Lung Cancer 2017 Whats New! Sam Janes Wellcome Trust Senior Fellow - - PowerPoint PPT Presentation

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

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LDCT for lung cancer screening and the US

Aberle et al, NEJM, 2011

• 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

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Lung Screen Uptake Trial 2015/16

Jane Wardle Sam Janes Mamta Ruparel Sammantha Quaife Stephen Duffy, Neal Navani, Anand Devaraj, David Baldwin

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Test Invitational Materials

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Test Invitational Materials

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Standard NHS Screening Invitational Materials Made for Lung Screening

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Standard NHS Screening Invitational Materials

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Preliminary data: Recruitment via primary care

53% 46% 1%

Did not attend Recruited Attended but not recruited 10 20 30 40 UCLH HUH

Uptake Recruitment

On average: 1.5% of GP population is invited for screening

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Preliminary data: Outcomes from screening so far

25% 47% 15% 9% 4%

Normal Scan Non-malignant pulmonary disease Non-pulmonary incidental finding Indeterminate pulmonary nodule(s) Suspicious thoracic lesion

10 20 30 40 50 60 70 80 COPD/ Emphysema IHD/ Coronary Calcification>mod % Frequency Self-reported co-morbidity CT detected co-morbidity

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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

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The future lung programme

• Lung health check and low dose CT scan
• Target population
• Asymptomatic north central and north east London

residents – eligible population c.100,000

• Current and former smokers with 30 pack years
• Aged 55-77 years
• No previous lung cancer diagnosis
• 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

GP data extract (55-77yrs, smokers, ex-smokers) Invitation letter sent out to all patients Patient contacts admin team to book appt. Patients triaged over the phone. Appt confirmation sent and reminder text 2/3 days prior to appt. Patient attends lung health check appt (spirometry, height, weight, CO, risk profile, VBA smoking)

Meets risk profile score

Low dose CT scan provided Scan read and reported Normal Scan

• GP receives letter
• Patient receives

letter

• Patient will get

another scan in 1 or 2 years (randomised)

Suspected cancer / nodules

• GP receives letter with results
• Patient receives letter about appt

at the hospital

• Patient booked into 2 ww clinic

with results of health check and scan result OR consultant upgrade to ensure no delay to patient getting an appt.

Indeterminate pulmonary nodule detected

• GP receives letter with the

results and management plan

• Patient has repeat scan 3

mths (BTS guidelines)

DNA Incidental findings (Lung & Non-lung)

• GP receives a letter with health

check result, result of CT scan and management plan

• Patient receives a letter asking

them to make an appt with the GP

Smoking cessation Patient ready to quit: Referral to local smoking cessation service Patient not ready to quit: Referral not made Patient not eligible/declines for scan: GP and patient receive letter about the lung health check

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If we screened 5000 people (based on UKLS data)

5000 screened 1185- repeat scan (may require repeat scans at 3-12 month intervals for up to 4 years or may be discharged sooner) 160 referrals to MDT at baseline + 105 at repeat scan = total 265

275 repeat CTs (ie some had 2-4)

50 CT biopsies 5 EBUS 115 PETs 80 surgical reviews 30 oncology reviews 3655 baseline scans= normal/ <5mm/ 100mm3 nodules ≤5 cancers 75 cancers

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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

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THANK YOU