The effect of direct access to CT scan in early lung cancer detection: an unblinded, cluster-randomised trial.

Louise Mahncke Guldbrandt,Finn Rasmussen,Peter Meldgaard,Torben Riis Rasmussen,Peter Vedsted,Morten Fenger-Grøn

doi:10.1186/s12885-015-1941-2

Louise Mahncke Guldbrandt, Finn Rasmussen + Show 4 more

Open Access

https://doi.org/10.1186/s12885-015-1941-2

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Journal: BMC cancer	Publication Date: Nov 25, 2015
Citations: 18	License type: cc-by

Affiliation: Aarhus University Hospital, Aarhus University

Abstract

BackgroundLower lung cancer survival rates in Britain and Denmark compared with surrounding countries may, in part, be due to late diagnosis. The aim of this study was to evaluate the effect of direct access to low-dose computed tomography (LDCT) from general practice in early lung cancer detection on time to diagnosis and stage at diagnosis.MethodsWe conducted a cluster-randomised, controlled trial including all incident lung cancer patients (in 19-month period) listed with general practice in the municipality of Aarhus (300,000 citizens), Denmark. Randomisation and intervention were applied at general practice level. A total of 266 GPs from 119 general practices. In the study period, 331 lung cancer patients were included. The intervention included direct access to low-dose CT from primary care combined with a 1 h lung cancer update meeting. Indication for LDCT was symptoms or signs that raised the GP’s suspicion of lung cancer, but fell short of satisfying the fast-track referral criteria on red flag’ symptoms. ResultsThe intervention did not significantly influence stage at diagnosis and had limited impact on time to diagnosis. However, when correcting for non-compliance, we found that the patients were at higher risk of experiencing a long diagnostic interval if their GPs were in the control group.ConclusionDirect low-dose CT from primary care did not statistically significantly decrease time to diagnosis or change stage at diagnosis in lung cancer patients. Case finding with direct access to LDCT may be an alternative to lung cancer screening. Furthermore, a recommendation of low-dose CT screening should consider offering symptomatic, unscreened patients an access to CT directly from primary care.Trial registrationwww.clinicaltrials.gov, registration ID number NCT01527214.

Highlights

Lower lung cancer survival rates in Britain and Denmark compared with surrounding countries may, in part, be due to late diagnosis
Participants flow During the study period, 331 incident lung cancer patients were diagnosed; 171 were listed with intervention general practitioner (GP) and 160 with control GPs (Fig. 1)
Lung cancer patients from the intervention and the control GPs were similar with respect to age, education, marital status and comorbidity, while the control group had a higher proportion of women (Table 2)

Summary

Introduction

Lower lung cancer survival rates in Britain and Denmark compared with surrounding countries may, in part, be due to late diagnosis. Most lung cancer patients with symptomatic disease present to the general practitioner (GP) before diagnosis [7, 8]. Symptoms that may indicate lung cancer are common in primary care [9]. GPs must distinguish between those few patients whose symptoms are due to lung cancer and the large group of patients who have benign disease [10]. For many of these symptomatic patients, the ideal strategy might not be a full fast-track referral, but easy access to a relevant investigation in general practice

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