M14 Implementing a low dose CT screening programme for lung cancer into routine NHS practice – the south tyneside model

Abstract

Our local population has one of the highest incidences of lung cancer in the country with a high proportion of the most deprived socioeconomic quintile. This leads to around a third presenting as emergency admissions often at late stage and hence with poorer outcomes. We wished to improve earlier diagnosis by embedding a low dose CT (LDCT) screening programme for our high risk population into the routine NHS practice within the financial constraints of the current NHS. The NLST criteria are established but the UK hasn’t implemented these into routine NHS practice with concerns about sensitivity. In mainland Europe it has been shown in long running projects that using COPD and emphysema are independent significant risk factors for lung cancer. Hence we planned to use the established annual COPD review by practice nurses within the GP practice to offer eligible patients a LDCT. Smoking cessation already occurs as a brief intervention in these reviews but the importance was to be again emphasised. A CCG business case was successful with support from the Trust at a cost of £94 per LDCT to include reporting with a standardised report with advice to GPs for the next step. If the LDCT is suspicious of lung cancer the lung cancer physician is informed and patient sent an appointment in the one stop lung cancer clinic. 528 scans were estimated in the 1st year by the business case if uptake was 31%. Face to face training of practice nurses in 6 voluntary GP practices took place alongside production of guidelines and patient information leaflets for 4 month initial feasibility. The full pilot was then rolled out across all GP practices in the CCG area. Results To date 444 scans have been performed. 3 lung cancers have been diagnosed and 2 other cancers identified. 74 nodules have been picked up and all follow up scans have been requested. This pilot has demonstrated the feasibility of embedding LDCT screening for lung cancer in a high risk group into routine NHS service without additional funding. Ongoing evaluation is required to establish Health economics, cost effectiveness and patient experience.