The Liverpool Lung Project Primary Care Implementation Programm

Published Date: 19th July 2016

Publication Authors: Ashton M, Hughes J, Mimnagh C

Background

More than 90% of people diagnosed with lung cancer in the UK die within a 5-year period. The poor survival is partly linked with late diagnosis often at an advanced stage when various treatment options are less efficacious. The cornerstone of early diagnosis includes prompt identification of high risk individuals, necessitating a need for a validated screening approach that could be used in the primary care setting to target people before onset of symptoms The LLP-PCIP was set up in Knowsley, which has amongst the highest rates of lung cancer in the UK, as a pilot study evaluating the combined role of the LLP risk model, lung function test, sputum cytology and methylation profiling in complementing Bronchospic/CT for early diagnosis of lung cancer. We will describe the design, progress, limitation and expectation of this pioneer initiative.

Methods

The study utilises a prospective cohort design with annual follow up for incident of lung cancer and mortality. In a first step, the LLP risk model is used to assess lung cancer risk for patients aged 50-80 years attending the General Practitioner. Eligibility into the intervention arm is dependent on the LLP risk model score (5-year risk >=5%) and lung function test (FEV1/FVC<0.70) results. Also, patients in the intervention arm receive sputum cytology (suspicious or malignant) and chest X-ray (suspicious or malignant) investigations. Based on a positive or suspicious result, a broncoschopy followed by a CT scan and surgery are recommended in succession for definitive diagnosis. Disease free participants in the intervention arm are invited annually for follow-up clinical investigations. All participants are regularly follow-up through the GP and/or record linkage with routine data from cancer registry and death registration. All participants diagnosed with lung cancer are managed by the GP following the NHS standard treatment pathway.

Results

Since study start in January 2009, the LLP risk model has been applied to 1192 patients, and 271(23%) have been identified as high risk of developing lung cancer within 5 years (i.e. 5-year risk >=5%). Lung function test was performed in 175 (65%) of high risk patients, of which 142 (81%) had FEV1/FVC<0.70. To date, no lung cancer cases have been identified in the intervention arm, but 11 suspicious patients are undergoing clinical investigation (bronscoscopy/CT scan). The first annual recall for sputum cytology investigation and methylation profiling are now underway.

Conclusion

The LLP-PCIP investigates the effectiveness and clinical feasibility of the combined role of the LLP risk model, lung function test, sputum cytology and methylation profiling to complement Brochoscopic/CT scan for diagnosis of lung cancer, thereby providing a mechanism for early detection before onset of symptoms. An evaluation of the study progress has provided insight on the aspects which need improvement; in particular, how to recruit the hard-to-reach and reducing withdrawal. The experience gained from this study will be very valuable in the planned population-based UK Lung Screening trial (UKLS) currently under pilot in Liverpool and Cambridge.

Field, JK; Mimnagh, C; Hughes, J; Ashton, M et al. (2011).  A pilot lung cancer early detection study in a primary care practice in knowsley, merseyside: The liverpool lung project primary care implementation programme (llppcip) . Journal of Thoracic Oncology. 6 (Suppl 2), S1393

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