A nurse-led screening programme in Liverpool has boosted early detection of lung cancer and chronic obstructive pulmonary disease, an evaluation has found.
The city’s Healthy Lung Programme involves specialist nurses assessing potentially at risk patients and has almost certainly saved lives as well as proving cost effective, according to analysis by Queen Mary University of London and University of Liverpool.
“From a nursing perspective, the role is a really interesting one”
Liverpool currently has one of the highest mortality rates for lung cancer in England and there are an estimated 6,000 people in the city with undiagnosed COPD.
The Healthy Lung Programme was launched in April 2016 as part of the national ACE (Accelerate, Co-ordinate, Evaluate) Programme, which was aimed at improving early cancer diagnosis. It is a collaboration between Liverpool Clinical Commissioning Group, local hospital trusts, NHS England and the charities Cancer Research UK and Macmillan Cancer Support.
As part of the scheme, people aged 58 to 70 who report having smoked at any point in their life are invited to attend an appointment with a nurse at a clinic held at their local GP surgery.
Nurses carry out a short assessment, which involves calculating the patient’s risk of developing lung cancer in the next five years. Those given a risk factor of 5% or more are then invited to have a chest CT scan at a local hospital to look at their lungs more closely.
“If required, we will also take a non-diagnostic spirometry breathing test during the clinic,” said Paula McCann-Finney, a specialist lung nurse from Liverpool Heart and Chest Hospital NHS Trust, who has been involved with the programme since it started.
“Depending on the results, we may refer a patient on to their GP for further support to monitor and manage their condition, or refer patients for a full diagnostic spirometry test,” she said. “In addition, we also provide lifestyle advice and offer referrals to other support services as relevant, such as stop smoking services.”
“We have been sharing lots of survivor stories and working to educate more people about the benefits of early detection”
In its first year, the programme, which is targeted at areas of the city where lung cancer and mortality rates are highest, invited 7,150 people from four neighbourhoods to attend a Healthy Lung Clinic.
Of those, 45% – or 3,207 people – have already attended a clinic or booked an appointment to go soon, according to a preliminary report published on the evaluation (see attached PDF below).
The review found three quarters of those diagnosed with lung cancer through the scheme got an early stage diagnosis. Typically, in Liverpool 70% of lung cancer cases are not diagnosed until a late stage.
To date, a total of 19 cases of lung cancer have been found at an early, pre-symptomatic stage and treated – this equates to one or two cancers being prevented each month, according to Liverpool CCG.
The evaluation also found high levels of patient satisfaction, with 96% of participants saying they would strongly advise a friend to attend.
Ms McCann-Finney said strong communication skills were essential for nurses involved in the programme to ensure people were prepared for the outcome of assessments and potential need for further tests.
“From a nursing perspective, the role is a really interesting one, because it bridges primary and secondary care,” she said. “We are working in a practice setting, offering lung function tests and risk stratifying patients, and then directly referring patients found to be at high risk for a CT scan.
Success for nurse-led Liverpool lung screening programme
“There’s no need to see a GP or another doctor for a second opinion, it’s all done right there for the patient on the day in a single clinic appointment,” she said. “We’re also following up the outcomes of those scans with patients, working in close partnership with their GP and the clinical teams providing treatment at the local hospital trusts – so we’re utilising a wide range of skills.”
The programme has also involved staging community events to raise awareness of lung health, where people can get free information, advice and spirometry tests.
Nearly 2,000 people have attended one of these events, with just over 800 taking spirometry tests. Around one in five – 18% – of those tested were found to have abnormal results, which triggered a referral to primary care for further testing and support.
Dr Ed Gaynor, cancer lead GP for Liverpool CCG, described the evaluation findings as “extremely encouraging”.
“The Healthy Lung programme is starting to make a measurable impact on people’s lung health by increasing early detection – and we are successfully doing this in communities which we know have some of the highest rates of lung cancer nationally,” he said.
One of the overall goals of the initiative has been to “challenge some of the sense of fear and fatalism that exists towards cancer within these communities”, he noted.
“Many of those we have been targeting through the programme say they feel scared to talk about cancer, so we have been sharing lots of survivor stories and working to educate more people about the benefits of early detection,” said Dr Gaynor.
A preliminary analysis of the programme’s cost-effectiveness has suggested a substantial gain in “quality adjusted life years” – the equivalent of one year of perfect health – for modest expenditure.
The estimated “incremental cost-effectiveness ratio” – a way of measuring the cost-effectiveness of healthcare interventions – is about £4,000 per quality adjusted life year.
The programme, which is now into its second year, will now be rolled-out to other parts of Liverpool and the age range of those invited to clinics extended to encompass those aged 58 to 75.
Success for nurse-led Liverpool lung screening programme