APPENDIX A
Targeted Lung Health Checks Programme
Dr James Ramsay, Medical Director Luton & Dunstable Hospital Foundation Trust
www.england.nhs.uk Targeted Lung Health Checks Programme We are here tonight to share outline plans for introducing a lung health checks programme - following strong results from pilots sites across England - and start to co-design the service with you.
In summary, any patient assessed as being at high risk of developing lung cancer will have an immediate low-dose CT scan.
This will: identify a range of lung health conditions, including chronic obstructive pulmonary disease (COPD); diagnose more cancers quickly; and help reduce inequalities in lung health and cancer outcomes for Luton population.
www.england.nhs.uk England: Current Early Diagnosis of Cancer Rates
Early diagnosis: proportion cancers staged 1 or 2 out of all staged cancers (2016) 100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
PHOF cancers (2016) Other cancers (2016)
www.england.nhs.uk 4 This matters….
www.england.nhs.uk 5 Causes of death: Luton • Lung cancer is the 6th most common cause of death in Luton CCG, after ischaemic heart disease, Alzheimer’s disease, stroke, lower respiratory infections and COPD.
Source: Global Burden of Disease, 2017 data Main causes of lung cancer
Smoking tobacco is the biggest cause of lung cancer in the UK Around 70% of lung cancers are caused by smoking
Including asbestos, silica and diesel engine exhaust fume exposure
Exposure to outdoor air pollution causes around 10% of lung cancer cases in the UK
Previous lung diseases can increase risk particularly for smokers, e.g. tuberculosis and chronic obstructive pulmonary disease (COPD)
Exposure to radon causes a small number of lung cancers in the UK. The risk increases if you smoke
Your risk of lung cancer is higher if you have a close relative (such as a parent or sibling) who has had lung cancer
Radiotherapy for some types of cancer can slightly increase your risk of lung cancer including Hodgkin lymphoma, non-Hodgkin lymphoma, testicular cancer and womb cancer
Source: Cancer Research UK Luton: Smoking & COPD Prevalence
www.england.nhs.uk 8 Smoking prevalence: Luton
• Smoking prevalence is significantly higher in Luton CCG when compared to England and the East of England Cancer Alliance • 10% of the Luton population are estimated to be smokers
Source: CADEAS on CancerStats 2, 2017/18 Targeted Lung Health Checks Programme
Outline of the national programme and evidence & learning from Lung Health Check Pilot Projects across England
www.england.nhs.uk How were we selected for the programme? Three primary criteria
1. CCGs with the highest lung cancer mortality rates
2. In the event of a tie, the CCG with the highest incidence
3. Size of the target population (<50,000*)
*Luton has estimated target population of approx. 33,000 – and therefore has been paired with Thurrock CCG to meet the minimum target population of 50,000
www.england.nhs.uk We can save lives……
• Reduce variation in lung cancer outcomes • The NELSON study is providing evidence on mortality
Cumulative Numbers of Lung Cancers
Harry J. de Koning, Erasmus MC, Public Health Rotterdam www.england.nhs.uk 12 The Standard Protocol
CT Screening Advisory Sub-Group of the Lung Cancer Clinical Expert Group (CEG) have written a new Standard Protocol for the Targeted Lung Health Checks Programme to provide a blueprint for delivery.
Objectives
• Sets minimum standards for targeted lung health checks in England. • Ensures the identification, testing and surveillance of participants at high risk of lung cancer is consistent. • The protocol has been developed specifically for a targeted programme but can be adapted for a systematic population screening programme.
www.england.nhs.uk 13 The Standard Protocol
Aim: to improve mortality from lung cancer and other lung diseases • Describes how to set up a targeted lung health check programme; • Defines who should be invited; • Describes how to ensure participants take up the offer; • Describes the tests to be carried out; • Describes how to assess who should be offered a low dose CT and which risk assessment tools to use; • Describes the pathway for those who are offered a low dose CT; and • Describes the level of training of staff who run the targeted lung health checks.
www.england.nhs.uk 14 The Participant Journey Invitation to a lung health check sent to all aged 55 to 74 years and 364 days who have ever smoked The lung health check should identify the personal risk of developing lung cancer Those at high risk of lung cancer are offered low radiation dose CT scan
www.england.nhs.uk An example from Leeds……..
www.england.nhs.uk 1. Extraction from GP database 2. Invitation process 1. Extraction from GP database 2. Invitation process
3. Telephone triage
4. Community- based Lung Health Check 1. Extraction from GP database
2. Invitation process
3. Telephone triage
4. Community- based Lung Health Check 5. Smoking cessation 1. Extraction from GP database 2. Invitation process
3. Telep hone tria ge
4. Community- 6. Radiology based Lung reporting Health Check
5. Smoking cessation 1. Extraction from GP database 8. Actioning 2. Invitation results process
7. Review of Patient Management 3. Telephone results System triage
4. Community- 6. Radiology based Lung reporting Health Check
5. Smoking cessation Targeted Lung Health Checks Programme
Summary of local population need and current outcomes for people with lung diseases
www.england.nhs.uk Smoking prevalence: Luton
• Smoking prevalence is significantly higher in Luton CCG when compared to England and the East of England Cancer Alliance • 10% of the Luton population are estimated to be smokers
Source: CADEAS on CancerStats 2, 2017/18 www.england.nhs.uk 24 Lung cancer incidence: Luton • Around 110 new lung cancer cases are diagnosed each year in Luton CCG. • In 2015 there was a spike in lung cancer diagnoses, with the age-standardised rate statistically significantly higher than both England and the East of England.
Source: CancerStats Lung cancer under-75 mortality: Luton
• Luton CCG’s age- standardised rate of premature mortality due to lung cancer is the second highest in the East of England Cancer Alliance, after Thurrock CCG.
Source: CADEAS on CancerStats 2, 2016 data Early stage diagnosis for all cancers: Luton
• Luton CCG has a lower proportion of early stage diagnoses for 10 stageable cancers (including lung cancer) than the East of England Cancer Alliance and England overall.
Source: CADEAS on CancerStats 2, Oct-Dec 2017 data Emergency presentations for all cancers: Luton
• More than 22% of patients diagnosed with cancer present through an emergency route in Luton CCG • Luton CCG has the highest proportion of emergency presentations in BLMK STP • The proportion of emergency presentations in Luton CCG are higher than in the East of England Cancer Alliance and in England overall Source: CADEAS on CancerStats 2, Apr-Jun 2018 Stage at diagnosis for lung cancer: Luton • Patients living in Luton CCG who have been diagnosed with lung cancer are most likely to be diagnosed at stage 4 than any other stage. Out of all the CCGs in BLMK STP, patients in Luton are the least likely to be diagnosed at an early stage.
Source: CADEAS on CancerStats 2, 2016 data Trachea, Bronchus and Lung Cancer incidence and stage at diagnosis Luton - 2016 Area Stage at diagnosis % Area Stage at diagnosis %
25.71 3.80% 6.63% % NHS Luton 22.86 England CCG % (38,363 (105 tumours) tumours)
67.65 % 73.33 %
Stage 1 & 2 Stage 3 & 4 Unknown http://www.ncin.org.uk/pu blications Lung cancer survival: Luton • Luton CCG one-year lung cancer survival has been increasing consistently since the year 2000, mirroring the increase in England overall. Current one-year survival for lung cancer in Luton is 39%.
Source: ONS and NCRAS CANCER SCREENING IN LUTON
Bowel screening coverage (%) Cervical screening coverage (%) Breast screening coverage (%)