From ordeal to opportunity through innovation and cooperation

Background: Chest x-ray (CXR) is the first line investigation for lung cancer in many healthcare systems. Understanding of the consequences of false negative CXRs on time to diagnosis, stage and survival is limited. Aims: To determine the sensitivity of CXR for lung cancer and to compare stage at diagnosis, time to diagnosis and survival between those with CXR which detected, or did not detect, lung cancer. Design & Setting: Retrospective observational study using routinely collected healthcare data. Methods: All patients diagnosed with lung cancer in a teaching hospital trust during 2008 – 2015 who had a GP requested CXR in the year before diagnosis were categorised based on the result of the earliest CXR performed in that period. We calculated sensitivity of CXR and performed analyses with respect to time to diagnosis, survival and stage at diagnosis. Results: CXR was negative for 18% of patients (n=376/2129). Median time from initial CXR to diagnosis was 43 days (IQR: 27-78) for those with positive CXR and 204 days (105-287) for those with negative CXR. Of those with positive CXR, 29% (95% CIs 27-31%) were diagnosed at either stage I/II, compared to 34% (95% CIs 29-39%) of those with a negative CXR. Conclusion: GPs should consider lung cancer in patients with persistent symptoms even when CXR is negative. Despite longer duration to diagnosis for those with ‘false negative’ CXRs, there was no evidence of adverse impact on stage at diagnosis or survival; however this comparison is likely to be affected by confounding variables.

ObjectivesThe SafeSpace study codesigned and tested a virtual reality (VR) intervention, incorporating relaxation and compassionate mind training to determine acceptability/feasibility in an oncology setting and evaluate impact on physical/psychological well-being and quality of life.DesignA two-phase study. Phase I determined key characteristics using an experienced-based codesign approach. Phase II evaluated the intervention using various measures and qualitative interviews in a mixed methods approach. Descriptive statistics were used to analyse measures data and framework analysis to analyse interviews.SettingA specialist cancer centre, UK.Participants11 in phase I and 21 in phase II. Participants were in cancer treatment, recovery or palliative care.Primary and secondary outcomePrimary outcome: acceptability of the intervention, assessed by >60% uptake of three sessions. Secondary outcomes: impact on psychological well-being using EQ-5D/QLQ-C30, Profile of Mood Scale, Warwick and Edinburgh Mental Well-being Scale, Depression and Anxiety Severity Scale 21, Self-Compassion Scale, Acceptance and Action Questionnaire and a locally developed questionnaire to capture self-compassion post use. Physiological impact was assessed by change in heart rate (HR)/HR variability and electrodermal activity (EDA).ResultsTwenty participants (mean age=48.7 years; SD=16.87); 65% (n=13) completed three sessions. Mental well-being improved following each use and from baseline to after session 3 (VR 1—z=2.846, p≤0.01; VR 2—z=2.501, p≤0.01; VR 3—z=2.492, p≤0.01). There was statistically significant difference in mean scores for EDA at mid-session and post session compared with pre session (F (1.658, 4.973)=13.364, p<0.05). There was statistically significant reduction in stress levels from baseline to post session 3. Participants found the intervention acceptable and highlighted areas for development.ConclusionThe intervention is acceptable and feasible and has shown positive effects on mental well-being/stress in the oncology setting. Larger studies are needed to confirm findings.

No abstract

No abstract