For nearly 2 years I’ve been working as the Clinical Director for the Targeted Lung Health Check Programme (LHC).
With my team (Clare Glazebrook, Programme Manager, Dr. Steph Edgar and Dr. Mo Kyi, Deputy CDs, Dr. Abdul Maimudeen, Responsible Clinician and Dr. Sue Matthews, Responsible Radiologist) and many other people’s support within the Cancer Alliance, Doncaster CCG and DBTH we have managed to procure, set up and start the program in Doncaster. Alliance Medical were procured to run the service and they have the CT trucks, with their partners Ashfield Engage who provide the nursing and admin teams and TMC who provide the radiology team.
The basic idea of LHCs is to provide CT scans for those people at risk and pick up lung cancer early, with a significantly higher survival rate if being picked up at Stage 1 or 2.
Doncaster was selected due to the high smoking and lung cancer rate and we therefore took that on board and started the checks in the most deprived areas of Doncaster. The CT truck has just left its first destination of Rossington to move to Dearne Valley Leisure Centre where it will be for the next couple of months. After that it moves North to catch the next part of Doncaster.
Before Covid a LHC was to include a face to face appointment and examination with a nurse including Spirometry but that had to change to a telephone consultation which will continue for the whole Doncaster project. From the consultation a risk score of Lung Cancer is created (in fact there are 2 done in different ways and a high score in either is sufficient) and those with a high score are offered a CT scan. So far roughly 55% of people having a check have gone on to a CT scan.
After the CT is read abnormal findings are dealt with depending on severity. Significant findings are passed to the clinical team in our “Screening MDT” where a decision is made as to where the patient needs to go, with the attitude of getting the patient to the correct place first time. Potential Lung Cancers go to the Lung MDT, but we have also picked up a breast cancer through the programme, several Thoracic Aneurysms and many other incidental findings. In fact, the Doncaster program incidental finding rate is more than double that in the early test areas, probably a combination of our Doncaster population’s industrial background and that the initial test centres had more patient interaction than we have been able to have due to Covid.
To date one patient has had surgery for their Early Stage Lung Cancer and a further 7 are being worked up, with a further 12 being followed up in the Lung MDT for possible cancer. We have performed over 800 CT scans.
Those less significant findings such as Coronary Artery Calcification and Mild Emphysema have been passed back to primary care but this has led to a much larger than predicted burden and the LHC team have written information leaflets to try and reduce that primary care workload.
(Almost) Everybody who has a CT scan will be invited back for a follow up scan after 24 months, making it a 3-year project in Doncaster, but we are already planning expansion to Rotherham, Barnsley and Bassetlaw with bids placed to expand the programme from April 2022.
It has certainly been challenging to set up this process essentially from scratch, but I think that everybody who works on the programme is enjoying that challenge and I would really like to thank them. I’m looking forward to speaking to some of the patients who have great outcomes over the next few weeks and months and showing how effective the programme is.