ELCID

ELCID is a pilot clinical trial looking at the effect on lung cancer diagnosis of giving a chest X-ray (CXR) to smokers aged over 60 with chest symptoms.

Background

In 2006 lung cancer killed over 34,000 people in the UK, accounting for 7% of all deaths and 22% of all deaths from cancer. Five-year survival in the UK is just over 5%, compared with 13% in the US and similar proportions for several other European Union countries. Compared with other countries, the UK has more advanced stage at presentation, a low rate of lung cancer resections and poorer survival.

Earlier diagnosis

In order to improve survival figures in the UK, a greater proportion of resectable cancers must be diagnosed. These can only be diagnosed if more cancers are diagnosed at an earlier stage, when they are smaller and amenable to surgery. Aside from screening, the only way of achieving this is to reduce the time to diagnosis in symptomatic cancers.

Proposing new guidelines

Currently, lung cancers are mainly diagnosed by general practitioners using the NICE guideline for urgent referral for chest X-ray. The NICE guideline recommends urgent referrals for patients who have one of a number of chest symptoms for more than 3 weeks. We are proposing to expand this recommendation to include one of a number of chest symptoms of any duration in patients who smoke and are over 60 years of age i.e. high risk patients. We are calling this expanded recommendation: extra-NICE.

Significance of pilot study

We would like to conduct a trial of extra-NICE and compare it with NICE guidelines. This trial would have to be very large (and consequently resource intensive) owing to the fact that many of these patients will not actually have lung cancer so it is important that it is designed carefully and in a well-informed fashion. There are certain critical pieces of information that we need in order to be able to do this and in the ELCID “pilot study” we are collecting them. The actual trial of the intervention will be submitted in a later proposal.

Results

We have demonstrated the feasibility of recruiting to an individually randomised controlled trial in primary care for earlier chest X-ray for patients at higher risk of lung cancer who present to primary care with new symptoms. We are now developing a Phase III trial with the intention of evaluating the effect of timelier symptomatic diagnosis on lung cancer outcomes.

Related publications

• Neal, R. D. et al., 2017. Immediate chest X-ray for patients at risk of lung cancer presenting in primary care: randomised controlled feasibility trial. British Journal of Cancer 116 (3), pp.293-302. (10.1038/bjc.2016.414)
• Hurt, C. N. et al. 2013. A feasibility study examining the effect on lung cancer diagnosis of offering a chest X-ray to higher-risk patients with chest symptoms: protocol for a randomized controlled trial. Trials 14 (1) 405. (10.1186/1745-6215-14-405)