Attitudes to participation in a lung cancer screening trial: a qualitative study

Patel, Deesha A.; Akporobaro, Ajiri; Chinyanganya, Nyasha; Hackshaw, Allan; Seale, Clive; Spiro, Stephen; Griffiths, Chris

doi:10.1136/thoraxjnl-2011-200055

Cited by 82 publications

(136 citation statements)

References 28 publications

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“…Our qualitative findings confirmed that similar to NLST survey findings (Park et al, 2009(Park et al, , 2012) and other recent lung screening studies (Patel et al, 2012;Schnoll et al, 2002), smokers expressed relatively high-risk perceptions. This finding suggests that smokers who undergo lung screening differ from smokers in the general population who underestimate their risks of lung cancer and smoking-related diseases (Ayanian & Cleary, 1999;.…”

Section: Discussionsupporting

confidence: 91%

A Qualitative Study of Lung Cancer Risk Perceptions and Smoking Beliefs Among National Lung Screening Trial Participants

Park

Streck

Gareen

et al. 2013

Nicotine & Tobacco Research

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The National Comprehensive Cancer Network and the American Cancer Society recently released lung screening guidelines that include smoking cessation counseling for smokers undergoing screening. Previous work indicates that smoking behaviors and risk perceptions of the National Lung Screening Trial (NLST) participants were relatively unchanged. We explored American College of Radiology Imaging Network (ACRIN)/NLST former and current smokers' risk perceptions specifically to (a) determine whether lung screening is a cue for behavior change, (b) elucidate risk perceptions for lung cancer and smoking-related diseases, and (c) explore postscreening behavioral intentions and changes.

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Section: Discussionsupporting

confidence: 91%

A Qualitative Study of Lung Cancer Risk Perceptions and Smoking Beliefs Among National Lung Screening Trial Participants

Park

Streck

Gareen

et al. 2013

Nicotine & Tobacco Research

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“…A profile of potential risk factors for non-uptake of lung screening was revealed: high-risk individuals who were older (> 70 years of age), female, smokers, from a lower socioeconomic group or with a higher affective risk perception were less willing to participate in the trial. These findings are consistent with barriers to uptake reported in previous lung screening studies, including female gender, 100 perceived threat associated with lung cancer and lung screening tests, 95,96 and low perceived benefit among smokers. 92 Individuals from more affluent backgrounds may have a better understanding of the benefits of screening and face fewer barriers than those from poorer backgrounds.…”

Section: Trial Non-uptakesupporting

confidence: 82%

“…94 Other barriers may include fears about lung screening tests and radiation exposure, and fatalistic beliefs about lung cancer. 95,96 Psychosocial impact of lung screening trial allocation…”

Section: Barriers To Uptake Of Lung Cancer Screeningmentioning

confidence: 99%

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Field

Duffy

Baldwin

et al. 2016

Health Technol Assess

235

231

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BackgroundLung cancer kills more people than any other cancer in the UK (5-year survival < 13%). Early diagnosis can save lives. The USA-based National Lung Cancer Screening Trial reported a 20% relative reduction in lung cancer mortality and 6.7% all-cause mortality in low-dose computed tomography (LDCT)-screened subjects.ObjectivesTo (1) analyse LDCT lung cancer screening in a high-risk UK population, determine optimum recruitment, screening, reading and care pathway strategies; and (2) assess the psychological consequences and the health-economic implications of screening.DesignA pilot randomised controlled trial comparing intervention with usual care. A population-based risk questionnaire identified individuals who were at high risk of developing lung cancer (≥ 5% over 5 years).SettingThoracic centres with expertise in lung cancer imaging, respiratory medicine, pathology and surgery: Liverpool Heart & Chest Hospital, Merseyside, and Papworth Hospital, Cambridgeshire.ParticipantsIndividuals aged 50–75 years, at high risk of lung cancer, in the primary care trusts adjacent to the centres.InterventionsA thoracic LDCT scan. Follow-up computed tomography (CT) scans as per protocol. Referral to multidisciplinary team clinics was determined by nodule size criteria.Main outcome measuresPopulation-based recruitment based on risk stratification; management of the trial through web-based database; optimal characteristics of CT scan readers (radiologists vs. radiographers); characterisation of CT-detected nodules utilising volumetric analysis; prevalence of lung cancer at baseline; sociodemographic factors affecting participation; psychosocial measures (cancer distress, anxiety, depression, decision satisfaction); and cost-effectiveness modelling.ResultsA total of 247,354 individuals were approached to take part in the trial; 30.7% responded positively to the screening invitation. Recruitment of participants resulted in 2028 in the CT arm and 2027 in the control arm. A total of 1994 participants underwent CT scanning: 42 participants (2.1%) were diagnosed with lung cancer; 36 out of 42 (85.7%) of the screen-detected cancers were identified as stage 1 or 2, and 35 (83.3%) underwent surgical resection as their primary treatment. Lung cancer was more common in the lowest socioeconomic group. Short-term adverse psychosocial consequences were observed in participants who were randomised to the intervention arm and in those who had a major lung abnormality detected, but these differences were modest and temporary. Rollout of screening as a service or design of a full trial would need to address issues of outreach. The health-economic analysis suggests that the intervention could be cost-effective but this needs to be confirmed using data on actual lung cancer mortality.ConclusionsThe UK Lung Cancer Screening (UKLS) pilot was successfully undertaken with 4055 randomised individuals. The data from the UKLS provide evidence that adds to existing data to suggest that lung cancer screening in the UK could potentially be implemented in the 60–75 years age group, selected via the Liverpool Lung Project risk model version 2 and using CT volumetry-based management protocols.Future workThe UKLS data will be pooled with the NELSON (Nederlands Leuvens Longkanker Screenings Onderzoek: Dutch–Belgian Randomised Lung Cancer Screening Trial) and other European Union trials in 2017 which will provide European mortality and cost-effectiveness data. For now, there is a clear need for mortality results from other trials and further research to identify optimal methods of implementation and delivery. Strategies for increasing uptake and providing support for underserved groups will be key to implementation.Trial registrationCurrent Controlled Trials ISRCTN78513845.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 40. See the NIHR Journals Library website for further project information.

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“…Such a incidence rate suggests that individual-based prevention against cancer targeting at non-selective subjects may not be cost-effective since the number needed to treat (NNT) is too big (Bender et al, 2007). It also leads to perception of low susceptibility by ordinary residents since only less than "a few out of thousands" could get cancer for a whole year (Patel et al, 2012). These issues may be solved by assessment tools capable of distinguishing high from low risk individuals.…”

Section: Introductionmentioning

confidence: 99%

Refining and Validating a Two-stage and Web-based Cancer Risk Assessment Tool for Village Doctors in China

Shen¹,

Chai²,

Feng³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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The big gap between efficacy of population level prevention and expectations due to heterogeneity and complexity of cancer etiologic factors calls for selective yet personalized interventions based on effective risk assessment. This paper documents our research protocol aimed at refining and validating a two-stage and webbased cancer risk assessment tool, from a tentative one in use by an ongoing project, capable of identifying individuals at elevated risk for one or more types of the 80% leading cancers in rural China with adequate sensitivity and specificity and featuring low cost, easy application and cultural and technical sensitivity for farmers and village doctors. The protocol adopted a modified population-based case control design using 72, 000 non-patients as controls, 2, 200 cancer patients as cases, and another 600 patients as cases for external validation. Factors taken into account comprised 8 domains including diet and nutrition, risk behaviors, family history, precancerous diseases, related medical procedures, exposure to environment hazards, mood and feelings, physical activities and anthropologic and biologic factors. Modeling stresses explored various methodologies like empirical analysis, logistic regression, neuro-network analysis, decision theory and both internal and external validation using concordance statistics, predictive values, etc..

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Attitudes to participation in a lung cancer screening trial: a qualitative study

Cited by 82 publications

References 28 publications

A Qualitative Study of Lung Cancer Risk Perceptions and Smoking Beliefs Among National Lung Screening Trial Participants

A Qualitative Study of Lung Cancer Risk Perceptions and Smoking Beliefs Among National Lung Screening Trial Participants

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Refining and Validating a Two-stage and Web-based Cancer Risk Assessment Tool for Village Doctors in China

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