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The Chest Australia Trial: A Randomised Controlled Trial of an Intervention to Reduce Time to Consult with Symptoms of Lung Cancer

30 Pages Posted: 20 Sep 2018

See all articles by Jon Emery

Jon Emery

University of Melbourne - Centre for Cancer Research; University of Melbourne - Department of General Practice; The University of Western Australia - Department of General Practice; University of Cambridge - The Primary Care Unit

Sonya R Murray

The University of Western Australia

Fiona M Walter

University of Melbourne; The University of Western Australia; University of Cambridge

Andrew Martin

The University of Sydney

Stephen Goodall

University of Technology Sydney (UTS)

Danielle Mazza

Monash University

Emily Habgood

University of Melbourne

Yvonne Kutzer

The University of Western Australia; Edith Cowan University

David Barnes

The University of Sydney - Royal Prince Alfred Hospital; The University of Sydney

Peter Murchie

University of Aberdeen

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Abstract

Background: Lung cancer has one of the lowest survival rates of any cancer because most patients are diagnosed when curative surgical treatment is not possible. International research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial aimed to test the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms.

Methods: Parallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and over, including ex-smokers if their cessation date was less than 15 years ago, identified through electronic searches of general practice records. 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 by 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.

Results: We 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 - 0.70), control 0.41 (0.32 - 0.52), relative rate 1.40 (1.08 - 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 $1,289 per additional respiratory consultation.

Conclusions: A behavioural intervention can significantly increase the likelihood of consulting for respiratory symptoms in patients at increased risk of lung cancer. Further efforts may be required to promote earlier presentation. The CHEST intervention could potentially have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk.

Clinical Trial Number: Trial registration Australian New Zealand Clinical Trial Registry 1261300039 3752.

Funding Statement: This trial was funded by the National Health and Medical Research Council (NHMRC grant ID 1064121). It was supported by the Cancer Australia Primary Care Collaborative Cancer Clinical Trials Group (PC4). JDE is supported by an NHMRC Practitioner Fellowship. FMW was supported by a Clinician Scientist award (RG 68235) from the National Institute for Health Research (NIHR).

Declaration of Interests: No conflicts of interest declared.

Ethics Approval Statement: : Ethical approval has been obtained from The University of Western Australia’s Human Research Ethics Committee (RA/4/1/ 6018) and The University of Melbourne Human Research Committee (1 441 433)

Keywords: Lung Cancer, Primary Care, Symptom Appraisal, Diagnostic Delay, RCT, Behavioural Intervention

Suggested Citation

Emery, Jon and Murray, Sonya R and Walter, Fiona M and Martin, Andrew and Goodall, Stephen and Mazza, Danielle and Habgood, Emily and Kutzer, Yvonne and Barnes, David and Murchie, Peter, The Chest Australia Trial: A Randomised Controlled Trial of an Intervention to Reduce Time to Consult with Symptoms of Lung Cancer (February 8, 2018). Available at SSRN: https://ssrn.com/abstract=3225497

Jon Emery (Contact Author)

University of Melbourne - Centre for Cancer Research ( email )

Victoria, 3010
Australia

University of Melbourne - Department of General Practice ( email )

200 Berkeley Street
Carlton, Victoria 3053
Australia

The University of Western Australia - Department of General Practice ( email )

35 Stirling Hwy
Crawley, WA 6009
Australia

University of Cambridge - The Primary Care Unit ( email )

Cambridge
United Kingdom

Sonya R Murray

The University of Western Australia

35 Stirling Highway
Crawley, Western Australia 6009
Australia

Fiona M Walter

University of Melbourne

185 Pelham Street
Carlton, Victoria 3053
Australia

The University of Western Australia

35 Stirling Highway
Crawley, Western Australia 6009
Australia

University of Cambridge

Trinity Ln
Cambridge, CB2 1TN
United Kingdom

Andrew Martin

The University of Sydney

University of Sydney
Sydney, NC NSW 2006
Australia

Stephen Goodall

University of Technology Sydney (UTS)

15 Broadway, Ultimo
PO Box 123
Sydney, NSW 2007
Australia

Danielle Mazza

Monash University

23 Innovation Walk
Wellington Road
Clayton, Victoria 3800
Australia

Emily Habgood

University of Melbourne

185 Pelham Street
Carlton, Victoria 3053
Australia

Yvonne Kutzer

The University of Western Australia

35 Stirling Highway
Crawley, Western Australia 6009
Australia

Edith Cowan University

Mount Lawley Campus
Perth
Churchlands 6018 WA, Victoria
Australia

David Barnes

The University of Sydney - Royal Prince Alfred Hospital

Missenden Road
Level 11, KGV Building
Camperdown, New South Wales 2050
Australia

The University of Sydney

University of Sydney
Sydney, NC NSW 2006
Australia

Peter Murchie

University of Aberdeen

Dunbar Street
Aberdeen, Scotland AB24 3QY
United Kingdom

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