that any such misconceptions can be alleviated through the extensive information and educational materials we are providing and, of course, with your own advice to your patients.
Referral of patients from UKLS to secondary care
There are two categories of patients that will be referred from UKLS:
- The CT suggests lung cancer is the likely diagnosis.
This will result in an urgent rapid access clinic referral as in normal NHS practice. The patient and GP will be informed that the scan is abnormal and be aware that this might mean lung cancer is the diagnosis. Trial subjects may have had contact with the medical team at the trial centre and any communication will be documented and forwarded to you. You will have a copy of the CT report and the images will be available if requested. Screening CT scans are low dose and do not use contrast, so further imaging will be necessary.
- The CT has shown a nodule that requires further work-up.
These nodules are either >10mm diameter or have, after repeat CT, shown significant growth. All patients in UKLS are in the high risk category for lung cancer and this increases the probability that nodules are malignant. To assist in the work-up of these nodules, we will provide an estimate of the probability of malignancy based on data available from the latest screening trial results.
What other patients might be referred as a result of UKLS?
We do not know if other patients in the trial will seek referral to a chest physician as no such trial has been run in the UK. However, in other screening trials we find that a small number of patients in the control arm wish to have a CT. It is also possible that subjects that have had a nodule detected that needs to be followed for growth measurement become anxious and want to be referred. As there is no proven benefit of CT screening in the UK, patients in the control group should be managed in the normal away – on the basis of symptoms. Subjects in the CT group are best managed according to the UKLS follow-up scan protocol link to algorithm.
What if patients ask about screening in the Independent Sector?
Screening should not be offered by the Independent Sector until the benefit is proven. However, it is recognised that this may happen and so UKLS have produced a statement that includes recommendations about the minimum standards that should be applied. Link to Thorax statement