Fighting lung cancer deaths with earlier diagnosis

Someone in Australia dies from lung cancer every hour.
 
The disease also has a very poor prognosis for Australians who are diagnosed – for a largely preventable reason.
 
‘Only 17% of people in Australia survive more than five years after a diagnosis of lung cancer, and that’s mainly due to late presentation,’ Professor Jon Emery, GP and Herman Professor of Primary Care Cancer Research at the University of Melbourne and Western Health, told newsGP.
 
‘Patients with lung cancer have often had symptoms for several months before they go and talk to a doctor about those symptoms. And the vast majority of people with lung cancer, when they first present, have late-stage disease that’s beyond the option of curative surgery.’
 
Research has uncovered a number of reasons patients with lung cancer tend to present to their GP at a later stage of their disease.
 
‘[Patients may have] limited awareness about symptoms that are important and they often normalise their symptoms, particularly if they are current smokers,’ Professor Emery explained.
 
‘Fear of cancer is another barrier to seeking help, and then there’s stigma: If you are smoker or ex-smoker, people often have chronic respiratory disease already, and they do experience a very negative stigma in relation to consulting about their symptoms.’
 

Professor Jon Emery hopes the CHEST Australia intervention will help GPs and patients identify the symptoms of lung cancer earlier.

Professor Emery was a lead researcher for the CHEST Australia trial, which aimed to reduce lung cancer death through increased early detection.
 
Adapted from an earlier, smaller trial in Scotland, CHEST Australia was designed to assess the effects of a behavioural approach towards reducing delay in lung cancer diagnosis, tailored to a specific population and implemented through general practice.
 
‘There have been two general approaches to symptom-awareness type interventions,’ Professor Emery said. ‘The more common are large mass-media campaigns that you see on TV and the backs of buses, and there’s limited evidence to their effectiveness.
 
‘This is a much more targeted approach of a symptom awareness-type intervention in people we know are at higher risk of developing lung cancer. So it allows us to target this intervention much more in the population at risk.’
 
The CHEST Australia trial, a joint project run by the University of Melbourne and the University of Western Australia, is also the largest of its type, involving 11 practices and 550 patients who were identified by age and recorded smoking history through their general practices’ electronic records.
 
‘[Once selected], patients were randomised to either receive the CHEST intervention or be part of the control group,’ Professor Emery said.
 
‘Both groups received spirometry, but the CHEST group also received a talk through a self-help manual that was aimed at increasing their salience of respiratory symptoms and knowledge about the symptoms that were important to monitor.
 
‘It was also aimed at raising awareness about the importance of early detection of chest disease, and trying to reduce the stigma of seeking help.’
 
The CHEST trial followed patients for a year, documenting positive results for the intervention.
 
‘We monitored the patients’ consulting patterns, and we showed a 40% relative increase in consulting specifically for respiratory symptoms in people who received the CHEST intervention,’ Professor Emery said.
 
‘This was the primary outcome of the trial and is based on the logic model that if you can get people to consult more often when they develop new or changed respiratory symptoms, then that is an important pathway to early detection of lung cancer.
 
‘It might also prompt GPs to consider patients’ symptoms more quickly, and investigate them sooner.’
 
Professor Emery is pleased with the results of the trial, and believes the CHEST intervention is something that could be quickly and realistically integrated into Australian general practice.
 
‘The self-help manual could potentially be used by practice nurses as part of a chronic disease check for somebody with known respiratory disease,’ he said. ‘It could also be part of consultations where you’re case-finding for both COPD [chronic obstructive pulmonary disease] and identifying people who are at higher risk of lung cancer.’

CHEST trial COPD Lung Cancer Medical research