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The Chest Australia Trial: a randomised controlled trial of an intervention to increase consultation rates in smokers at risk of lung cancer
  1. Jon D Emery1,2,3,
  2. Sonya R Murray2,
  3. Fiona M Walter1,2,3,
  4. Andrew Martin4,
  5. Stephen Goodall5,
  6. Danielle Mazza6,
  7. Emily Habgood1,
  8. Yvonne Kutzer2,7,
  9. David John Barnes8,9,
  10. Peter Murchie10
  1. 1 Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Department of General Practice, The Medical School, University of Western Australia, Perth, Australia
  3. 3 The Primary Care Unit, Public Health and Primary Care, University of Cambridge, Cambridge, UK
  4. 4 NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
  5. 5 Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
  6. 6 Department of General Practice, Monash University, Melbourne, Victoria, Australia
  7. 7 School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
  8. 8 Royal Prince Alfred Hospital, Newtown, New South Wales, Australia
  9. 9 Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
  10. 10 The Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Jon D Emery, Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, VIC 3010, Australia; jon.emery{at}unimelb.edu.au

Abstract

Background International research has focused on screening and mass media campaigns to promote earlier patient presentation and detect lung cancer earlier. This trial tested the effect of a behavioural intervention in people at increased risk of lung cancer on help-seeking for respiratory symptoms.

Methods Parallel, individually randomised controlled trial. Eligible participants were long-term smokers with at least 20 pack-years, aged 55 and above. The CHEST intervention entailed a consultation to discuss and implement a self-help manual, followed by self-monitoring reminders to encourage help-seeking for respiratory symptoms. The control group received a brief discussion about lung health. Both groups had baseline spirometry. Telephone randomisation was conducted, 1:1, stratified Medical Research Council (MRC) dyspnoea score and general practice. Participants could not be blinded; data extraction and statistical analyses were performed blinded to group assignment. The primary outcome was respiratory consultation rates.

Results We randomised 551 participants (274 intervention, 277 control) from whom the primary outcome was determined for 542 (269 intervention, 273 control). There was a 40% relative increase in respiratory consultations in the intervention group: (adjusted rates (95% CI) intervention 0.57 (0.47 to 0.70), control 0.41 (0.32 to 0.52), relative rate 1.40 (1.08 to 1.82); p=0.0123). There were no significant differences in time to first respiratory consultation, total consultation rates or measures of psychological harm. The incremental cost-effectiveness ratio was $A1289 per additional respiratory consultation.

Conclusions A behavioural intervention can significantly increase consulting for respiratory symptoms in patients at increased risk of lung cancer. This intervention could have an important role in primary care as part of a broader approach to improve respiratory health in patients at higher risk.

Trial registration number Australian New Zealand Clinical Trial Registry (1261300039 3752). This was registered pre-results.

  • lung cancer

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Footnotes

  • Contributors JDE, PM, FMW, AM, SG, DM and DJB contributed to the design of the trial and obtained funding for the trial. JDE, SRM, EH and YK contributed to the implementation of the trial protocol and acquisition of the data. AM led the statistical analyses and SG the health economic analyses. All authors contributed to the interpretation of the analyses. All authors contributed to the drafting of the manuscript and have approved the final version. JDE is guarantor.

  • Funding This trial was funded by the NHMRC (grant ID 1064121). It was supported by the Cancer Australia Primary Care Collaborative Cancer Clinical Trials Group (PC4). JDE is supported by an NHMRC Practitioner Fellowship. FMW was supported by a Clinician Scientist award (RG 68235) from the National Institute for Health Research.

  • Competing interests None declared.

  • Ethics approval University of Western Australia Human Research Ethics Committee (RA/4/1/6018) and University of Melbourne (1441433).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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