Evaluation of a health service adopting proactive approach to reduce high risk of lung cancer: The Liverpool Healthy Lung Programme

Abstract

This Liverpool Healthy Lung Programme is a response to high rates of lung cancer and respiratory diseases locally and aims to diagnose lung cancer at an earlier stage by proactive approach to those at high risk of lung cancer. The objective of this study is to evaluate the programme in terms of its likely effect on mortality from lung cancer and its delivery to deprived populations. Methods Persons aged 58-75 years, with a history of smoking or a diagnosis of chronic obstructive pulmonary disease (COPD) 1 according to general practice records were invited for lung health check in a community health hub setting. A detailed risk assessment and spirometry were performed in eligible patients. Those with a 5% or greater five-year risk of lung cancer were referred for a low dose CT 2 scan. Results A total of 4 566 subjects attended the appointment for risk assessment and 3 591 (79%) consented to data sharing. More than 80% of the patients were in the most deprived quintile of the index of multiple deprivation. Of those attending, 63% underwent spirometry and 43% were recommended for a CT scan. A total of 25 cancers were diagnosed, of which 16 (64%) were stage I. Comparison with the national stage distribution implied that the programme was reducing lung cancer mortality by 22%. Conclusions 1 COPD, chronic obstructive pulmonary disease; 2 CT, computed tomography 3 Community based proactive approaches to early diagnosis of lung cancer in health deprived regions are likely to be effective in early detection of lung cancer.

The challenges of implementing low-dose computed tomography for lung cancer screening in low- and middle-income countries

“…118 ). The LLP v2 was assessed in the community-based Liverpool Healthy Lung Programme, using a cutoff of ≥5% risk over five years, with predicted results, though tentative, similar to those observed in the NLST (22% versus 20% lung cancer mortality RR, respectively) 119 . These multivariable RPMs are currently being validated in the National Health Services Targeted Lung Health Checks Programme, in England, at a proposed risk threshold ≥1.51% over six years and ≥2.5% over five years, respectively, for the PLCO m2012 and the LLP v2…”

“…Seeking international consultations with previously established programs is also encouraged as an opportunity to share know-how involving the necessary steps for screening implementation and for planning for future integration into large health systems 136 . For instance, completed and ongoing community-based pilot programs from the United Kingdom have successfully engaged high-risk individuals of lower socioeconomic status and deprived communities with effective outcomes, and can serve as a reference for LMICs 60,119,120,137 . Finally, large-scale demonstration programs can help define and build new infrastructure, train healthcare workers and harness opportunities to overcome local resource limitations 138 .…”

Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe

“…The UK Lung Screen (UKLS) trial took advantage of the Liverpool Lung Project (LLP v2 ) risk model (5% risk over 5 years) to select high risk patients, identifying 2.1% lung cancers at baseline, which was higher than observed in either NLST or NELSON trial [32]. Recently, the NHS England Lung Health Projects [33,34] in the UK have used both the PLCO M2012 and the LLP v2 [35][36][37]. Probability thresholds adopted for screening eligibility with PLCO M2012 are ≥1.3% [38], ≥1.5% [3], and ≥2.0% [39,40].…”

Lung cancer screening implementation: Complexities and priorities

“…11 Pilot programmes are underway in countries including China, Canada and the United Kingdom (UK). 8,12,13 In Manchester and Liverpool, the Lung Health Check pilot programme has demonstrated successful implementation in deprived communities using mobile screening vans. The National Health Service has funded a further 10 pilot sites and released a standard protocol to facilitate implementation in 2019.…”

“…Pilot programmes are underway in countries including China, Canada and the United Kingdom (UK) 8,12,13 . In Manchester and Liverpool, the Lung Health Check pilot programme has demonstrated successful implementation in deprived communities using mobile screening vans.…”