Lung cancer

CHEST Australia trial shows it’s an uphill challenge to detect lung cancer early


A behavioural intervention to encourage people at increased risk of lung cancer to seek help for respiratory symptoms has led to more consultations but failed to reduce the time to consultation and a potential diagnosis.

The CHEST Australia trial, conducted in general practices in Perth and Melbourne, comprised 551 long-term smokers and ex-smokers over age 55 years.

The intervention group received a self-help manual about chest symptoms that call for action, were assisted to develop action and coping plans and provided with monthly prompts to monitor their symptoms. People randomised to the control group received only a brief discussion about lung health.

The study, published in Thorax, found a 40% relative increase in consultation rates for respiratory symptoms in the intervention group during the following 12 months but no difference in total consultation rates between the groups.

It also found the time from symptom onset to consultation was a non-significant nine days shorter in the intervention group compared to the control group.

Secondary outcomes such as cancer-related anxiety, depression and quality of life scores were not significantly different between the two groups.

The cost per additional consultation was estimated at $1,289.

Lead researcher Dr Jon Emery told the limbic the findings highlight some of the difficulties in changing behaviour in this patient group.

“We did get people to consult more but they were still waiting for quite some time with their symptoms before they actually made the decision to consult.”

“It’s a tricky balance because people don’t necessarily want to be bothering their doctor and equally, these are people who often have ongoing respiratory symptoms anyway because they are either current or former smokers so they are quite used to being symptomatic.”

Dr Emery, from the Department of General Practice and the Centre for Cancer Research at the University of Melbourne, said if 3% of the additional consultations led to a diagnosis of lung cancer the cost per case detected would be about $42,500.

“It’s not a very expensive intervention and it is a relatively simple thing to implement within primary care,” he said.

He added that the European NELSON trial, presented last year at the International Association for the Study of Lung Cancer (IASLC) 19th World Conference on Lung Cancer but still unpublished, had confirmed a mortality reduction from CT screening for people at high risk of lung cancer.

If Australia eventually made the decision to offer low-dose CT screening for lung cancer, it may be possible to integrate the behavioural intervention into the model, Dr Emery said.

“We think this is an area where primary care could play a key role to assess the risk of lung cancer in populations of current or former heavy smokers. So, a behavioural intervention might be something you could offer within that primary care consultation for those for whom CT screening is not considered appropriate.”

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