The Chest Australia Trial: A Randomised Controlled Trial of an Intervention to Reduce Time to Consult with Symptoms of Lung Cancer

Abstract

Background: Lung cancer has one of the lowest survival rates of any cancer because most patients are diagnosed when curative surgical treatment is not possible. International research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial aimed to test the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms. Methods: Parallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and over, including ex-smokers if their cessation date was less than 15 years ago, identified through electronic searches of general practice records. The CHEST intervention entailed a consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to encourage help-seeking for respiratory symptoms. The control group received a brief discussion about lung health. Both groups had baseline spirometry. Telephone randomisation was conducted, 1:1, stratified by Medical Research Council (MRC) dyspnoea score and general practice. Participants could not be blinded; data extraction and statistical analyses were performed blinded to group assignment. The primary outcome was respiratory consultation rates. Results: We randomised 551 participants (274 intervention; 277 control) from whom the primary outcome was determined for 542 (269 intervention, 273 control). There was a 40% relative increase in respiratory consultations in the intervention group: (adjusted rates (95% CI) intervention 0.57 (0.47 - 0.70), control 0.41 (0.32 - 0.52), relative rate 1.40 (1.08 - 1.82, p=0.0123). There were no significant differences in time to first respiratory consultation, total consultation rates or measures of psychological harm. The incremental cost-effectiveness ratio was $1,289 per additional respiratory consultation. Conclusions: A behavioural intervention can significantly increase the likelihood of consulting for respiratory symptoms in patients at increased risk of lung cancer. Further efforts may be required to promote earlier presentation. The CHEST intervention could potentially have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk. Clinical Trial Number: Trial registration Australian New Zealand Clinical Trial Registry 1261300039 3752. Funding Statement: This trial was funded by the National Health and Medical Research Council (NHMRC grant ID 1064121). It was supported by the Cancer Australia Primary Care Collaborative Cancer Clinical Trials Group (PC4). JDE is supported by an NHMRC Practitioner Fellowship. FMW was supported by a Clinician Scientist award (RG 68235) from the National Institute for Health Research (NIHR). Declaration of Interests: No conflicts of interest declared. Ethics Approval Statement: : Ethical approval has been obtained from The University of Western Australia’s Human Research Ethics Committee (RA/4/1/ 6018) and The University of Melbourne Human Research Committee (1 441 433)