Lung screening in people cured of Hodgkin lymphoma
Research type
Research Study
Full title
Lung screening in people cured of Hodgkin lymphoma: a feasibility study
IRAS ID
294837
Contact name
Kim Linton
Contact email
Sponsor organisation
The Christie NHS Foundation Trust
Clinicaltrials.gov Identifier
Duration of Study in the UK
1 years, 8 months, 2 days
Research summary
"Research Summary"
People cured of Hodgkin lymphoma (HL) are at risk of developing lung cancer, which is the commonest cause of cancer related death in long-term survivors. The excess risk of lung cancer is due to their prior cancer treatment (radiation to the chest and alkylating agents) and is exacerbated by smoking. Lung cancer screening (LCS) using a low dose CT scan (LDCT) of the chest saves lives in people who have smoked by diagnosing lung cancer early. LCS pilots are underway in England for smokers but many HL survivors will not be eligible.
This is a feasibility study of LCS in HL survivors. HL survivors will be recruited to the study from the Christie Hospital's long-term follow-up database (ADAPT). Survivors will be eligible if they are aged 18-80, have not had a relapse of HL within the last 5 years, were treated with radiation to the chest and /or alkylating agent chemotherapy and live within approximately 40 miles of the Christie Hospital and have not previously been diagnosed with lung cancer.
Individuals interested in participating will be sent a decision aid to support informed decision making. Participants will undergo a baseline LDCT scan at the Christie. Participants will be offered a 3 month surveillance LDCT scan to monitor a lung nodules, if required. Participants will be referred to lung cancer / other specialties as required based on the scan findings and patient-reported outcomes are collected over 14 months following the scan. Selected individuals will be contacted for interview.
The main aim of the study is to report uptake rates of LCS in HL survivors. The study will also report on decision making, psychological impact, smoking cessation, acceptability, scan findings and the barriers and motivators to undergoing screening. An optional sub-study will explore genetic changes as risk factors for lung cancer."Summary of Results"
In some people lung cancer is caused by treatment of a previous cancer. For survivors of Hodgkin lymphoma (the most common cancer in children) ‘second’ breast and lung cancers are the leading cause of death. Second lung cancers are not captured by screening programmes being run across England and most survivors are not aware of their risk. This study developed a patient-centred approach to promote screening uptake and inform national study prevention and screening of lung cancer in high-risk cancer survivors.We know that most lung cancers in Hodgkin lymphoma survivors are diagnosed at an incurable, late stage, and that lung cancer screening saves lives in the general population by picking up cancers at an early stage when surgery is possible. Consequently, screening is being rolled out across England. Unfortunately, this effort doesn’t capture many high-risk Hodgkin survivors who don’t qualify for screening. Furthermore, most survivors are unaware of their risk of lung cancer. This study investigated optimal ways to inform survivors and to encourage them to take up screening and follow no smoking advice.
We established the feasibility of lung cancer screening for people diagnosed with Hodgkin Lymphoma which could lead to better outcomes for this group through early diagnosis. Participants are now better informed of their risks of developing lung cancer; of the symptoms to look out for and the importance of following no smoking advice. Education materials have been developed to communicate late effects and lung cancer risks to the wider Hodgkin Lymphoma survivor population.
Furthermore, In the pilot screening study, two asymptomatic patients were diagnosed with small cell lung cancer, one with early-stage disease who underwent potentially curative surgical resection and one with advanced stage disease treated with chemotherapy. The former patient directly benefitted from this study as their participation led to early diagnosis and a significantly improved prognosis. A third patient continued to have a lung nodule surveyed beyond the timelines of this study, and was diagnosed with non-small cell lung cancer which was successfully resected.
Following completion of the study a successful funding bid was submitted SBRI Healthcare with £1,294,330 awarded for SEARCH, a follow-on multicentre study (CI Linton) SBRI Healthcare – NHS Cancer Programme awards £14.4 million to accelerate new front-line innovations that detect and diagnose cancer earlier. SEARCH is a NIHR Manchester BRC implementation and evaluation study designed to generate evidence to support an application to the UK National Screening committee for routine adoption in the NHS.
Summary of Results
• 218 people who had been cured of Hodgkin lymphoma were invited, and 102 people took part
• 2 participants were diagnosed with lung cancer on the study lung screening CT scan
• Almost two thirds of the participants had an unexpected abnormality (which was not cancer) picked up on their scan, but the abnormality was only considered significant for three participants (in 3% of the participants overall)
• Around a third of participants had ‘coronary artery calcification’ detected on their scan. This is thickening of the arteries which supply the heart. The participants’ GP was informed if coronary artery calcification was found.
• The decision aid booklet was shown to help people weigh up the pros and cons of undergoing a lung screening scanREC name
Wales REC 7
REC reference
21/WA/0137
Date of REC Opinion
4 May 2021
REC opinion
Favourable Opinion