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Matthew Evison



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    MA03 - Lung Cancer Screening - Next Step (ID 896)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 10:30 - 12:00, Room 206 AC
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      MA03.01 - Manchester Lung Cancer Screening: Results of the First Incidence Screening Round (ID 12568)

      10:30 - 10:35  |  Author(s): Matthew Evison

      • Abstract
      • Presentation
      • Slides

      Background

      The European position on lung cancer (LC) screening has recommended planning for implementation to commence throughout Europe (1). The Manchester lung cancer screening pilot is one of the first real world implementation projects to take place in Europe and to publish baseline results (2). In this abstract we share, for the first time, the results from the first incidence screening round of the Manchester pilot.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The methodology and results of the baseline round of the Manchester screening pilot have been published previously (2). In brief, ever smokers, aged 55-74, from deprived areas of Manchester were invited to a free ‘Lung Health Check’ (LHC) in mobile units located at their local shopping centres. The PLCOm2012 LC risk stratification model was incorporated into the LHC and those at high risk of LC (PLCOm2012 ≥1.51%) were offered immediate LDCT in a co-located mobile scanner. At baseline, 75% of attendees were ranked in the lowest deprivation quintile; 56% were at high risk and 1384 screened with LDCT. 3% had LC diagnosed of which 80% were early stage (I+II) and 90% offered curative treatment.

      In this round of screening, all high risk individuals screened at baseline with no subsequent diagnosis of LC (screening or non-screening) were invited back for an annual LDCT scan at the same community locations. Exclusion criteria included death, other malignancies under follow-up and CT thorax within 3-months of due screening date. National and GP specific registries were checked for interval LC diagnosis.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 1,194 LDCT scans were performed as part of the first incidence round of screening. Overall 28 (2.3%) individuals received a positive scan result and were referred to the MDT. Of these, 18 (1.5%) individuals were diagnosed with LC of which 78% (n=14/18) were lower stage (I-II) and 89% (n=16/18) offered curative treatment. The false positive rate was 0.8% of the screened population as a whole and 36% of those with a positive scan result. There were no interval LCs diagnosed at one year.

      The cumulative LC detection rate over the first 12 months of the programme was 4.3% (n=60/1384) of which 80% (n=51/64) were stage I-II.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Annual LDCT screening of high risk individuals in this real world lung cancer screening implementation project continues to identify a significant number of early stage lung cancers amenable to curative treatment. No interval lung cancers were diagnosed at one year suggesting the baseline selection criteria for screening was appropriate.

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    P2.11 - Screening and Early Detection (Not CME Accredited Session) (ID 960)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.11-03 - Cardiovascular Risk Prediction in a Community-Based Lung Cancer Screening Programme (ID 12567)

      16:45 - 18:00  |  Author(s): Matthew Evison

      • Abstract
      • Slides

      Background

      Cardiovascular disease (CVD) is a major cause of morbidity and mortality in populations eligible for lung cancer screening. The aim of this study was to determine whether a brief CV risk assessment, delivered as part of a community-based lung cancer screening programme, was effective in identifying individuals at high risk who might benefit from primary prevention.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The Manchester Lung Screening Pilot consisted of annual low dose CT (LDCT) over 2 screening rounds, targeted at individuals in deprived areas at high risk of lung cancer (age 55-74 and 6-year risk ≥1.51%, using PLCOM2012 risk model). All participants of the second screening round were eligible to take part in the study. Ten-year CV risk was estimated using QRISK2 in participants without CVD and compared to age (±5 years) and sex matched Health Survey for England (HSE) controls; high risk was defined as QRISK2 score ≥10%. Coronary artery calcification (CAC) was assessed on LDCT scans and compared to QRISK2 score.

      4c3880bb027f159e801041b1021e88e8 Result

      Seventy-seven percent (n=920/1,194) of screening attendees were included in the analysis; mean age 65.6±5.4 and 50.4% female. QRISK2 and lung cancer risk (PLCOM2012) scores were correlated (r=0.26, p<0.001). Median QRISK2 score was 21.1% (IQR 14.9-29.6) in those without established CVD (77.6%, n=714/920), double that of HSE controls (10.3%, IQR 6.6-16.2; n=714) (p<0.001). QRISK2 score was significantly higher in those with CAC (p<0.001). Screening attendees were 10-fold more likely to be classified high risk (OR 10.2 [95% CI 7.3-14.0]). One third (33.7%, n=310/920) of all study participants were high risk but not receiving statin therapy for primary CVD prevention.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Opportunistic CVD risk assessment within a lung cancer screening programme is feasible and is likely to identify a very large number of individuals suitable for primary prevention.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.16-16 - SABRTOOTH: A Fasibility Study of SABR Versus Surgery in Patients with Peripheral Stage I NSCLC Considered to be at Higher Risk for Surgery. (ID 13679)

      16:45 - 18:00  |  Author(s): Matthew Evison

      • Abstract
      • Slides

      Background

      Stage I NSCLC is curable by surgery and Stereotactic Ablative Radiotherapy (SABR). Many patients have co-morbidities that place them at higher risk of surgical complications. For such patients it is unknown whether the potential benefits of surgery are outweighed by the risks since published randomised trials comparing surgery with SABR have been underpowered. The SABRTooth study was designed to determine the feasibility of randomising patients between the two treatments and thus performing a larger RCT.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Four thoracic oncology centres and a referral site participated. Patients with peripheral (>2cm from the main airways) stage T1-T2bN0M0 NSCLC were considered for study entry. Patients at higher risk were identified using several criteria including Thoracoscore and the Nottingham Risk Score and confirmed by multidisciplinary team consensus.

      Eligible patients were approached by a respiratory physician and research nurse, consented and randomised (1:1) before consulting a surgeon or oncologist. Surgery was preferably by lobectomy with lymph node sampling/resection although sub-lobar resection was permitted. SABR was delivered as per the UK SABR guidelines.

      An average recruitment rate of 3 patients/month from the 5 centres over a formal monitoring period was set to prove feasibility of a larger RCT. Meetings with the trial sites and patient representatives were held through-out to improve recruitment. Qualitative research was embedded into the study with interviews for patients who declined participation or randomised treatment.

      4c3880bb027f159e801041b1021e88e8 Result

      Between July 2015-January 2017 318 patients were assessed for eligibility of which 106 were initially considered eligible. 84 patients were approached for the study and 24 (29%) were randomised (10 surgery, 14 SABR); a mean recruitment rate of 1.7 per month. The median age was 75 (range 54-88). The main reason for declining the study was patient preference with 29% preferring surgery and 42% SABR. Overall 9/24 (38%) did not receive their randomised treatment. Of 7 patients randomised to surgery, 6 received SABR, 1 radical radiotherapy and of 2 patients randomised to SABR, 1 received radical radiotherapy, 1 was lost to follow-up.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Despite recruiting at higher rate/centre than previous SABR versus surgery trials, the SABRTooth study failed to meet its recruitment target and the majority of patients randomised to surgery subsequently underwent SABR. Therefore, conducting a large RCT in the UK was shown not to be feasible. However, establishing which patients should have surgery or SABR for early stage NSCLC remains a critical question and alternative study designs are being developed to provide an answer for patients and clinicians.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 981)

    • 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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      P3.15-14 - Using Creative Co-Production to Develop a Treatment Decision Support Tool for People with Malignant Pleural Effusion (ID 11337)

      12:00 - 13:30  |  Author(s): Matthew Evison

      • Abstract
      • Slides

      Background

      Malignant pleural effusion (MPE) is a common, serious problem predominantly seen in metastatic lung and breast cancer and malignant pleural mesothelioma (MPM). Recurrence of MPE is common, and symptoms significantly impact on people’s daily lives.

      No ideal treatment strategy for MPE currently exists. However, there are four main treatment options aimed at relieving symptoms and improving quality of life. These include aspiration, thoracoscopy with pleurodesis, bedside pleurodesis and indwelling pleural catheter Choosing which option is best depends on many factors and making decisions can be challenging in pressured clinical environments. This project aimed to develop a support tool to help this decision making process for people with MPE.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Pleural teams from three sites in the UK undertook a creative co-production (CC-P) approach led by the translating knowledge into action (TK2A) team of the NIHR Research Collaboration and Leadership in Applied Health Research and Care Yorkshire and Humber.

      The geographical distance between the three sites and the ill-health of service users meant a novel distributed model of CC-P was used. This comprised of three locally run workshops with clinicians, patients and carers that were designed and structured by the TK2A CC-P experts. This was followed by a joint national workshop with representatives from all stakeholder groups to consider findings and outputs from local meetings.

      The design team worked with participants to develop outputs including patient timelines and personas. These were used as the basis to develop and test visible and tangible prototype ideas.

      4c3880bb027f159e801041b1021e88e8 Result

      Some key messages emerged that informed prototype development. Understanding and managing their pleural effusion was the priority for patients, not their overall cancer journey. Preferred methods for receiving information were varied but visual and graphic approaches were favoured. The main influences on people’s decisions about their MPE treatment were personal aspects of their lives (e.g. how active they are, what support they have at home).

      The design team developed a first prototype (i.e. a video representing a web-based support tool) to help people identify personal priorities and guide shared treatment decisions. This requires further development before implementation into practice.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The creative design methods and distributed model of co-production used in this project overcame many of the barriers to traditional co-production methods such as power, language and time. They allowed specialist pleural teams and service users to work together to create a patient-facing decision support tool owned by those who will use it.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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