PLUS study - Pharmacy referral for Lung cancer Symptoms: a feasibility study to asses the role of pharmacists in lung cancer diagnosis compared to current pathways

Lung cancer is the leading cause of cancer mortality worldwide, primarily due to the late stage at which patients are diagnosed.

In Wales lung cancer has a high incidence of 2300 new cases per year and poor one-year survival of just 30%. Lung cancer incidence is highest and survival is poorest in areas of greater social deprivation.

Within Hywel Dda University Health Board GP cluster areas with greater social deprivation have a higher incidence and a greater proportion of late stage lung cancer at presentation in comparison to affluent areas. Stage at presentation is associated with poorer survival leading to inequalities in health care.

Welsh Government's 'Together for Health: Cancer Delivery Plan' (2012) set out objectives to improve cancer outcomes through local initiatives, including increased symptom awareness and access to diagnostic tests. In addition the UK Lung Cancer Coalition emphasizes the need to encourage earlier presentation and symptom recognition.

25 by 25 recommended local screening initiative and promotes running awareness campaigns annually and introducing local campaigns at a Health Board level to raise awareness. National public awareness campaigns have been shown to increase the proportion of early stage lung cancer at diagnosis leading to increased surgical resection rates, although campaign reach was limited to more affluent groups.

This study will run a targeted local awareness campaign and test the feasibility of a novel diagnostic pathway as recommended by Welsh Government and national strategies. In addition to meeting these recommendations this proposal meets the theme of bridging the gap between richest and poorest.

Advice from community pharmacists is readily accessible and it is more likely for an individual to see their local pharmacist for common ailments than to see their doctor in the first instance. The role of pharmacists in the diagnosis and management of chronic diseases such as Type 2 diabetes mellitus and hypertension is well published.

Within lung cancer, similar projects have already been under taken by community pharmacists in North London and Doncaster with good acceptance from patients. This work will build on previous campaigns but will be more focused to the specific communities with the greatest inequalities.

We propose to refine the referral proses and answer the question, is it feasible for pharmacists to refer patients with symptoms of possible lung cancer for chest x-ray and would this be acceptable to patients and health care professionals?

The aims of this study are to:

1- Promote and introduce pharmacy assessment of chest x-rays by determining acceptability and feasibility of a potential future large-scale trial.
2- Explore patient and health professional views and experiences of the campaign and modify training and campaign materials in response to views.

We will run a series of focus groups to develop pharmacy training, campaign strategies and material by engaging patient, professional and public representatives. Following this we will launch the campaign to promote consulting the pharmacist with symptoms of lung cancer, such as cough, shortness of breath and haemoptysis.

We will asses referral rates and diagnosis of early stage lung cancer. We will also interview patients and health care professionals to fully understand the role and impact of the proposed referral process and acceptability of a large-scale trial.