Likely uptake of a future lung cancer screening programme in Hodgkin lymphoma survivors: a questionnaire study

Abstract

Background Many Hodgkin lymphoma (HL) survivors are at increased risk of subsequent malignant neoplasms (SMN), including lung cancer, due to previous treatment for HL. Lung cancer screening (LCS) detects early-stage lung cancers in ever smokers but HL survivors without a heavy smoking history are ineligible for screening. There is a rationale to develop a targeted LCS. The aim of this study was to investigate levels of willingness to undergo LCS in HL survivors, and to identify the psycho-social factors associated with screening hesitancy. Methods A postal questionnaire was sent to 281 HL survivors registered in a long-term follow-up database and at increased risk of SMNs. Demographic, lung cancer risk factors, psycho-social and LCS belief variables were measured. Multivariable logistic regression analysis was performed to determine the factors associated with lung cancer screening hesitancy, defined as those who would ‘probably’ or ‘probably not’ participate. Results The response rate to the questionnaire was 58% (n = 165). Participants were more likely to be female, older and living in a less deprived area than non-participants. Uptake (at any time) of breast and bowel cancer screening among those previously invited was 99% and 77% respectively. 159 participants were at excess risk of lung cancer. The following results refer to these 159. Around half perceived themselves to be at greater risk of lung cancer than their peers. Only 6% were eligible for lung cancer screening pilots aimed at ever smokers in the UK. 98% indicated they would probably or definitely participate in LCS were it available. Psycho-social variables associated with LCS hesitancy on multivariable analysis were male gender (OR 5.94 CI 1.64–21.44, p < 0.01), living in an area with a high index of multiple deprivation decile (deciles 6–10) (OR 8.22 CI 1.59–42.58, p < 0.05) and lower levels of self-efficacy (OR 1.64 CI 1.30–2.08 p < 0.01). Conclusion HL survivors responding to this survey were willing to participate in a future LCS programme but there was some hesitancy. A future LCS trial for HL survivors should consider the factors associated with screening hesitancy in order to minimise barriers to participation.

Pilot study of lung cancer screening for survivors of Hodgkin lymphoma

“…36,37 Some of those invited to this study had been invited to and/or participated in other late effects research studies, including studies exploring HL survivors' willingness to be screened for lung cancer which also recruited using the ADAPT database. 8,38 Those who had previously been contacted about these studies may have had increased awareness about lung cancer risk and screening, increasing their motivation to participate. Therefore, uptake of lung cancer screening by the cohort invited to our study may not be representative of the uptake by HL survivors who lack prior awareness of lung cancer risk and screening.…”

“…Since most HL survivors lack a significant smoking history, most at-risk survivors do not meet the lung cancer risk threshold for lung cancer screening. 7,8 A targeted lung cancer screening programme is therefore worthy of exploration in this under-represented risk group. Here, we report results of a lung cancer screening pilot in HL survivors using established protocols developed for the general population.…”