The COVID-19 pandemic has caused significant disruption to healthcare services. Participants in lung cancer screening programmes are at elevated risk of lung cancer, have high rates of comorbidities, and therefore may be adversely affected by delayed or cancelled appointments. Analysis of lung health check data collected within the SUMMIT study allow us to quantify the impact on this population.
Methods
The SUMMIT study aims to assess the implementation of low-dose CT (LDCT) for lung cancer screening in a high-risk population and to validate a multi-cancer early detection blood test (NCT03934866). Enrolled participants attend three annual lung health checks. Participants attending their second (Year 1) lung health check were asked about the impact COVID-19 had on their health service utilisation the preceding year.
Results
8,304 participants completed a Year 1 lung health check between June 2020 and May 2021 (mean age 66.3, IQR 61–71, 4855 (58.5%) male). 3333 (40%) reported reduced health service utilisation due to the COVID-19 pandemic. Of those, 3062 (91.9%) stated this was due to the NHS cancelling or delaying appointments, whilst in 204 (6.1%) appointments were cancelled by the participant. Reasons given by participants included not wanting to burden the NHS, difficulty with telephone consultations, and concern from media reports of hospital overcrowding. Participants with a respiratory comorbidity (COPD, bronchiectasis, asthma, fibrosis, or sarcoidosis, as self-reported at initial study visit) (RR 1.29, p=<0.001) and female participants (RR 1.16, p = <0.001) were more likely to report impacted healthcare utilisation (table 1). Reported impact on healthcare use was not significantly affected by age or socioeconomic quintile.
Conclusions
40% of individuals in a cohort at high risk of lung cancer and respiratory comorbidities reported reduced utilisation of health care services due to the COVID-19 pandemic. Limitations to our data include the lung health check questions not distinguishing between primary and secondary care or routine and urgent visits, and self-reported co-morbidity data limited to selected respiratory conditions. Nevertheless, we provide evidence for the scale of the problem and highlight that individuals with chronic respiratory conditions are particularly likely to be impacted. Please refer to page A193 for declarations of interest related to this abstract.
Pulmonary nodules are commonly found in Lung Cancer Screening (LCS), with results typically communicated by face-to-face or telephone consultation. Providing LCS on a population basis requires resource efficient and scalabe communication methods. Written communication provides one such method. Here, we assess participant satisfaction with this approach in a LCS setting and investigate characteristics associated with dissatisfaction.
We report a retrospective analysis of 447 patients with IPF treated from 2013 to 2019 at the Royal Papworth Hospital UK. In terms of single centre data, we believe this is the largest collection reported to date. All patients started on medication are recorded on a database; this was accessed on 25/06/19. Statistical analysis was performed with Graphpad Prism. Mean age was 71 years with male predominance (87%). Over the 6 year period, more patients were started on pirfenidone (58%) vs. nintedanib (42%). However when analysed from late 2015 onwards (when both drugs were fully available) we found an increase in nintedanib (59%) vs. pirfenidone (41%). Time from diagnosis at MDT to initiation of medication steadily dropped from a mean of 196 days in 2016, 112 in 2017, 56 in 2018 and 28 in the first 6 months of 2019 (figure 1a, p<0.01). Drug persistence is improving; 56 patients persisted >6 weeks in 2015 (85% of patients started that year), 75 (95%) in 2016, 79 (96%) in 2017 and 111 (97%) in 2018. These findings mirrored persistence >6/12 months. Nurse led telephone clinics began in 2017 to review medications at 6 weeks post drug initiation. These may have increased persistence; 46 of 78 patients (59%) persisted >6 months in the 12 months prior to starting clinics vs. 72 of 91 (79%) in the following 12 months. 113 (25%) of all patients switched between antifibrotics and this is becoming more common over time. Reviewing all new patients prescribed medication from 01/01/16–01/01/19, 73 out of 176 (41%) patients stopped nintedanib and 83 of 148 patients (56%) stopped pirfenidone. Fewer patients experienced a dose reduction on nintedanib (42%, predominantly due to lower GI side-effects) compared to pirfenidone (63%, predominantly nausea and fatigue). Median duration on nintedanib was significantly greater (304 days) vs. pirfenidone (214 days) figure1b, p=0.002. Accepting inherent limitations of retrospective data, we show differences in drug prescribing, decrease in time to initiating treatment and increase in persistence over time. This may reflect an increased learning curve for managing side-effects as well as novel management strategies e.g. virtual MDT, shared care and nurse led clinics.
The SUMMIT Study aims to assess the implementation of Low-Dose Computed Tomography (LDCT) for lung cancer screening in a high-risk population and to validate a multi-cancer early detection blood test. LDCT results are communicated to participants and their GPs by standardised letter. We aim to evaluate the turnaround time from the scan report to the subsequent management and communication of results via letter.
Methods
Results are automatically sent to participants and GPs according to pre-defined management plans based on findings collected via proformatised radiology report. Possible outcomes from these reports are: urgent referrals for suspicious findings, nodule surveillance LDCT at 3 months, 12 month surveillance LDCT, or suitable for randomisation at Year 1 to annual or biennial LDCT (see figure 1). Participants with suspicious findings are reviewed by the study clinicians. Where appropriate an urgent referral to the participant's local hospital is completed manually after discussion with the participant; the automated letters in these cases are delayed until contact is made with the participant and a clinical plan confirmed.
Results
We report outcomes from the first 11,551 SUMMIT Study participants with completed baseline LDCT reports. We aim to action results within 5 days: 11,319 (98.0%) of all results letters were mailed to participants and 11,423 (98.9%) to their GPs within 5 days. 645 (5.6%) participants required further review and consideration of an urgent referral. For these, 84.6% of results letters were mailed within 5 days, and 95.5% within 12 days. As expected, increased mailing times were observed in cases that were more complex, requiring liaison with an external clinical team or review of imaging at our internal weekly radiology meeting.
Discussion
Timely reporting of results is crucial in establishing wider roll-out of lung cancer screening in the UK. The vast majority of results are automated and are reliably sent as programmed. A minority require further clinical input and image review, prior to completion of an onwards referral. We demonstrate a scalable and feasible approach to feeding back results following LDCT.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)