Implementation of a lung health clinic in high-risk individuals in South East London: a prospective feasibility cohort study Background In 2013, lung cancer was the third most common cancer after breast cancer and prostate cancer. There were over 45,000 new cases of lung cancer in the UK Lung cancer is the most common cause of cancer death in the UK, with over 35,000 deaths from the condition in England in 2014, more than from breast and colorectal cancers combined. This accounts for 22% of all cancer deaths in both males and females combined. The clinical challenge: Lung cancer continues to be diagnosed at a late stage. In 2013, 77% of cases were stages IIIB or IV at the time of diagnosis 28% of cases were referred through the two-week urgent referral pathway 35% of cases are diagnosed via A&E admission. Outcomes are significantly worse for those diagnosed following an A&E presentation The pick up rate of early cancer in high risk patients is not ideal, as chest X-rays - the preferred imaging test – presents significant limitations Lung cancer tends to be diagnosed at a late stage and mainly via A&E which results in poorer clinical outcomes. Aims TOHETI aims to investigate uptake of low dose CT scans when offered as part of a lung health clinic assessment in patients aged 55-80 who are current or formers smokers (smoking cessation <15 years) Proposed pathway 1 2 3 4 5 6 Community pharmacy GP database search Smoking cessation clinics Secondary care: respiratory clinic Non- recruitment questionnaire Patient invitation + risk score questionnaire Low risk score or Symptoms of lung cancer Excluded Methods The current clinical pathway for lung cancer diagnosis relies on patients visiting their GP once symptoms suggestive of lung cancer have developed. Patients symptomatic for lung cancer at diagnosis tend to have more advanced stages of lung cancer and are less likely to be eligible for treatment of curative intent. A successful lung cancer screening strategy must correctly identify patients with lung cancer, where the benefits of early chest low dose CT outweigh the possible risks, while simultaneously minimising the risks arising from the investigation of false-positive results. Non- acceptance High risk score Lung health clinic Chest x-ray Same day Invite eligible patients to complete a risk questionnaire GP EMIS Search Community pharmacy Secondary care Smoking cessation Patients with high risk invited to the lung health clinic Patients with a ≥5% risk of lung cancer over 5 years will be invited to attend the clinic Lung health clinic: Nurse led clinic Lung function tests (spirometry and CO test) Chest radiology and low dose chest CT Patients will be notified of the result of their scans No lung cancer or nodules Suspicion of lung cancer Lung nodules No lung nodule or lung cancer Low dose chest CT Suspected lung cancer Lung nodule UKLS lung nodule pathway Lung cancer pathway GP refers patient with respiratory disease Very high risk Low risk Localised spirometry service No scan Discharge to GP Intermediate and high risk Refer to Chest Clinic Low-dose CT scan Low to intermediate risk nodule Normal scan High risk nodule Interval low-dose CT scan Patient follow up Patient information leaflet Outcomes Expected impact Patient experience and satisfaction Improved patient experience and satisfaction due to a streamlined clinical pathway Quality of care Better patient outcomes by reducing late lung cancer diagnosis and ultimately improving patient prognosis Efficiency Improved cost-effectiveness by decreasing the cost per QALY (quality-adjusted life year) both from NHS and societal perspective CONTACT US: Project Manager: Ms Yvonne Akande Ext. 89578 Yvonne.Akande@kcl.ac.uk