The Chest Australia Trial: a randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer

Jon D Emery; Sonya R Murray; Fiona M Walter; Andrew Martin; Stephen Goodall; Danielle Mazza; Emily Habgood; Yvonne Kutzer; David John Barnes; Peter Murchie

doi:10.1136/thoraxjnl-2018-212506

The Chest Australia Trial: a randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer

Thorax. 2019 Apr;74(4):362-370. doi: 10.1136/thoraxjnl-2018-212506. Epub 2019 Jan 10.

Authors

Jon D Emery^{1

2

3}, Sonya R Murray², Fiona M Walter^{1

2

3}, Andrew Martin⁴, Stephen Goodall⁵, Danielle Mazza⁶, Emily Habgood¹, Yvonne Kutzer^{2

7}, David John Barnes^{8

9}, Peter Murchie¹⁰

Affiliations

¹ Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia.
² Department of General Practice, The Medical School, University of Western Australia, Perth, Australia.
³ The Primary Care Unit, Public Health and Primary Care, University of Cambridge, Cambridge, UK.
⁴ NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
⁵ Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia.
⁶ Department of General Practice, Monash University, Melbourne, Victoria, Australia.
⁷ School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia.
⁸ Royal Prince Alfred Hospital, Newtown, New South Wales, Australia.
⁹ Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.
¹⁰ The Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK.

Abstract

Background: International research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested 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 above. 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 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 to 0.70), control 0.41 (0.32 to 0.52), relative rate 1.40 (1.08 to 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 $A1289 per additional respiratory consultation.

Conclusions: A behavioural intervention can significantly increase consulting for respiratory symptoms in patients at increased risk of lung cancer. This intervention could have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk.

Trial registration number: Australian New Zealand Clinical Trial Registry (1261300039 3752). This was registered pre-results.

Keywords: lung cancer.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Australia
Diagnostic Self Evaluation
Early Detection of Cancer / methods
Female
Health Behavior
Humans
Lung Neoplasms / diagnosis*
Lung Neoplasms / etiology
Male
Middle Aged
Patient Acceptance of Health Care / statistics & numerical data*
Primary Health Care
Respiration Disorders / etiology
Self Care
Smokers / psychology*
Smoking / adverse effects