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Low-Dose Computed Tomography (LDCT) screening for lung cancer can result in several potential outcomes of varying significance. Communication methods used in Lung Cancer Screening (LCS) programmes must, therefore, ensure that participants are prepared for the range of possible results and follow-up. Here, we assess perceptions of a written preparatory information booklet provided to participants in a large LCS cohort designed to convey this information.All participants in the SUMMIT Study (NCT03934866) were provided with a results preparation information booklet, entitled 'The SUMMIT Study: Next Steps' at their baseline appointment which outlined potential results, their significance, and timelines for follow up. Results from the LDCT scan and Lung Health Check were subsequently sent by letter. Perceptions of this booklet were assessed among participants with indeterminate pulmonary findings when they attended a face-to-face appointment immediately before their three-month interval scan. Specifically, questions assessed the perceived usefulness of the booklet and the amount of information contained in it.70.1% (n = 1,412/2,014) participants remembered receiving the booklet at their appointment. Of these participants, 72.0% (n = 1,017/1,412) found it quite or very useful and 68.0% (n = 960/1,412) reported that it contained the right amount of information. Older participants, those from the least deprived socioeconomic quintile and those of Black ethnicity were less likely to report finding the booklet either quite or very useful, or that it contained the right amount of information. Participants who remembered receiving the booklet were more likely to be satisfied with the process of results communication by letter.Providing written information that prepares participants for possible LDCT results and their significance appears to be a useful resource and a helpful adjunct to a written method of results communication for large scale LCS programmes.

Lung cancer screening (LCS) eligibility is largely determined by tobacco consumption. Primary care smoking data could guide LCS invitation and eligibility assessment. We present observational data from the SUMMIT Study, where individual self-reported smoking status was concordant with primary care records in 75.3%. However, 10.3% demonstrated inconsistencies between historic and most recent smoking status documentation. Quantified tobacco consumption was frequently missing, precluding direct LCS eligibility assessment. Primary care recorded "ever-smoker" status, encompassing both recent and historic documentation, can be used to target LCS invitation. Identifying those with missing or erroneous "never-smoker" smoking status is crucial for equitable invitation to LCS.

The optimal management of small but growing nodules remains unclear. The SUMMIT study nodule management algorithm uses a specific threshold volume of 200 mm

Pulmonary nodules are commonly found in Lung Cancer Screening (LCS), with results typically communicated by face-to-face or telephone consultation. Providing LCS on a population basis requires resource efficient and scalabe communication methods. Written communication provides one such method. Here, we assess participant satisfaction with this approach in a LCS setting and investigate characteristics associated with dissatisfaction.The SUMMIT Study is a prospective observational cohort study which aims to assess the implementation of Low-Dose Computed Tomography (LDCT) scanning for LCS in a high-risk population and validate a multi-cancer early detection blood test (NCT03934866). Participants with indeterminate pulmonary nodules requiring a three-month interval LDCT were informed of their result by postal letter and given a face-to-face appointment with a study practitioner at their interval LDCT appointment. At this appointment, having previously received their results letter, participants were verbally asked questions to assess their satisfaction with, and preferences for, methods of results communication.1,900 participants were included in the analysis. 82.8% (n = 1573) were satisfied with receiving their results by letter, with 2.9% (n = 55) reporting dissatisfaction. 86.3% (n = 1640) stated it was their preferred communication method and 77.3% (n = 1469) reported that their letter contained the right amount of information. Participants from less deprived socioeconomic quintiles were more likely to report that the letter contained insufficient information and individuals aged ≥ 70 years were less likely to do so. Although 13.7% (n = 261) participants had discussed their results with their General Practitioner (GP) prior to the study visit, 83.9% (n = 219) of these participants were satisfied with receiving results by letter, with the same proportion preferring this communication method.We report high participant satisfaction with the reporting of pulmonary nodule results by letter in a LCS setting. We believe this provides a feasible route forward for large-scale screening programmes.

Background: CHEST guidelines on lung cancer screening during the COVID-19 pandemic1 support delaying interval scans for 3-6 months. There is a concern that progression during this time could result in a higher stage at diagnosis. To determine the safety of this approach, we investigated whether time to interval scan was associated with disease stage at diagnosis. Method: The SUMMIT Study aims to assess the implementation of low-dose CT for lung cancer screening in a high-risk population and to validate a multi-cancer early detection blood test. Indeterminate nodules are followed up at 3 months. Participants with interval scans delayed to ≥4 months due to the pandemic and a comparison pre-pandemic group with scans performed at the target timeframe of 3-4 months were identified. Outcomes from cases referred for definitive assessment following interval scan were analysed. Results: Conclusion: Preliminary data does not suggest a shift to higher stage at diagnosis from delayed interval scans performed at 4-6 months. Whilst this must be validated with additional cases, if confirmed this evidence supports the safety of the CHEST guidelines for lung cancer screening during the COVID pandemic. 1. Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic CHEST 2020

BackgroundCOPD is a major comorbidity in lung cancer screening (LCS) cohorts, with a high prevalence of undiagnosed COPD. Combining symptom assessment with spirometry in this setting may enable earlier diagnosis of clinically significant COPD and facilitate increased understanding of lung cancer risk in COPD. In this study, we wished to understand the prevalence, severity, clinical phenotype and lung cancer risk of individuals with symptomatic undiagnosed COPD in a LCS cohort.Methods16 010 current or former smokers aged 55–77 years attended a lung health check as part of the SUMMIT Study. A respiratory consultation and spirometry were performed alongside LCS eligibility assessment. Those with symptoms, no previous COPD diagnosis and airflow obstruction were labelled as undiagnosed COPD. Baseline low-dose computed tomography (LDCT) was performed in those at high risk of lung cancer (PLCOm2012score ≥1.3% and/or meeting USPSTF 2013 criteria).ResultsNearly one in five (19.7%) met criteria for undiagnosed COPD. Compared with those previously diagnosed, those undiagnosed were more likely to be male (59.1%versus53.2%; pversus47.6%; pversus68.4%; pversus77.9%; pConclusionsTargeted case-finding within LCS detects high rates of undiagnosed symptomatic COPD in those most at risk. Individuals with undiagnosed COPD are at high risk for lung cancer.

Introduction: Quality standards (QS) for flexible bronchoscopy are markers of high-quality, cost-effective patient care and provide a quick and efficient way to assess the clinical performance of a service and the standards of provided care. Aim: To compare our departmental practice against established Trust quality improvement processes (QIP) and quality standards as per national guidelines (British Thoracic Society, BTS) for flexible bronchoscopy. Methods: Retrospective review of paper and electronic patient records (EPR) of all bronchoscopies performed from January–October 2015. Data collection and analysis with MS Excel software. Results: 187 patients referred for bronchoscopy (121 males, 66 females, age range 19-95 years, 147 performed). BTS bronchoscopy safety checklist was used in 95.2% cases (QS 100%). All patients had CT scan prior to bronchoscopy (QS met). 89.7% of patients requiring urgent bronchoscopy for suspected lung cancer had it within 7 working days(QS 100%).Informed consent was obtained from all patients, but 95.2% of forms were in EPR. Administered drugs were electronically prescribed in 72.1%(QS 100%). 96.6% of patients had observations recorded before-during-after the procedure. Level of sedation was not officially recorded, only stated in miscellaneous bronchoscopy reports (QS 100%). We have not collected regular patient feedback on the bronchoscopy, consent and written information (QS 100%). Conclusion: BTS quality standards assessment for our service has been a valuable tool highlighting areas of good practice and areas in need of improvement. It has set up the foundations for future QIPs (patient feedback, capacity review, safe sedation policy) that will aim to improve the provision of quality of care.