Lung cancer stage-shift following a symptom awareness campaign

Martyn P.T. Kennedy; Leanne Cheyne; Michael Darby; Paul Plant; Richard Milton; Jonathan M. Robson; Alison Gill; Puneet Malhotra; Victoria Ashford-Turner; Kirsty Rodger; Elankumaran Paramasivam; Annette Johnstone; Bobby Bhartia; Shishir Karthik; Catherine Foster; Veronica Lovatt; Francesca Hewitt; Louise Cresswell; Victoria Coupland; Margreet Luchtenborg; Ruth H. Jack; Henrik Moller; Matthew E.J. Callister

doi:10.1136/thoraxjnl-2018-211842

Lung cancer stage-shift following a symptom awareness campaign

Martyn P.T. Kennedy, Leanne Cheyne, Michael Darby, Paul Plant, Richard Milton, Jonathan M. Robson, Alison Gill, Puneet Malhotra, Victoria Ashford-Turner, Kirsty Rodger, Elankumaran Paramasivam, Annette Johnstone, Bobby Bhartia, Shishir Karthik, Catherine Foster, Veronica Lovatt, Francesca Hewitt, Louise Cresswell, Victoria Coupland, Margreet LuchtenborgRuth H. Jack, Henrik Moller, Matthew E.J. Callister^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

74 Citations (Scopus)

Abstract

Background Lung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes. Methods An early diagnosis campaign for lung cancer commenced in Leeds, UK in 2011 comprising public and primary-care facing components. Rates of community referral for chest X-ray and lung cancer stage (TNM seventh edition) at presentation were collected from 2008 to 2015. Linear trends were assessed by ² test for trend in proportions. Headline figures are presented for the 3 years pre-campaign (2008-2010) and the three most recent years for which data are available during the campaign (2013-2015). Findings Community-ordered chest X-ray rates per year increased from 18 909 in 2008-2010 to 34 194 in 2013-2015 (80.8% increase). A significant stage shift towards earlier stage lung cancer was seen ( ² (1)=32.2, p<0.0001). There was an 8.8 percentage point increase in the proportion of patients diagnosed with stage I/II lung cancer (26.5% pre-campaign vs 35.3% during campaign) and a 9.3% reduction in the absolute number of patients diagnosed with stage III/IV disease (1254 pre-campaign vs 1137 during campaign). Interpretation This is the largest described lung cancer stage-shift in association with a symptom awareness campaign. A causal link between the campaign and stage-shift cannot be proven but appears plausible. Limitations of the analysis include a lack of contemporary control population.

Original language	English
Pages (from-to)	1128-1136
Number of pages	9
Journal	Thorax
Volume	73
Issue number	12
DOIs	https://doi.org/10.1136/thoraxjnl-2018-211842
Publication status	Published - 1 Dec 2018

Bibliographical note

Funding Information:
Funding the campaign was funded by naeDi (UK Department of Health; cochaired by cancer research UK) 2011, nHS leeds Primary care trust (2011–2013), the three leeds clinical commissioning groups (2013–current) and leeds city council (2013–current).

Publisher Copyright:
© 2018 Article author(s) (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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Kennedy, M. P. T., Cheyne, L., Darby, M., Plant, P., Milton, R., Robson, J. M., Gill, A., Malhotra, P., Ashford-Turner, V., Rodger, K., Paramasivam, E., Johnstone, A., Bhartia, B., Karthik, S., Foster, C., Lovatt, V., Hewitt, F., Cresswell, L., Coupland, V., ... Callister, M. E. J. (2018). Lung cancer stage-shift following a symptom awareness campaign. Thorax, 73(12), 1128-1136. https://doi.org/10.1136/thoraxjnl-2018-211842

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abstract = " Background Lung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes. Methods An early diagnosis campaign for lung cancer commenced in Leeds, UK in 2011 comprising public and primary-care facing components. Rates of community referral for chest X-ray and lung cancer stage (TNM seventh edition) at presentation were collected from 2008 to 2015. Linear trends were assessed by 2 test for trend in proportions. Headline figures are presented for the 3 years pre-campaign (2008-2010) and the three most recent years for which data are available during the campaign (2013-2015). Findings Community-ordered chest X-ray rates per year increased from 18 909 in 2008-2010 to 34 194 in 2013-2015 (80.8% increase). A significant stage shift towards earlier stage lung cancer was seen ( 2 (1)=32.2, p<0.0001). There was an 8.8 percentage point increase in the proportion of patients diagnosed with stage I/II lung cancer (26.5% pre-campaign vs 35.3% during campaign) and a 9.3% reduction in the absolute number of patients diagnosed with stage III/IV disease (1254 pre-campaign vs 1137 during campaign). Interpretation This is the largest described lung cancer stage-shift in association with a symptom awareness campaign. A causal link between the campaign and stage-shift cannot be proven but appears plausible. Limitations of the analysis include a lack of contemporary control population.",

author = "Kennedy, {Martyn P.T.} and Leanne Cheyne and Michael Darby and Paul Plant and Richard Milton and Robson, {Jonathan M.} and Alison Gill and Puneet Malhotra and Victoria Ashford-Turner and Kirsty Rodger and Elankumaran Paramasivam and Annette Johnstone and Bobby Bhartia and Shishir Karthik and Catherine Foster and Veronica Lovatt and Francesca Hewitt and Louise Cresswell and Victoria Coupland and Margreet Luchtenborg and Jack, {Ruth H.} and Henrik Moller and Callister, {Matthew E.J.}",

note = "Funding Information: Funding the campaign was funded by naeDi (UK Department of Health; cochaired by cancer research UK) 2011, nHS leeds Primary care trust (2011–2013), the three leeds clinical commissioning groups (2013–current) and leeds city council (2013–current). Publisher Copyright: {\textcopyright} 2018 Article author(s) (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted.",

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month = dec,

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doi = "10.1136/thoraxjnl-2018-211842",

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Kennedy, MPT, Cheyne, L, Darby, M, Plant, P, Milton, R, Robson, JM, Gill, A, Malhotra, P, Ashford-Turner, V, Rodger, K, Paramasivam, E, Johnstone, A, Bhartia, B, Karthik, S, Foster, C, Lovatt, V, Hewitt, F, Cresswell, L, Coupland, V, Luchtenborg, M, Jack, RH, Moller, H & Callister, MEJ 2018, 'Lung cancer stage-shift following a symptom awareness campaign', Thorax, vol. 73, no. 12, pp. 1128-1136. https://doi.org/10.1136/thoraxjnl-2018-211842

TY - JOUR

T1 - Lung cancer stage-shift following a symptom awareness campaign

AU - Kennedy, Martyn P.T.

AU - Cheyne, Leanne

AU - Darby, Michael

AU - Plant, Paul

AU - Milton, Richard

AU - Robson, Jonathan M.

AU - Gill, Alison

AU - Malhotra, Puneet

AU - Ashford-Turner, Victoria

AU - Rodger, Kirsty

AU - Paramasivam, Elankumaran

AU - Johnstone, Annette

AU - Bhartia, Bobby

AU - Karthik, Shishir

AU - Foster, Catherine

AU - Lovatt, Veronica

AU - Hewitt, Francesca

AU - Cresswell, Louise

AU - Coupland, Victoria

AU - Luchtenborg, Margreet

AU - Jack, Ruth H.

AU - Moller, Henrik

AU - Callister, Matthew E.J.

N1 - Funding Information: Funding the campaign was funded by naeDi (UK Department of Health; cochaired by cancer research UK) 2011, nHS leeds Primary care trust (2011–2013), the three leeds clinical commissioning groups (2013–current) and leeds city council (2013–current). Publisher Copyright: © 2018 Article author(s) (or their employer(s) unless otherwise stated in the text of the article). All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background Lung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes. Methods An early diagnosis campaign for lung cancer commenced in Leeds, UK in 2011 comprising public and primary-care facing components. Rates of community referral for chest X-ray and lung cancer stage (TNM seventh edition) at presentation were collected from 2008 to 2015. Linear trends were assessed by 2 test for trend in proportions. Headline figures are presented for the 3 years pre-campaign (2008-2010) and the three most recent years for which data are available during the campaign (2013-2015). Findings Community-ordered chest X-ray rates per year increased from 18 909 in 2008-2010 to 34 194 in 2013-2015 (80.8% increase). A significant stage shift towards earlier stage lung cancer was seen ( 2 (1)=32.2, p<0.0001). There was an 8.8 percentage point increase in the proportion of patients diagnosed with stage I/II lung cancer (26.5% pre-campaign vs 35.3% during campaign) and a 9.3% reduction in the absolute number of patients diagnosed with stage III/IV disease (1254 pre-campaign vs 1137 during campaign). Interpretation This is the largest described lung cancer stage-shift in association with a symptom awareness campaign. A causal link between the campaign and stage-shift cannot be proven but appears plausible. Limitations of the analysis include a lack of contemporary control population.

AB - Background Lung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes. Methods An early diagnosis campaign for lung cancer commenced in Leeds, UK in 2011 comprising public and primary-care facing components. Rates of community referral for chest X-ray and lung cancer stage (TNM seventh edition) at presentation were collected from 2008 to 2015. Linear trends were assessed by 2 test for trend in proportions. Headline figures are presented for the 3 years pre-campaign (2008-2010) and the three most recent years for which data are available during the campaign (2013-2015). Findings Community-ordered chest X-ray rates per year increased from 18 909 in 2008-2010 to 34 194 in 2013-2015 (80.8% increase). A significant stage shift towards earlier stage lung cancer was seen ( 2 (1)=32.2, p<0.0001). There was an 8.8 percentage point increase in the proportion of patients diagnosed with stage I/II lung cancer (26.5% pre-campaign vs 35.3% during campaign) and a 9.3% reduction in the absolute number of patients diagnosed with stage III/IV disease (1254 pre-campaign vs 1137 during campaign). Interpretation This is the largest described lung cancer stage-shift in association with a symptom awareness campaign. A causal link between the campaign and stage-shift cannot be proven but appears plausible. Limitations of the analysis include a lack of contemporary control population.

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Lung cancer stage-shift following a symptom awareness campaign

Abstract

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