Implementing direct access to low-dose computed tomography in general practice--method, adaption and outcome

PLoS One. 2014 Nov 10;9(11):e112162. doi: 10.1371/journal.pone.0112162. eCollection 2014.

Abstract

Background: Early detection of lung cancer is crucial as the prognosis depends on the disease stage. Chest radiographs has been the principal diagnostic tool for general practitioners (GPs), but implies a potential risk of false negative results, while computed tomography (CT) has a higher sensitivity. The aim of this study was to describe the implementation of direct access to low-dose CT (LDCT) from general practice.

Methods: We conducted a cohort study nested in a randomised study. A total of 119 general practices with 266 GPs were randomised into two groups. Intervention GPs were offered direct access to chest LDCT combined with a Continuing Medical Education (CME) meeting on lung cancer diagnosis.

Results: During a 19-month period, 648 patients were referred to LDCT (0.18/1000 adults on GP list/month). Half of the patients needed further diagnostic work-up, and 15 (2.3%, 95% CI: 1.3-3.8%) of the patients had lung cancer; 60% (95% CI: 32.3-83.7%) in a localised stage. The GP referral rate was 61% higher for CME participants compared to non-participants.

Conclusion: Of all patients referred to LDCT, 2.3% were diagnosed with lung cancer with a favourable stage distribution. Half of the referred patients needed additional diagnostic work-up. There was an association between participation in CME and use of CT scan. The proportion of cancers diagnosed through the usual fast-track evaluation was 2.2 times higher in the group of CME-participating GPs. The question remains if primary care case-finding with LDCT is a better option for patients having signs and symptoms indicating lung cancer than a screening program. Whether open access to LDCT may provide earlier diagnosis of lung cancer is yet unknown and a randomised trial is required to assess any effect on outcome.

Trial registration: Clinicaltrials.gov NCT01527214.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • General Practice*
  • Health Services Accessibility*
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Male
  • Middle Aged
  • Radiation Dosage*
  • Referral and Consultation
  • Sensitivity and Specificity
  • Smoking
  • Tomography, X-Ray Computed*
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT01527214

Grant support

The project was supported by the Committee for Quality Improvement and Continuing Medical Education (KEU) of the Central Denmark Region, the Multi-Practice Committee (MPU) of the Danish College of General Practitioners (DSAM), the Danish Cancer Society, and the Novo Nordisk Foundation. Sponsoring organizations were not involved in any part of the study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.