Bhamani, Amyn Ahmed;
(2024)
Delivery of Lung Cancer Screening
to a large, high-risk population.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Introduction: Low-Dose Computed Tomography (LDCT) screening reduces lung cancer related mortality, but screening protocols require further optimisation. In this thesis, I focused on the management of screen-detected findings and operational aspects of Lung Cancer Screening (LCS). Methods: First, I assessed baseline SUMMIT Study screening results to demonstrate that large-scale LCS can be delivered safely and efficiently. Next, I analysed outcomes of participants with incidental, screen-detected anterior mediastinal masses (AMM) and bronchiectasis to determine how management protocols for these findings can be optimised. I then analysed participant-reported outcomes of communicating screening results by letter to assess the feasibility of this approach in the wider context of LCS and finally, evaluated outcomes of a practitioner-made ‘opt-out’ smoking cessation referral policy for individuals currently smoking tobacco who attended a Lung Health Check (LHC) appointment. Results: 2.0% of SUMMIT participants were diagnosed with screen-detected lung cancer. 79% were diagnosed at an early-stage and 90% received treatment with curative intent. Most screen-detected AMM followed-up within the study remained stable on interval imaging, while adverse outcomes of clinical significance (increased burden of exacerbations and greater risk of emergency respiratory hospitalisation during follow-up) were observed amongst participants with moderate-severe, but not mild, bronchiectasis. Most participants who received their non-urgent screening results by letter reported satisfaction with this method of communication. Finally, 33% of individuals currently smoking tobacco who attended a LHC consented to a practitioner-made smoking cessation referral and the four-week quit rate amongst individuals accepting support was 18%. Conclusions: Results reported in this thesis will help inform policies for the safe and efficient delivery of a national LCS programme.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Delivery of Lung Cancer Screening to a large, high-risk population |
| Language: | English |
| Additional information: | CC BY-NC: Copyright © The Author 2024. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10200667 |
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