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Kate Brain

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    P3.11 - Screening and Early Detection (Not CME Accredited Session) (ID 977)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.11-15 - Lung Cancer Symptom Perception and Intervention Preferences in the UK’s Most Deprived Communities: A Qualitative Study (ID 13283)

      12:00 - 13:30  |  Presenting Author(s): Kate Brain

      • Abstract


      People at highest risk for lung cancer- current or former smokers, aged over 40 years, with serious lung comorbidity and living in areas of deprivation- are more likely to prolong presenting to a GP with symptoms, leading to advanced stage diagnosis. This qualitative study sought to understand the influences on early presentation with lung cancer symptoms and intervention preferences in a sample of high risk, highly deprived individuals.


      Semi-structured interviews were conducted with 37 high risk participants recruited purposively according to age, lung comorbidity and smoking status from primary care practices in deprived areas of England, Scotland and Wales. A lung symptom attribution task was used to explore symptom interpretations, symptom presentation and beliefs surrounding lung cancer, underpinned by Leventhal’s Common Sense model. Four focus groups with members of the public and local stakeholders (healthcare professionals and community partners) were conducted to explore intervention preferences. Data were analysed using Framework method.



      All participants resided in the most deprived quintile and most were unemployed or seeking benefits, and/or rented social housing. Key themes were: fixation on short term health (chest infections) leading to avoidance of longer term health (lung cancer), and the importance of the relationship with their healthcare professional to facilitate or deter help seeking. Focusing on detecting and managing ‘treatable’ chest infections led to denial of symptoms of ‘inevitable and incurable’ lung cancer. For example, participants normalised haemoptysis. Feeling judged by healthcare professionals and unworthy of medical help because of residence in a disadvantaged area or smoking habit deterred help seeking. Some participants, particularly those without caring responsibilities, anticipated refusal of treatment for lung cancer, with some contemplating suicide.

      Focus groups

      Suggestions for intervention content included information to raise awareness of lung cancer symptoms, modify negative lung cancer beliefs and highlight the importance of earlier diagnosis. Multi-faceted interventions were suggested including talks and stands in community venues, led by a trained, non-judgemental facilitator.


      In the context of difficult life circumstances and stigma, individuals who are high risk for lung cancer manage their lung health in the short term. Fixation on the treatment and detection of immediate health concerns may lead to avoidance and denial of important lung cancer symptoms. Community based multi-faceted interventions are required to empower highly deprived individuals to seek timely help, using a non-judgmental and welcoming approach.

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    S01 - IASLC CT Screening Symposium: Forefront Advances in Lung Cancer Screening (Ticketed Session) (ID 853)

    • Event: WCLC 2018
    • Type: Symposium
    • Track: Screening and Early Detection
    • Presentations: 1
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      S01.15 - Integration of Smoking Cessation into Lung Cancer Screening (ID 11896)

      10:05 - 10:20  |  Presenting Author(s): Kate Brain

      • Abstract
      • Slides


      Cigarette smoking is the largest preventable risk factor for lung cancer, disproportionately affecting people from socioeconomically disadvantaged communities. Low dose computed tomography (CT) screening for high risk smokers is now the standard of care in the United States, with implementation pending in Europe. The potential health gains from combined CT lung screening and smoking cessation are considerable. Recent evidence disputes the notion that CT screening offers a “license to smoke” and reveals that engaging with lung screening can give smokers an opportunity to access smoking cessation support at a time when they are likely to be receptive to offers of help. However, considerable challenges remain in identifying methods of engaging high risk smokers in lung screening, and little evidence exists on the optimal design and delivery of effective smoking cessation interventions in this setting. Findings from studies including the United Kingdom Lung Screening trial (UKLS1) will be presented to highlight patient barriers and facilitators to successful integration of smoking cessation within the lung screening pathway, including beliefs and attitudes towards lung screening among high risk smokers, and the impact of abnormal lung scan results. Using the UK-wide Lung Symptom Awareness and Health (LUSH) study example, reflections will also be made on contextual barriers to engaging smokers with comorbid lung conditions living in areas of socioeconomic deprivation. Emerging issues and trends will be presented in methods of recruiting high risk smokers using community-based strategies, and developing personalised materials to support smoking cessation. Novel methods of designing, delivering and testing smoking cessation interventions embedded in the lung screening context will be considered. This presentation will be relevant to clinicians and scientists who are interested in the contribution of behavioural science to optimising lung cancer screening protocols as a teachable moment for smoking cessation, designing evidence-based clinical services to deliver the maximum health benefits for current and future generations.

      1 Brain K, Carter B, Lifford KJ, Burkes O, Devaraj A, Baldwin D, Duffy S, Field JK. Impact of low-dose CT screening on smoking cessation among high-risk participants in the UK Lung Cancer Screening trial. Thorax 2017 72:912–918.

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