A study to see if having a chest X-ray reduces the length of time it takes to diagnose lung cancer in people over 60 who are smokers (ELCID)

Cancer type:

Lung cancer

Status:

Results

Phase:

Pilot

This study looked at whether having an urgent chest x-ray affected the diagnosis of lung cancer in people over 60 who are at high risk due to smoking. 

Cancer Research UK supported this study as part of the National Awareness and Early Detection Initiative (NAEDI).

This study was open to people to join between 2011 and 2014. These results were published in 2017.

More about this trial

Your GP might arrange for you to have a chest x-ray if you have symptoms that could be caused by lung cancer. But symptoms could be caused by other less serious conditions and may go away by themselves. 

So the National Institute for Health and Care Excellence (NICE) has produced guidelines for GPs. The guidelines say that you should have an urgent chest x-ray if you’ve had certain symptoms for more than 3 weeks.

Researchers wanted to find out if people who were at higher risk of getting lung cancer should have an urgent chest x-ray. Even if they’ve had symptoms for less than 3 weeks.

This was a pilot study to see if it was possible to run a larger trial looking at this.

The aims of the pilot study were to:

  • see if people are willing to take part in a trial looking at this
  • find out how many people go to their GP with symptoms they have had for less than 3 weeks
  • see how many of those people were diagnosed with lung cancer
     

Summary of results

The study team found it was possible to do a larger randomised trial  Open a glossary itemcomparing urgent referral for chest x-ray with usual care for people at high risk of lung cancer. 

About this study
This was a pilot study. 255 people joined the study. 22 GP practices took part in the study. 

Heavy smokers or ex heavy smokers over the age of 60 who saw their GPs because of a new or changed cough, breathlessness or wheezing were invited to join the study. 

It was a randomised study. Neither the people nor their doctor chose which group they were in. 

128 people weren’t referred for an urgent chest x-ray. This was the usual care.

127 people were referred for an urgent chest x-ray.

They completed questionnaires just after they were put into their group and 2 months later. The questions asked were about:

  • anxiety and depression
  • quality of life Open a glossary item
  • their ability to ‘do’ and ‘be’ the things that are important in their life, for example doing things that make them feel valued and how independent they are

The team contacted GPs a year later to find out the results of the chest x-rays. 

Results
In the following year the team looked at how many people had x-rays and the total number of x-rays. During the year some people had more than 1 x-ray. 

Urgent chest x-ray group
113 of the 127 people (89%) who were referred for an urgent x-ray had a total of 148 x-rays. The team looked at when people had their first x-ray. They found that the average length of time they had to wait for their first x-ray appointment was 3 days. 

10 people (7.9%) had another x-ray within 3 months. 

Usual care group
Of the 128 people in this group, 43 (33.6%) had a total of 50 chest x-rays. The average length of time people in this group had to wait for their first x-ray appointment was 71 days. 

In this group 3 people (2.8%) had another chest x-ray within 3 months. 

Questionnaires
In both groups 89 out of every 100 people (89.4%) completed all the questionnaires just after they were put into their groups. 

At 2 months the number of people who completed the questionnaires was the same in both groups. Just under 66 out of every 100 people (66%) did so. 

Just after being put into their groups there was no difference in the anxiety or depression levels between the 2 groups. Overall this was also the case at 2 months. 

The team found that in the usual care group people who were 75 years and older reported higher anxiety and depression levels at 2 months. 

Chest x-ray results and cancer diagnosis
The number of normal x-rays in each group was:

  • 105 (70.9%) in the urgent x-ray group
  • 25 (50%) in the usual care group

But number of people in each group who had at least 1 problem with their lung was:

  • 31 people (25.8%) in the urgent x-ray group
  • 20 people (16.3%) in the usual care group

Overall the number of people who had a cancer diagnosed was 3 people (1.2%) of the 255 people who were in the study. This was 2 people in the urgent x-ray group and 1 person in the usual care group.

The 2 people in the urgent x-ray group had a CT scan Open a glossary item within 3 weeks of their x-ray which confirmed lung cancer. 

The person in the usual care group was diagnosed 34 days after being put into their group. They were diagnosed without having had a CT scan. 

Conclusion
The study team concluded that they have demonstrated the feasibility of doing a larger trial. 

They believe their findings can help other research teams who might use a very similar design. And the findings could also have consequences for studies of urgent investigation for serious conditions. 

The team were looking at doing a larger phase 3 trial. Unfortunately they haven’t able to do this. 

Where this information comes from    
We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item) and published in a medical journal. The figures we quote above were provided by the study team who did the research. We have not analysed the data ourselves.
 

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Professor Richard Neal

Supported by

Bangor University
National Awareness and Early Diagnosis Initiative (NAEDI)
National Institute for Health Research Cancer Research Network (NCRN)
Wales Clinical Trials Unit (WCTU)

Freephone 0808 800 4040

Last review date

CRUK internal database number:

Oracle 8996

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Charlie took part in a trial to try new treatments

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“I think it’s really important that people keep signing up to these type of trials to push research forward.”

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