The Chest Australia Trial: a randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer

Abstract

BackgroundInternational research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms.MethodsParallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and above. 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 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.ResultsWe 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 to 0.70), control 0.41 (0.32 to 0.52), relative rate 1.40 (1.08 to 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 $A1289 per additional respiratory consultation.ConclusionsA behavioural intervention can significantly increase consulting for respiratory symptoms in patients at increased risk of lung cancer. This intervention could have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk.Trial registration numberAustralian New Zealand Clinical Trial Registry (1261300039 3752). This was registered pre-results.

The role of chronic conditions in influencing symptom attribution and anticipated help-seeking for potential lung cancer symptoms: a vignette-based study

“…A few studies have evaluated interventions for increasing prompt help-seeking for possible lung cancer symptoms, showing some benefits for patients at increased cancer risk. 53 , 54 However, there are some concerns that mass-media campaigns are short-lived and may create an increased workload for primary care. 55 , 56 …”

Lung cancer

“…A behavioural intervention aimed at reducing barriers to help-seeking in current or former heavy smokers over 55 years old reported a significant positive impact on consultation rates in Scotland,13 and an increase in respiratory consultations in Australia 14…”

Evaluating the delay prior to primary care presentation in patients with lung cancer: a cohort study

“…Current /ever-smokers are identifiable through smoking registers available in primary care 51 . A network nurse could liaise, by phone, text or email, with these at-risk people, ensuring they receive proactive education, using self-help manuals 52,15 , checking for lung cancer symptoms and encouraging earlier referral for investigations or to secondary care. This is possible during the current Covid-19 crisis, and would require only modest funding.…”

“…Despite targets in secondary care 13 , results remain poor. Interventions which target high-risk groups can improve respiratory consultation rates 14,15 .…”